Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Pediatr Surg. 2008 May;43(5):874-8. doi: 10.1016/j.jpedsurg.2007.12.030.

Gastroschisis closure--does method really matter?

Author information

  • 1Division of Pediatric General Surgery, IWK Health Centre, Dalhousie University, Halifax, Canada B3K 6R8.

Abstract

BACKGROUND/PURPOSE:

Management of gastroschisis varies. This study aims to determine which aspects of practice influence outcomes.

METHODS:

All cases of simple gastroschisis (N = 99) in the Canadian Pediatric Surgery Network database were analyzed looking at methods of preoperative bowel protection, timing of closure, and closure techniques; and outcome measures included time to onset of enteral feeds, duration of parenteral nutrition (PN), and length of stay (LOS).

RESULTS:

One third of infants had initial bowel protection using a spring-loaded silo, which was significantly associated with a delay (beyond 24 hours) in establishing primary closure. Neither preoperative bowel protection methods nor defect closure techniques conferred any significant effects on success at establishing primary closure or functional outcomes. After adjusting for all covariates, only failure to establish primary closure was associated with impaired outcomes with significantly delayed initiation of enteral feeds and prolonged LOS. Low birth weight (<2000 g) and younger gestational age (<36 weeks) were associated with a 3-fold increased risk of longer PN dependence and 5-fold risk of extended LOS, respectively. Babies undergoing the sutureless spontaneous closure technique had significant delays in initiating enteral feeds but no increased requirements for PN or LOS.

CONCLUSIONS:

Modes of preoperative bowel protection and techniques of abdominal wall closure ultimately have no association with functional outcomes in infants with gastroschisis. Failure to establish primary closure, however, is significantly associated with delays in establishing intestinal function and subsequent time to discharge.

PMID:
18485957
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk