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J Pediatr Surg. 2019 Jan;54(1):60-64. doi: 10.1016/j.jpedsurg.2018.10.033. Epub 2018 Oct 5.

Closing gastroschisis: The good, the bad, and the not-so ugly.

Author information

1
University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI; University of Michigan, Fetal Diagnosis and Treatment Center. Electronic address: eperrone@med.umich.edu.
2
Loma Linda University Children's Hospital, Loma Linda, CA; Nationwide Children's Hospital, Columbus, OH 43205. Electronic address: JKOlson@llu.edu.
3
Children's Hospital of Los Angeles, Los Angeles, CA. Electronic address: Jamie.m.golden@gmail.com.
4
Nationwide Children's Hospital, Columbus, OH 43205. Electronic address: gail.besner@nationwidechildrens.org.
5
Children's Hospital of Los Angeles, Los Angeles, CA. Electronic address: cgayer@chla.usc.edu.
6
University of Florida, Gainesville, FL. Electronic address: saleem.islam@surgery.ufl.edu.
7
Rady Children's Hospital, San Diego, CA. Electronic address: ggollin@rchsd.org.

Abstract

PURPOSE:

The diagnosis of "closing" or "closed gastroschisis" is made when bowel is incarcerated within a closed or nearly closed ring of fascia, usually with associated bowel atresia. It has been described as having a high morbidity and mortality.

METHODS:

A retrospective review of closing gastroschisis cases (n = 53) at six children's hospitals between 2000 and 2016 was completed after IRB approval.

RESULTS:

A new classification system for this disease was developed to represent the spectrum of the disease: Type A (15%): ischemic bowel that is constricted at the ring but without atresia; Type B (51%): intestinal atresia with a mass of ischemic, but viable, external bowel (owing to constriction at the ring); Type C (26%): closing ring with nonviable external bowel +/- atresia; and Type D (8%): completely closed defect with either a nubbin of exposed tissue or no external bowel. Overall, 87% of infants survived, and long-term data are provided for each type.

CONCLUSIONS:

This new classification system better captures the spectrum of disease and describes the expected long-term results for counseling. Unless the external bowel in a closing gastroschisis is clearly necrotic, it should be reduced and evaluated later. Survival was found to be much better than previously reported.

TYPE OF STUDY:

Retrospective case series with no comparison group.

LEVEL OF EVIDENCE:

Level IV.

KEYWORDS:

Atresia; Classification; Closed/closing; Gastroschisis; Short gut

PMID:
30482541
DOI:
10.1016/j.jpedsurg.2018.10.033
[Indexed for MEDLINE]

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