Evolution of staged versus primary closure of gastroschisis.
OBJECTIVE
Since the introduction of a preformed silo to the authors' practice in 1997, there has been a decrease in primary closure of gastroschisis. To clarify the impact of this change, the authors reviewed their results over the past 10 years.


METHODS
From patient records, the authors abstracted the closure method, mechanical ventilation days, time to full feeds, mechanical and infectious complications, and length of stay. The authors compared groups using the Student t test and the Mann-Whitney test, as appropriate.


RESULTS
Between 1993 and the present, 124 patients were identified. Between 1993 and 1997, 38 children presented with gastroschisis. Thirty-two (84.2%) closures were primary and six (18.8%) were staged. After 1997, the authors treated 80 children with gastroschisis. There were 27 (33.8%) primary and 53 (66.2%) staged closures. Six patients with other lethal anomalies were excluded. Length of stay and ventilator days were higher for the staged closure group, but infection and mechanical complications were less common in the staged closure group. The time to full feeds did not differ.


CONCLUSIONS
A lower incidence of infection and complications related to abdominal compartment syndrome has made staged closure of gastroschisis more common in the authors' practice. While it has resulted in a longer hospital stay, staged closure decreases the risk of long-term bowel dysfunction and need for reoperation.
Kidd
Joseph N
JN
Department of Pediatric Surgery, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72223, USA.
Jackson
Richard J
RJ
Smith
Samuel D
SD
Wagner
Charles W
CW
D002648:Child; D003161:Compartment Syndromes / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome