Gastroschisis closure--does method really matter?
OBJECTIVE
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.
Weinsheimer
Robert L
RL
Division of Pediatric General Surgery, IWK Health Centre, Dalhousie University, Halifax, Canada B3K 6R8.
Yanchar
Natalie L
NL
Bouchard
Sarah B
SB
Kim
Peter K
PK
Laberge
Jean-Martin
JM
Skarsgard
Erik D
ED
Lee
S K
SK
McMillan
Douglas
D
von Dadelszen
Peter
P
D034861:Abdominal Wall / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D020139:Gastroschisis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008423:Maternal Age; D010288:Parenteral Nutrition; D011247:Pregnancy; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome