Preservation of extracorporeal tissue in closing gastroschisis augments intestinal length.
BACKGROUND
Prenatal closure of the umbilical ring in gastroschisis may result in an amorphous, nonviable appearing extracorporeal tissue that is resected during the repair. However, it is unclear whether such remnant intestine is truly nonviable.


RESULTS
We examined the outcomes of patients when this tissue is preserved. We identified 8 patients who presented with a closing gastroschisis and a mass of tissue connected by a vascular pedicle. Four patients underwent abdominal exploration with resection of the mass and gastroschisis closure. Histologic examination revealed normal intestinal wall architecture. All patients in this group developed short bowel syndrome, requiring long-term parenteral nutrition. Conversely, 4 patients underwent abdominal exploration with internalization of the remnant tissue, a maneuver referred to as "parking," along with either silo placement, or primary closure of the gastroschisis. At re-exploration, 3 of 4 patients were found to have viable intestine, and bowel continuity was reestablished. The mean parenteral nutrition requirement for this group was significantly shorter than the resected group.


CONCLUSIONS
In this series, we show that this amorphous tissue, when preserved, may exhibit normal intestinal architecture and absorptive function. Therefore, such remnant tissue should be preserved as it may significantly increase bowel length and minimize parenteral nutrition requirement.
Estrada
Joaquin J
JJ
Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, CA 90027, USA.
Petrosyan
Mikael
M
Hunter
Catherine J
CJ
Lee
Steven L
SL
Anselmo
Dean M
DM
Grikscheit
Tracy C
TC
Stein
James E
JE
Wang
Kasper S
KS
Ford
Henri R
HR
Shaul
Donald B
DB
D000714:Anastomosis, Surgical; D000886:Anthropometry; D001284:Atrophy; D004750:Enteral Nutrition; D005260:Female; D020139:Gastroschisis / Q000150:complications / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D054843:Negative-Pressure Wound Therapy; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000517:prevention & control*; D013997:Time Factors