Outcomes of sutureless gastroschisis closure.
BACKGROUND
A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures.


METHODS
A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications.


RESULTS
In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P < .001). Small umbilical hernias were seen in all patients.


CONCLUSIONS
Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.
Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305-5733, USA.
Jonathan
J
Riboh
Claire T
CT
Abrajano
Karen
K
Garber
Gary
G
Hartman
Marilyn A
MA
Butler
Craig T
CT
Albanese
Karl G
KG
Sylvester
Sanjeev
S
Dutta
D034861:Abdominal Wall / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D000071938:Fasciotomy; D020139:Gastroschisis / Q000601:surgery*; D006554:Hernia, Umbilical / Q000601:surgery; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009779:Occlusive Dressings; D010351:Patient Discharge / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014472:Umbilicus / Q000637:transplantation; D014945:Wound Healing