title: Monitoring intravesical pressure during gastroschisis closure. Does it help to decide between delayed primary or staged closure?
abstract: OBJECTIVE
  Correction of gastroschisis may be accomplished by either primary or staged closure or even delayed primary closure after the use of a preformed silo. However, there is neither a consensus on the best approach nor established criteria to favor one method over the other. The aim of this paper was to investigate the role of intravesical pressure (IVP) as a tool to prevent abdominal compartment syndrome in newborns undergoing correction of abdominal wall defects.
  
  
  METHODS
  We retrospectively analyzed 45 newborns with gastroschisis in whom trans-operative intravesical pressure was used to choose between primary or staged closure. A threshold of 20 cm H(2)O was used and the outcomes between the two methods were compared.
  
  
  RESULTS
  In 24 children delayed primary closure was achieved while the remaining 21 underwent staged reduction and closure. There was no difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay between the children of the two groups. The incidence of temporary oliguria or anuria, averaged 33% and it was similar in both groups of children.
  
  
  CONCLUSIONS
  The data here presented suggests that monitoring intraoperative IVP during correction of gastroschisis may help to select children in whom staged closure is necessary, keeping their complication rate and overall outcome similar to that of children undergoing delayed primary closure. Further prospective studies should investigate more deeply the correlation between type of closure and the development of a compartment syndrome.
authors.affiliation: Departmento de Cirurgia, Universidade Estadual de Campinas, Rua Alexander Fleming, Campinas, Brazil.
authors.forename: Augusto Frederico
authors.initials: AF
authors.lastname: Santos Schmidt
authors.forename: Anderson
authors.initials: A
authors.lastname: Goncalves
authors.forename: Joaquim Murray
authors.initials: JM
authors.lastname: Bustorff-Silva
authors.forename: Antonio Gonçalves
authors.initials: AG
authors.lastname: Oliveira-Filho
authors.forename: Marcio Lopes
authors.initials: ML
authors.lastname: Miranda
authors.forename: Edison Rissato
authors.initials: ER
authors.lastname: Oliveira
authors.forename: Sergio
authors.initials: S
authors.lastname: Marba
authors.forename: Lourenço
authors.initials: L
authors.lastname: Sbragia
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D020139:Gastroschisis / Q000453:epidemiology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D006874:Hydrostatic Pressure; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors; D001743:Urinary Bladder / Q000502:physiology*; D058106:Wound Closure Techniques / Q000009:adverse effects; D055815:Young Adult