title: Gastroschisis-related complications requiring further surgical interventions.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of gastroschisis-related complications (GRCs) after closure of the abdominal wall defect, with a focus on frequency, type and timing of required surgical interventions, and to identify the impact of these on further outcome.
  
  
  METHODS
  All gastroschisis patients treated from 1975 to 2008 in a tertiary-level center were retrospectively reviewed. Surgical procedures for GRCs following abdominal wall closure of simple gastroschisis [SG (intact continuous bowel)] and complex gastroschisis [CG (additional gastrointestinal malformations)] were compared, and outcomes were determined.
  
  
  RESULTS
  One hundred and eight patients were identified with a median follow-up of 15.0 years (range 4-37). Ninety-four (87%) had SG, and 14 (13%) CG. Surgical interventions for GRCs were performed in 28 (26%) patients with 16 requiring multiple operations. Overall, 60 surgical procedures were performed. Bowel obstruction (n = 34) was the most common GRC, followed by anastomotic stricture (n = 8) and ischemic bowel (n = 3). The median interval between gastroschisis closure and secondary surgery for GRCs was 62.5 days (range 1 day-15 years). Surgical interventions were significantly more frequent in CG compared with SG [12/14 (86%) vs. 16/94 (17%); P < 0.0001]. The overall survival rate was 90%. Significantly, more patients required parenteral nutrition for more than 28 days [9/28 (32%) vs. 13/80 (16 %); P = 0.0468], longer median time to achieve full enteral feedings (87 vs. 33 days; P < 0.0001) and longer median hospital stay (117 vs. 54 days; P < 0.0001) compared with those not requiring additional surgery.
  
  
  CONCLUSIONS
  GRCs requiring surgical interventions were more common in patients with CG, which were associated with delay in achieving full enteral feedings and prolonged hospital stay.
authors.affiliation: Department of Pediatric and Adolescent Surgery, Medical University Graz, Auenbruggerplatz 34, 8036, Graz, Austria, Florian.Friedmacher@gmx.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Friedmacher
authors.forename: Andras
authors.initials: A
authors.lastname: Hock
authors.forename: Christoph
authors.initials: C
authors.lastname: Castellani
authors.forename: Alexander
authors.initials: A
authors.lastname: Avian
authors.forename: Michael E
authors.initials: ME
authors.lastname: Höllwarth
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001724:Birth Weight; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000150:complications* / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000601:surgery; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
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