title: A risk-stratified comparison of fascial versus flap closure techniques on the early outcomes of infants with gastroschisis.
abstract: BACKGROUND
  While fascial closure is traditionally used in gastroschisis (GS), flap closure (skin or umbilical cord) has gained popularity. We evaluated early outcomes and complications of the two techniques.
  
  
  METHODS
  A national, population-based gastroschisis data registry was analyzed from 2005 to 2011. We compared fascial to flap closures and stratified patients into low or high-risk groups using the Gastroschisis Prognostic Score (GPS), a validated marker of post-natal bowel injury. Demographic and outcome data, including length of stay, complications, and markers of resource utilization were analyzed using Fisher's exact and Student's t-tests for categorical and continuous variables, respectively (p<0.05 significant).
  
  
  RESULTS
  The analyzed dataset included 436 fascial closures (344 [78.8%] low-risk, 92 high-risk) and 129 flap closures (112 [86.7%] low-risk, 17 high-risk; p=0.06). Demographics and birth weight did not differ between groups. In patients with low GPS, flap closure demonstrated significant decreases in resource utilization and failure of closure, without differences in complication rates. Analysis of high-risk patients revealed no statistically significant differences in outcome.
  
  
  CONCLUSIONS
  Flap closure was not associated with an increase in patient morbidity and seemed suitable as a definitive closure method for gastroschisis patients irrespective of disease severity. Furthermore, flap closure reduced several markers of resource utilization in patients with low-risk disease.
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H3H 1P3.
authors.forename: Claudia N
authors.initials: CN
authors.lastname: Emami
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H3H 1P3.
authors.forename: Fouad
authors.initials: F
authors.lastname: Youssef
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H3H 1P3.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Baird
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H3H 1P3.
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.affiliation: Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada, V6J 4K7.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H3H 1P3. Electronic address: pramod.puligandla@mcgill.ca.
authors.forename: Pramod S
authors.initials: PS
authors.lastname: Puligandla
mesh_terms: D001724:Birth Weight; D000071938:Fasciotomy; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D012306:Risk; D018570:Risk Assessment; D013524:Surgical Flaps; D058106:Wound Closure Techniques
keywords: Fascial closure; Gastroschisis; Gastroschisis prognostic score; Surgical outcomes; Umbilical flap closure