title: Contemporary trends in the use of primary repair for gastroschisis in surgical infants.
abstract: BACKGROUND
  Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with gastroschisis to examine trends in contemporary surgical management.
  
  
  METHODS
  Infants who underwent initial surgical management of gastroschisis from 1996 to 2014 at a pediatric hospital were reviewed. Closure techniques included primary fascial repair using suture or sutureless umbilical closure, and staged repair using sutured or spring-loaded silo (SLS). Data were separated into 3 clinical eras: pre-SLS (1996 to 2004), SLS (2005 to 2008), and umbilical closure (2009 to 2014).
  
  
  RESULTS
  In the pre-SLS era, 60% (34/57) of infants with gastroschisis underwent primary repair. With the advent of SLS, there was a decrease in primary repair (15%, 10/68, P < .0001). Following introduction of sutureless umbilical closure, 61% (47/77) of infants have undergone primary repair. On multivariate regression, primary repair was associated with shorter intensive care unit stays (P < .001) and time to initiate enteral nutrition (P < .01).
  
  
  CONCLUSIONS
  Following introduction of a less invasive technique for gastroschisis repair, most infants with gastroschisis were able to be repaired primarily. Primary repair should be considered in all babies with gastroschisis and favorable anatomy.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA; Department of General Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Chesley
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ledbetter
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Meehan
authors.affiliation: Core for Biostatistics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Assaf P
authors.initials: AP
authors.lastname: Oron
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA. Electronic address: patrick.javid@seattlechildrens.org.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Javid
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods / Q000706:statistics & numerical data*; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Complicated gastroschisis; Gastroschisis; Spring-loaded silo; Umbilical sutureless closure