title: Umbilical hernia following gastroschisis closure: a common event?
abstract: OBJECTIVE
  To assess incidence and natural history of umbilical hernia following sutured and sutureless gastroschisis closure.
  
  
  METHODS
  With audit approval, we undertook a retrospective clinical record review of all gastroschisis closures in our institution (2007-2013). Patient demographics, gastroschisis closure method and umbilical hernia occurrence were recorded. Data, presented as median (range), underwent appropriate statistical analysis.
  
  
  RESULTS
  Fifty-three patients were identified, gestation 36 weeks (31-38), birth weight 2.39 kg (1-3.52) and 23 (43 %) were male. Fourteen patients (26 %) underwent sutureless closure: 12 primary, 2 staged; and 39 (74 %) sutured closure: 19 primary, 20 staged. Sutured closure was interrupted sutures in 24 patients, 11 pursestring and 4 not specified. Fifty patients were followed-up over 53 months (10-101) and 22 (44 %) developed umbilical hernias. There was a significantly greater hernia incidence following sutureless closure (p = 0.0002). In sutured closure, pursestring technique had the highest hernia rate (64 %). Seven patients underwent operative hernia closure; three secondary to another procedure. Seven patients had their hernias resolve. One patient was lost to follow-up and seven remain under observation with no reported complications.
  
  
  CONCLUSIONS
  There is a significant umbilical hernia incidence following sutureless and pursestring sutured gastroschisis closure. This has not led to complications and the majority have not undergone repair.
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: L G C
authors.initials: LG
authors.lastname: Tullie
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Bough
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Shalaby
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Kiely
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: J I
authors.initials: JI
authors.lastname: Curry
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.|Division of General Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Pierro
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.|Stem Cells and Regenerative Medicine Section, DBC, Institute of Child Health, University College London, London, WC1N 1EH, UK.
authors.forename: P
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK. Kate.Cross@gosh.nhs.uk.
authors.forename: K M K
authors.initials: KM
authors.lastname: Cross
mesh_terms: D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006554:Hernia, Umbilical / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures
keywords: Gastroschisis; Primary closure; Staged closure; Sutured closure; Sutureless closure; Umbilical hernia