title: [Primary versus secondary closure: ventilatory and nutritional differences in patients with gastrosquisis].
abstract: OBJECTIVE
  Optimal surgical treatment of patients with gastroschisis remains controversial. Recent studies suggest better outcomes with secondary closure techniques (surgical or preformed silo). The purpose of the study is to identify differences in outcome of infants treated with traditional primary closure (PC) versus surgical silo (SS).
  
  
  METHODS
  Retrospective study of patients primarily treated of gastroschisis between 2004 and 2014. Patients were divided in PC and SS according to abdominal wall closure. Non-parametric statistical analysis was used with p< 0.05 regarded as significant.
  
  
  RESULTS
  Twenty-seven patients were included (14M/13F). Primary closure was performed on 17 and 10 underwent surgical silo placement with a median of 6 (5-26) days till secondary closure. Prenatal diagnosis was available in most patients (74%) by the 20th week of gestation. There were no significant differences regarding sex, gestational age or birthweight between groups. Fewer ventilation days were required in PC group compared to SS (4 vs 13, p< 0,05), however, there was no difference in type of ventilation or oxygen needs. Sedation and parenteral nutrition requirements were also lower in PC patients 4 vs 10 and 12 vs 20 days respectively (p< 0,05). Post-operative complications (5vs6) and median length of stay (36vs43 days) were also similar in PC and SS patients. One patient ultimately died due to catheter-related sepsis. Mean length of stay in hospital was 42 days (20-195).
  
  
  CONCLUSIONS
  Patients with gastroschisis who underwent primary closure showed shorter ventilator support and PN dependency than those treated with surgical silo. However, SS is as safe and effective technique as PC and led to similar outcome regarding digestive autonomy and hospital length of stay.
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: M
authors.initials: M
authors.lastname: Dore Reyes
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: P
authors.initials: P
authors.lastname: Triana Junco
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: S
authors.initials: S
authors.lastname: Barrena Delfa
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: J L
authors.initials: JL
authors.lastname: Encinas
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: M
authors.initials: M
authors.lastname: Romo Muñoz
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: A
authors.initials: A
authors.lastname: Vilanova Sánchez
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: G
authors.initials: G
authors.lastname: Chocarro Amatriain
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: F
authors.initials: F
authors.lastname: Hernández Oliveros
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: L
authors.initials: L
authors.lastname: Martínez Martínez
authors.affiliation: Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
authors.forename: M
authors.initials: M
authors.lastname: López-Santamaría
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gastroschisis; Primary closure; Secondary or delayed closure; Treatment