title: Sutureless vs Sutured Gastroschisis Closure: A Prospective Randomized Controlled Trial.
abstract: BACKGROUND
  Sutureless gastroschisis repair involves covering the abdominal wall defect with the umbilical cord or a synthetic dressing to allow closure by secondary intention. No randomized studies have described the outcomes of this technique. Our objective was to prospectively compare short-term outcomes of sutureless vs sutured closure in a randomized fashion.
  
  
  METHODS
  We recruited patients who presented with gastroschisis between 2009 and 2014 and were randomized into either sutureless or sutured treatment groups. Patients with complicated gastroschisis (stricture, perforation, and ischemia) were excluded. Predefined ventilation, feeding, and dressing change protocols were instituted. Primary outcomes were time to extubation and time to full feeds. Secondary outcomes included time to discharge and rate of complications. Data were analyzed using Fisher's exact or t-tests using a p value ≤ 0.05. Factors associated with increased time to discharge were estimated using multivariate analyses.
  
  
  RESULTS
  Thirty-nine patients were enrolled, 19 to sutureless and 20 to sutured repair. There was no statistical difference in time to extubation (sutureless 1.89 vs sutured 3.15 days; p = 0.061). The sutureless group had a significant increase in mean time to full feeds (45.1 vs 27.8 days; p = 0.031) and mean time to discharge (49.3 vs 31.4 days; p = 0.016). Complication rates were similar in both groups. Multivariate regression modeling showed that an increase in time to discharge was independently associated with sutureless repair, feeding complications, and sepsis.
  
  
  CONCLUSIONS
  Sutureless repair of uncomplicated gastroschisis can be performed safely, however, it is associated with a significant increase in time to full feeds and time to discharge.
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Jaramillo
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Dunlap
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Claire
authors.initials: C
authors.lastname: Abrajano
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Shobha W
authors.initials: SW
authors.lastname: Stack
authors.affiliation: Division of Pediatrics, Neonatal and Development Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA. Electronic address: sdutta@mac.com.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Dutta
mesh_terms: D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D000071062:Sutureless Surgical Procedures; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome