Presented at the Neonatal Society 2013 Spring Meeting.
Naqvi S, Giuliani S, Mukhtar Z, Okoye B, Nicholls E, Cleeve S
Department of Paediatric Surgery, St George’s Hospital, Blackshaw Road, London, SW17 0QT
Background: The method of gastroschisis closure is controversial. Closure using a preformed silo (PFS) is being used more frequently. Predicting which patients are most suitable for this technique is yet to be determined (1,2). Aim: To determine whether the size of the ventral defect (diameter in centimetres), at birth, predicts complications (particularly subsequent ventral hernia) in patients managed with a PFS.
Methods: A retrospective notes review of a prospectively maintained neonatal database of babies born with gastroschisis and managed with a PFS, over a 7 year period (January 2006 to December 2012) was carried out. Subsequent closure was achieved by sutured operative closure (SOC) under general anaesthetic or suture-less non-operative closure (SLNOC). Parameters collected were gestational age (GA), birth weight (BW), size of defect, number of days to full enteral feeds, complications, mortality and length of follow-up. Data is presented as median (range), 0.05 taken as significant and the Mann-Whitney U test was used to compare observations.
Results: During the study period 55 patients with gastroschisis were treated. Complete data was available for 37 patients managed with a PFS: BW 2332g (1454g – 3450g), GA 37 weeks (33 – 39 weeks), defect size 3.5 cm (3 – 6 cm). Sixteen (43%) patients were managed with sutured operative closure (SOC) and 21 (57%) patients with suture-less non-operative (SLNOC) closure. Time to full feeds was 24 days (13 – 165 days). Complications include wound infection (2), ventral hernia (11), sepsis (9), necrotising enterocolitis and evisceration. There was no mortality. Follow-up was 9 months (3 months to discharge). There was no statistical difference in the in the size of the ventral defect at birth when patients that developed a ventral hernia were compared to patients that did not develop a ventral hernia.
Conclusion: The size of the ventral defect at birth, in patients with gastroschisis managed with a PFS, does not predict which patients will develop a ventral hernia. Further investigation is necessary to define which patients with gastroschisis are most suitable for PFS closure.
Corresponding author: scleeve@hotmail.com
References
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