Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1991 Jan;66(1 Spec No):34–36. doi: 10.1136/adc.66.1_spec_no.34

Controversies in the management of gastroschisis: a study of 40 patients.

M D Stringer 1, R J Brereton 1, V M Wright 1
PMCID: PMC1590358  PMID: 1825461

Abstract

Forty infants with gastroschisis were referred to two paediatric surgeons during a 13 year period. Overall survival was 90%. Nine patients were transferred in utero and 31 were referred postnatally. Birth weights, gestational ages, and Apgar scores were similar for both groups. Primary closure of the defect was successfully achieved in seven (78%) patients in the prenatally transferred group compared with 17 (55%) in the postnatal group. Significantly less postoperative assisted ventilation, and a trend in favour of early discharge home, were noted after prenatal transfer. Problems arising during postnatal transfer may have contributed to these differences. No major differences resulting from the mode of delivery were identified. Patients treated by primary closure fared significantly better than those undergoing staged repairs with prosthetic material. Prospective randomised studies are required to confirm these findings.

Full text

PDF
34

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen R. G., Wrenn E. L., Jr Silon as a sac in the treatment of omphalocele and gastroschisis. J Pediatr Surg. 1969 Feb;4(1):3–8. doi: 10.1016/0022-3468(69)90177-8. [DOI] [PubMed] [Google Scholar]
  2. Bethel C. A., Seashore J. H., Touloukian R. J. Cesarean section does not improve outcome in gastroschisis. J Pediatr Surg. 1989 Jan;24(1):1–4. doi: 10.1016/s0022-3468(89)80289-1. [DOI] [PubMed] [Google Scholar]
  3. Bond S. J., Harrison M. R., Filly R. A., Callen P. W., Anderson R. A., Golbus M. S. Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings. J Pediatr Surg. 1988 Jun;23(6):520–525. doi: 10.1016/s0022-3468(88)80360-9. [DOI] [PubMed] [Google Scholar]
  4. Caniano D. A., Brokaw B., Ginn-Pease M. E. An individualized approach to the management of gastroschisis. J Pediatr Surg. 1990 Mar;25(3):297–300. doi: 10.1016/0022-3468(90)90070-p. [DOI] [PubMed] [Google Scholar]
  5. Canty T. G., Collins D. L. Primary fascial closure in infants with gastroschisis and omphalocele: a superior approach. J Pediatr Surg. 1983 Dec;18(6):707–712. doi: 10.1016/s0022-3468(83)80009-8. [DOI] [PubMed] [Google Scholar]
  6. Carpenter M. W., Curci M. R., Dibbins A. W., Haddow J. E. Perinatal management of ventral wall defects. Obstet Gynecol. 1984 Nov;64(5):646–651. [PubMed] [Google Scholar]
  7. Di Lorenzo M., Yazbeck S., Ducharme J. C. Gastroschisis: a 15-year experience. J Pediatr Surg. 1987 Aug;22(8):710–712. doi: 10.1016/s0022-3468(87)80610-3. [DOI] [PubMed] [Google Scholar]
  8. Ein S. H., Rubin S. Z. Gastroschisis: primary closure or Silon pouch. J Pediatr Surg. 1980 Aug;15(4):549–552. doi: 10.1016/s0022-3468(80)80771-8. [DOI] [PubMed] [Google Scholar]
  9. Filston H. C. Gastroschisis--primary fascial closure. The goal for optimal management. Ann Surg. 1983 Mar;197(3):260–264. doi: 10.1097/00000658-198303000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fonkalsrud E. W. Selective repair of neonatal gastroschisis based on degree of visceroabdominal disproportion. Ann Surg. 1980 Feb;191(2):139–144. doi: 10.1097/00000658-198002000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. King D. R., Savrin R., Boles E. T., Jr Gastroschisis update. J Pediatr Surg. 1980 Aug;15(4):553–557. doi: 10.1016/s0022-3468(80)80772-x. [DOI] [PubMed] [Google Scholar]
  12. Kirk E. P., Wah R. M. Obstetric management of the fetus with omphalocele or gastroschisis: a review and report of one hundred twelve cases. Am J Obstet Gynecol. 1983 Jul 1;146(5):512–518. doi: 10.1016/0002-9378(83)90791-3. [DOI] [PubMed] [Google Scholar]
  13. Lafferty P. M., Emmerson A. J., Fleming P. J., Frank J. D., Noblett H. R. Anterior abdominal wall defects. Arch Dis Child. 1989 Jul;64(7):1029–1031. doi: 10.1136/adc.64.7.1029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lenke R. R., Hatch E. I., Jr Fetal gastroschisis: a preliminary report advocating the use of cesarean section. Obstet Gynecol. 1986 Mar;67(3):395–398. [PubMed] [Google Scholar]
  15. Luck S. R., Sherman J. O., Raffensperger J. G., Goldstein I. R. Gastroschisis in 106 consecutive newborn infants. Surgery. 1985 Oct;98(4):677–683. [PubMed] [Google Scholar]
  16. Mann L., Ferguson-Smith M. A., Desai M., Gibson A. A., Raine P. A. Prenatal assessment of anterior abdominal wall defects and their prognosis. Prenat Diagn. 1984 Nov-Dec;4(6):427–435. doi: 10.1002/pd.1970040606. [DOI] [PubMed] [Google Scholar]
  17. Muraji T., Tsugawa C., Nishijima E., Tanano H., Matsumoto Y., Kimura K. Gastroschisis: a 17-year experience. J Pediatr Surg. 1989 Apr;24(4):343–345. doi: 10.1016/s0022-3468(89)80265-9. [DOI] [PubMed] [Google Scholar]
  18. Ryan T. D., Kidd G. M. Maternal morbidity associated with in utero transfer. BMJ. 1989 Dec 2;299(6712):1383–1385. doi: 10.1136/bmj.299.6712.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Schwartz M. Z., Tyson K. R., Milliorn K., Lobe T. E. Staged reduction using a Silastic sac is the treatment of choice for large congenital abdominal wall defects. J Pediatr Surg. 1983 Dec;18(6):713–719. doi: 10.1016/s0022-3468(83)80010-4. [DOI] [PubMed] [Google Scholar]
  20. Stone H. H. Immediate permanent fascial prosthesis for gastroschisis and massive omphalocele. Surg Gynecol Obstet. 1981 Aug;153(2):221–224. [PubMed] [Google Scholar]
  21. Stringel G., Filler R. M. Prognostic factors in omphalocele and gastroschisis. J Pediatr Surg. 1979 Oct;14(5):515–519. doi: 10.1016/s0022-3468(79)80128-1. [DOI] [PubMed] [Google Scholar]
  22. Torfs C., Curry C., Roeper P. Gastroschisis. J Pediatr. 1990 Jan;116(1):1–6. doi: 10.1016/s0022-3476(05)81637-3. [DOI] [PubMed] [Google Scholar]
  23. Yaster M., Buck J. R., Dudgeon D. L., Manolio T. A., Simmons R. S., Zeller P., Haller J. A., Jr Hemodynamic effects of primary closure of omphalocele/gastroschisis in human newborns. Anesthesiology. 1988 Jul;69(1):84–88. doi: 10.1097/00000542-198807000-00012. [DOI] [PubMed] [Google Scholar]
  24. Yaster M., Scherer T. L., Stone M. M., Maxwell L. G., Schleien C. L., Wetzel R. C., Buck J. R., Nichols D. G., Colombani P. M., Dudgeon D. L. Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. J Pediatr Surg. 1989 Dec;24(12):1217–1220. doi: 10.1016/s0022-3468(89)80554-8. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES