Gastroschisis: delivery and immediate repair in the operating room.

BACKGROUND

Gastroschisis is a congenital abdominal wall defect with the small and large bowel protruding through. Early closure prevents heat and water loss, infection, and bowel edema. Immediate primary fascial closure should be done when possible.

OBJECTIVE

To compare the outcome of a group of gastroschisis neonates diagnosed before birth who underwent delivery and immediate surgical repair in the operating room (IOR group) with another group who underwent delivery outside the operating room and urgent surgical repair in the operating room later (OOR group).

MATERIAL AND METHOD

A retrospective cross sectional study between January 1, 2005 and December 31, 2007 was conducted on 49 neonates with gastroschisis treated at Khon Kaen Regional Hospital by one pediatric surgeon.

RESULT

Thirteen neonates were in the IOR group and 36 in the OOR group. Statistical significance was observed between both groups with regard to delivery-operation interval and operative procedure. The time interval from birth to operative repair of IOR group was shorter (0.8 +/- 0.4 vs. 11.4 +/- 4.2, p < 0.001). The abdominal wall defect of all neonates in IOR group could be corrected by primary fascial closure (100%) compared with only 61.1% in the OOR group (p < 0.01). There were no statistical significant difference between the two groups regarding days to extubation (4.7 +/- 2.7 vs. 8.3 +/- 6.3, p < 0.058), days to enteral feedings (10.5 +/- 4.5 vs. 13.7 +/- 5.9, p < 0.092), and length of stay (21.7 +/- 9.9 vs. 28.7 +/- 19.6, p < 0.235), but there was a trend in the IOR group toward earlier extubation, toleration of enteral feeding, and discharge. Overall mortality rate was 14%. All of the IOR group survived There were 19% deaths in the OOR group.

CONCLUSION

Delivery and immediate surgical repair in the operating room appear to be safe and feasible. Delivery-operation interval was decreased. The repair was easier and increased the possibility of primary fascial closure. The patients ate sooner and were discharged earlier. A policy of making immediate surgical repair upon the delivery in the operating room leads to decreased morbidity in infants with gastroschisis. A well prepared team is an important factor for this policy.