Tullie L G C, Bough G M, Shalaby A, Kiely E M, Curry J I, Pierro A, De Coppi P, Cross K M K
Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
Division of General Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
Pediatr Surg Int. 2016 Aug;32(8):811-4. doi: 10.1007/s00383-016-3906-1. Epub 2016 Jun 25.
To assess incidence and natural history of umbilical hernia following sutured and sutureless gastroschisis closure.
With audit approval, we undertook a retrospective clinical record review of all gastroschisis closures in our institution (2007-2013). Patient demographics, gastroschisis closure method and umbilical hernia occurrence were recorded. Data, presented as median (range), underwent appropriate statistical analysis.
Fifty-three patients were identified, gestation 36 weeks (31-38), birth weight 2.39 kg (1-3.52) and 23 (43 %) were male. Fourteen patients (26 %) underwent sutureless closure: 12 primary, 2 staged; and 39 (74 %) sutured closure: 19 primary, 20 staged. Sutured closure was interrupted sutures in 24 patients, 11 pursestring and 4 not specified. Fifty patients were followed-up over 53 months (10-101) and 22 (44 %) developed umbilical hernias. There was a significantly greater hernia incidence following sutureless closure (p = 0.0002). In sutured closure, pursestring technique had the highest hernia rate (64 %). Seven patients underwent operative hernia closure; three secondary to another procedure. Seven patients had their hernias resolve. One patient was lost to follow-up and seven remain under observation with no reported complications.
There is a significant umbilical hernia incidence following sutureless and pursestring sutured gastroschisis closure. This has not led to complications and the majority have not undergone repair.
评估缝合与非缝合方式关闭腹裂术后脐疝的发生率及自然病程。
经审核批准，我们对本机构（2007 - 2013年）所有腹裂关闭手术进行了回顾性临床记录审查。记录患者人口统计学资料、腹裂关闭方法及脐疝发生情况。数据以中位数（范围）表示，并进行了适当的统计分析。
共纳入53例患者，孕周36周（31 - 38周），出生体重2.39 kg（1 - 3.52 kg），男性23例（43%）。14例患者（26%）采用非缝合方式关闭：12例一期手术，2例分期手术；39例（74%）采用缝合方式关闭：19例一期手术，20例分期手术。24例患者采用间断缝合关闭，11例采用荷包缝合，4例未明确说明。50例患者随访53个月（10 - 101个月），22例（44%）发生脐疝。非缝合关闭术后疝发生率显著更高（p = 0.0002）。在缝合关闭中，荷包缝合技术疝发生率最高（64%）。7例患者接受了脐疝手术修复；3例因其他手术继发。7例患者的脐疝自行消退。1例患者失访，7例仍在观察中，未报告并发症。
非缝合及荷包缝合关闭腹裂术后脐疝发生率较高。这尚未导致并发症，且大多数患者未接受修复。
