Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, San Francisco.
JAMA Surg. 2019 Jan 1;154(1):33-39. doi: 10.1001/jamasurg.2018.3216.
Sutureless gastroschisis repair offers an alternative to the traditional sutured method and has been associated with decreased intubation time. Published study results are inconsistent regarding the advantages of sutureless closure.
To compare the clinical outcomes of sutureless and sutured gastroschisis repair.
DESIGN, SETTING, AND PARTICIPANTS: A single-center cohort review was performed of all consecutive patients (n = 97) who underwent gastroschisis repair from February 1, 2007, to April 30, 2017, at the University of California, San Francisco. Patients' medical records were evaluated for clinical characteristics and outcomes. Cases with incomplete data during initial hospitalization were excluded.
Length of hospital stay, time to full enteral feeds, total parenteral nutrition duration, days requiring intravenous analgesia, days intubated, wound infection rate, antibiotic treatment duration, rate of umbilical hernias that required an operation, and readmission rate.
In total, 97 patients (47 [48%] were female and 50 [52%] were male with a mean [SD] age of 2.8 [2.8] days) underwent gastroschisis repair, of which 7 were excluded for incomplete medical record. Of the 90 patients included in the study, 50 (56%) underwent sutured closure and 40 (44%) underwent sutureless closure. No statistical difference was found between the sutured and sutureless groups in length of hospital stay (mean [SD] days, 43.9 [40.4] vs 36.7 [21.2]; P = .71), time to full enteral feeds (mean [SD] days, 31.4 [20.2] vs 27.9 [17.3]; P = .22), total parenteral nutrition duration (mean [SD] days, 33.5 [29.8] vs 27.4 [18.2]; P = .23), wound infection rates (14 [28%] vs 10 [25%]; P = .81), and readmission rates (5 [10%] vs 7 [18%]; P = .36). The sutureless group, compared with the sutured group, had substantially fewer days receiving antibiotics (mean [SD], 7.2 [6.4] vs 12.4 [13.2]; P = .003), fewer days intubated (mean [SD], 2.8 [3.3] vs 6.8 [1.3]; P = .001), fewer days receiving intravenous analgesia (mean [SD], 4.2 [4.0] vs 7.1 [4.5]; P = .003), and fewer patients that required silo reduction (25 [63%] vs 48 [96%]; P < .001). Sutureless closures, compared with the sutured technique, had considerably more umbilical hernias requiring surgical repair (5 [13%] vs 0; P = .02).
Sutureless repair of gastroschisis appears to be associated with a statistically significant reduction in mechanical ventilation duration and pain medication requirements but may increase umbilical hernia risk. Multicenter randomized clinical trials are necessary to determine the true advantages of the sutureless approach.
无缝线关腹术为传统缝线关腹术提供了另一种选择，并已被证明与缩短插管时间有关。已发表的研究结果在无缝线关闭术的优势方面并不一致。
比较无缝线和缝线关腹术治疗先天性脐膨出的临床效果。
设计、地点和参与者：对 2007 年 2 月 1 日至 2017 年 4 月 30 日期间在加利福尼亚大学旧金山分校接受先天性脐膨出修复的所有连续患者（n=97）进行了单中心队列回顾。评估了患者的临床特征和结果。在最初住院期间数据不完整的病例被排除在外。
住院时间、全肠内喂养时间、全胃肠外营养时间、需要静脉镇痛的天数、插管天数、伤口感染率、抗生素治疗时间、需要手术修复的脐疝率和再入院率。
共有 97 例患者（47%为女性，50%为男性，平均[SD]年龄为 2.8[2.8]天）接受了先天性脐膨出修复，其中 7 例因病历不完整而被排除。在纳入研究的 90 例患者中，50 例（56%）接受了缝线关闭，40 例（44%）接受了无缝线关闭。在住院时间（平均[SD]天数，43.9[40.4]vs 36.7[21.2]；P=0.71）、全肠内喂养时间（平均[SD]天数，31.4[20.2]vs 27.9[17.3]；P=0.22）、全胃肠外营养时间（平均[SD]天数，33.5[29.8]vs 27.4[18.2]；P=0.23）、伤口感染率（14[28%]vs 10[25%]；P=0.81）和再入院率（5[10%]vs 7[18%]；P=0.36）方面，缝线组和无缝线组之间无统计学差异。与缝线组相比，无缝线组接受抗生素治疗的天数明显减少（平均[SD]，7.2[6.4]vs 12.4[13.2]；P=0.003）、插管天数减少（平均[SD]，2.8[3.3]vs 6.8[1.3]；P=0.001）、静脉镇痛天数减少（平均[SD]，4.2[4.0]vs 7.1[4.5]；P=0.003），需要行疝囊减张术的患者减少（25[63%]vs 48[96%]；P<0.001）。与缝线技术相比，无缝线关闭术与脐疝需要手术修复的风险增加有关（5[13%]vs 0；P=0.02）。
先天性脐膨出的无缝线修复似乎与机械通气时间和疼痛药物需求的显著减少有关，但可能会增加脐疝的风险。需要进行多中心随机临床试验来确定无缝线方法的真正优势。
