Gastroschisis--primary fascial closure. The goal for optimal management.

Since Raffensperger and Jona reported an 80% success rate with primary skin closure including a 16% rate of complete fascial closure in 24 patients with gastroschisis in 1974, primary fascial closure has been the author's preferred method. It has been possible to achieve complete fascial and skin closure in 17 of the last 21 patients (81%). Four infants in this series, one of whom was initially managed by another surgeon, were treated with brief application of a silon prosthesis with subsequent reduction and closure. The two keys to success of this method are thorough wash out of the meconium from the entire intestine and vigorous stretching of the abdominal wall. Assisted ventilation may be needed for 24 to 48 hours after operation and has been well tolerated. Transposition of an umbilical artery for cannulation and blood gas monitoring has been an important adjunct. The one death (5% mortality) resulted from prolonged bowel dysfunction and liver failure three months after operation. Other complications have been few and mild. Since some recent reports have indicated that primary closure is not being widely used in the treatment of gastroschisis, this series is presented to emphasize that this method can be used in most infants and with a very low complication rate.