Bedside reduction of gastroschisis: A feasible option

Abstract

Background: Gastroschisis is a common neonatal malformation, with an incidence of 0.4-3 per 10,000 live births worldwide. Objective: This study was planned to assess the feasibility of bedside reduction of gastroschisis (BRG) in the neonatal intensive care unit (NICU) at our institution. Materials and Methods: Retrospective analysis of newborns with gastroschisis managed at our institution between September 2008 and May 2013. Initial bedside reduction in NICU was attempted in all the neonates procedure was done underlocal anesthesia. Incision was extended transversely on the lateral aspect when required. Gradual reduction of bowel loops done with monitoring of parameters. Complete abdominal wall closure in multiple layers/skin closure only was done based on intra-abdominal tension. The final outcome was recorded. Results: During the study period of 60-month, 10 children were treated for gastroschisis at our institution. The sex ratio among them was 8:2 in favor of males. The average age was 23 h (range: 4-72 h). The average birth weight of the babies was 2290 g (range: 1700-2600 g). Six patients were in the high-risk group and 4 in the low-risk group. The BRG was successful in 7 patients and a silo was placed in 3 patients who did not tolerate BRG. General anesthesia was required in 3 patients only for subsequent repair. The overall survival was 70%. Conclusion: BRG is a feasible and safe option. Selective use of silo, gradual staged bowel reduction, and delayed primary closure of the defect can be done on the bedside when attempted BRG is unsuccessful.

Bedside Reduction of Gastroschisis: A Preliminary Experience in Yaounde-Cameroon

“…In addition, the occurrence of respiratory and cardiovascular disorders is easily detectable with this option, and immediate resuscitative manoeuvres can be started when required. [ 3 ] Although the mortality rate in our series remains high (67%), it has slightly improved from the 100% fatality rate recorded before implementation of bedside reduction in our institution. This mortality is multifactorial and late presentation appears to be one of the most important factors in our setting, as it correlates with infection, hypovolaemia and hypothermia.…”

“…The optimal treatment of the gastroschisis remains a subject of controversy in the literature with contests between primary closure versus staged repair of the defect, use of general or local anaesthesia and the different techniques for reducing intra-abdominal tension. [ 3 ] In our context, the therapeutic management faces three main pitfalls that are unique to our conditions: The absence of paediatric ventilators, the unavailability of preformed silo bags and the lack of an organised national health-care programme. Thus, the gradual reduction recommended by Bianchi and Dickson[ 4 ] in 1998 appears to be an attractive option in our practice where we do not have a neonatal intensive care unit.…”

“…The survival rate of 70% reported by Deepak et al . [ 3 ] in India encourages us in this optimism. However, some authors such as Krasna[ 6 ] firmly advocate primary closure as the preferred treatment.…”