Comment on “Secondary bladder herniation in isolated gastroschisis justifies increased surveillance”

Meller, Christian; Barrio, María Gabriela; Aiello, Horacio; Otaño, Lucas

doi:10.1002/pd.4291

Cited by 1 publication

(1 citation statement)

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“…There has been a lot of controversy about gestational age at delivery, as well as the best surgical technique to be performed. ( 1 , 3 - 5 ) Some studies suggest that elective earlier delivery anticipation may reduce intestinal damage and enhance neonatal outcome. ( 1 , 6 - 11 )…”

Section: Introductionmentioning

confidence: 99%

Novel multidisciplinary approach to monitor and treat fetuses with gastroschisis using the Svetliza Reducibility Index and the EXIT-like procedure

Oliveira

Svetliza

Vaz-Oliani

et al. 2017

Einstein (São Paulo)

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ObjectiveTo describe our initial experience with a novel approach to follow-up and treat gastroschisis in “zero minute” using the EXITlike procedure.MethodsEleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as historical controls. The Svetliza Reductibility Index consisted in dividing the real abdominal wall defect diameter by the larger intestinal loop to be fitted in such space. The EXIT-like procedure consists in planned cesarean section, fetal analgesia and return of the herniated viscera to the abdominal cavity before the baby can fill the intestines with air. No general anesthesia or uterine relaxation is needed. Exteriorized viscera reduction is performed while umbilical cord circulation is maintained.ResultsFour of the five cases were performed with the EXIT-like procedure. Successful complete closure was achieved in three infants. The other cases were planned deliveries at term and treated by construction of a Silo. The average time to return the viscera in EXIT-like Group was 5.0 minutes, and, in all cases, oximetry was maintained within normal ranges. In the perinatal period, there were significant statistical differences in ventilation days required (p = 0.0169), duration of parenteral nutrition (p=0.0104) and duration of enteral feed (p=0.0294).ConclusionThe Svetliza Reductibility Index and EXIT-like procedure could be new options to follow and treat gastroschisis, with significantly improved neonatal outcome in our unit. Further randomized studies are needed to evaluate this novel approach.

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