Long-term core outcomes of patients with simple gastroschisis

Bie, Felix De; Swaminathan, Vishal; Johnson, Gabrielle; Monos, Stylianos; Adzick, N. Scott; Laje, Pablo

doi:10.1016/j.jpedsurg.2020.09.008

Cited by 17 publications

(16 citation statements)

References 36 publications

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“…While this is comparable to some other series, 15 it is significantly higher than the 3.3% quoted in a recent study of long-term outcomes. 16 Significant complications of silo management of gastroschisis are reported in the literature. [17][18][19] While our patients did not experience such events, we recognize that nursing expertise is a key factor in patient management.…”

Section: Discussionmentioning

confidence: 99%

Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

et al. 2022

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Aim In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG). Methods After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes. Results Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life—median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups. Conclusion Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.

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Section: Discussionmentioning

confidence: 99%

Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

et al. 2022

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“…Furthermore, children with GS are prone to mediumand long-term complications, which are often overlooked and likely underestimated 21,23 . Gastrointestinal complications encompass chronic constipation, abdominal pain or bloating, gastroesophageal reflux disease, nutritional deficiency, adhesive bowel obstruction and need for additional surgery 14,21,62,63 .…”

Section: Absence Of Fully Effective Gold-standard Postnatal Therapymentioning

confidence: 99%

Complex gastroschisis: a new indication for fetal surgery?

Joyeux

Belfort

Coppi

et al. 2021

Ultrasound in Obstet & Gyne

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Gastroschisis (GS) is a congenital abdominal wall defect, in which the bowel eviscerates from the abdominal cavity. It is a non‐lethal isolated anomaly and its pathogenesis is hypothesized to occur as a result of two hits: primary rupture of the ‘physiological’ umbilical hernia (congenital anomaly) followed by progressive damage of the eviscerated bowel (secondary injury). The second hit is thought to be caused by a combination of mesenteric ischemia from constriction in the abdominal wall defect and prolonged amniotic fluid exposure with resultant inflammatory damage, which eventually leads to bowel dysfunction and complications. GS can be classified as either simple or complex, with the latter being complicated by a combination of intestinal atresia, stenosis, perforation, volvulus and/or necrosis. Complex GS requires multiple neonatal surgeries and is associated with significantly greater postnatal morbidity and mortality than is simple GS. The intrauterine reduction of the eviscerated bowel before irreversible damage occurs and subsequent defect closure may diminish or potentially prevent the bowel damage and other fetal and neonatal complications associated with this condition. Serial prenatal amnioexchange has been studied in cases with GS as a potential intervention but never adopted because of its unproven benefit in terms of survival and bowel and lung function. We believe that recent advances in prenatal diagnosis and fetoscopic surgery justify reconsideration of the antenatal management of complex GS under the rubric of the criteria for fetal surgery established by the International Fetal Medicine and Surgery Society (IFMSS). Herein, we discuss how conditions for fetoscopic repair of complex GS might be favorable according to the IFMSS criteria, including an established natural history, an accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence for fetoscopic repair and maternal and fetal safety of fetoscopy in expert fetal centers. Finally, we propose a research agenda that will help overcome barriers to progress and provide a pathway toward clinical implementation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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“…Gastroesophageal reflux (GER) is common in patients with abdominal wall defects, occurring in up to 70% [7,31,32]. Among multiple other factors, hiatal hernia contributes to the pathology of GER disease (GERD).…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

“…Overall, however, GER in patients with abdominal wall defects is reported to respond well to medical treatment and shows a clear tendency toward spontaneous improvement within the first years of life [5,32,34]. Anti-reflux surgery should therefore only be considered for severe cases of GER, GER on the basis of a hiatal hernia, and failure of medical treatment.…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele

et al. 2021

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Purpose This study aims to define the extent of additional surgical procedures after abdominal wall closure (AWC) in patients with gastroschisis (GS) and omphalocele (OC) with special focus on gastrointestinal related operations. Methods A retrospective chart review was performed including all operations in GS and OC patients in the first year after AWC (2010–2019). The risk for surgery was calculated using the one-year cumulative incidence (CI). Results 33 GS patients (18 simple GS, 15 complex) and 24 OC patients (12 without (= OCL), 12 OC patients with liver protrusion (= OCL +)) were eligible for analysis. 43 secondary operations (23 in GS, 20 in OC patients) occurred after a median time of 84 days (16–824) in GS and 114.5 days (12–4368) in OC. Patients with complex versus simple GS had a significantly higher risk of undergoing a secondary operation (one-year CI 64.3% vs. 24.4%; p = 0.05). 86.5% of surgical procedures in complex GS and 36.3% in OCL + were related to gastrointestinal complications. Complex GS had a significantly higher risk for GI-related surgery than simple GS. Bowel obstruction was a risk factor for surgery in complex GS (one-year CI 35.7%). Conclusion Complex GS and OCL + patients had the highest risk of undergoing secondary operations, especially those with gastrointestinal complications.

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Long-term core outcomes of patients with simple gastroschisis

Cited by 17 publications

References 36 publications

Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

Complex gastroschisis: a new indication for fetal surgery?

Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele

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