H. E. Arnold1, H. Short1, K. Baxter1, C. D. Travers2, A. M. Bhatia1, M. M. Durham1, M. V. Raval1 1Emory University School Of Medicine,Division Of Pediatric Surgery, Department Of Surgery,Atlanta, GA, USA 2Emory University School Of Medicine,Department Of Pediatrics,Atlanta, GA, USA 3Emory University School Of Medicine,Department Of Surgery,Atlanta, GA, USA 4Emory University School Of Medicine,Department Of Pediatrics,Atlanta, GA, USA
Introduction: Gastroschisis complicated by atresia represents a clinical challenge. In addition to the initial abdominal wall defect repair, these children require subsequent interventions to establish bowel continuity. After definitive abdominal closure, the second surgery is often delayed to enhance bowel recovery. The optimal timing of the second intervention has not been fully investigated. The purpose of this study was to determine if early intervention for patients with gastroschisis and atresia results in improved outcomes compared to late intervention.
Methods: Retrospective chart review of patients who underwent surgical repair of gastroschisis between January 1, 2009 and December 31, 2012 was performed at a quaternary children’s hospital. We identified a subset of patients who had gastroschisis complicated by atresia and compared those who had early intervention (<4 weeks) versus late intervention (>4 weeks) to manage the atresia.
Results: Of 143 gastroschisis patients identified, 13 (9.1%) had atresia including 5 (38.5%) primary abdominal wall closures and 8 (61.5%) that were delayed closures using a silo. From definitive closure to subsequent intervention for the atresia, 7 were considered early (<4 weeks, median 9 days), and 6 were considered delayed (>4 weeks, median 49 days). All patients in the early intervention group received ostomies, while patients in the late intervention group underwent primary anastomosis. Overall, 5 patients had major complications including 1 with volvulus, 1 with intestinal necrosis, and 3 with perforations. Of these, only one major complication occurred in the delayed group, which was the case of the volvulus. Excluding those patients with emergent complications (1 patient with necrosis, 1 patient with perforation) that forced earlier than planned intervention, overall length of stay trended toward shorter stays for early intervention patients (66 vs. 98 median days, p=0.30). Early intervention was associated with shorter time to enteral feeds (28 vs. 60 median days of life, p=0.02).
Conclusion: In this single-center, retrospective review, patients undergoing early intervention for atresia after definitive gastroschisis closure trended toward shorter length of stay and earlier initiation of feeds despite uniformly receiving ostomies. The optimal timing of surgical intervention in this complex patient population warrants further investigation.