S. Raymond1, S. D. St. Peter1, C. Downard1, F. Qureshi1, E. Renaud1, P. D. Danielson1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Purpose: Atresia is one of the most common associated anomalies in gastroschisis (GS), and renders the anomaly a complex one. A number of single center studies suggest that atresia has minimal effect on morbidity and mortality in GS, while others suggest otherwise. The purpose of this study was to report outcomes in the largest series of atresias in GS.
Methods: A retrospective cohort of GS from 8 institutions from 2006-2013 was created and clinical data collected for pre-, peri- and post-natal variables. Patients with a diagnosis of atresia were selected from this cohort for analysis, excluding those with bowel resection due to perforation or ischemia unrelated to atresia. Comparison was performed with other complex GS patients. Student’s t test and Fisher’s exact test were used for statistical evaluation and a p value of <0.05 was considered significant.
Results: Out of 566 cases of GS, 123 (21.7%) were complex and 51 had an atresia. Atresias were primarily in the jejunum and ileum (67%), and 23.5% were multiple. Despite 84% of GS found prenatally, there was no prenatal atresia diagnosis. Atresia patients had a 9.8% mortality rate in the NICU and a 15.8% mortality at follow up. Atresia’s LOS was over 3 months and 70% required repeat laparotomy. At discharge, 43% of atresia patients required TPN. A comparison of atresia with other complex GS shows atresia to be associated with higher rate of intestinal failure and a trend to higher LOS, rate of sepsis, and readmissions (Table).
Conclusions: GS associated atresia carries high morbidity and mortality rates, and has significantly higher rates of intestinal failure than other complex GS. A majority required multiple operations, readmissions, and long-term central lines. Identification of an atresia with GS should prompt a transfer to a facility with higher capability.
