J. Shelton1, K. J. Keck2, M. Alexander2, D. Van Der Heide2, J. Liao2, J. Shilyansky1 1University Of Iowa,Division Of Pediatric Surgery,Iowa City, IA, USA 2University Of Iowa,Department Of Surgery,Iowa City, IA, USA
Introduction:
Despite an increasing incidence of gastroschisis, controversy remains regarding ideal surgical management for these patients. Both sutured closure (SC) and sutureless plastic closure (PC) are commonly used techniques but little information exists regarding current surgeon practices. The purpose of this study was to query pediatric surgeons regarding preferred closure techniques, location of closure, and need for general anesthesia with the goal of developing a clinical trial to assess gastroschisis closure techniques and outcomes.
Methods:
A survey was developed using an iterative process and was focus group tested prior to circulation. An electronic version was distributed to 1351 active members of the American Pediatric Surgical Association. Responses were analyzed using Stata 15.0 (StataCorp, College Station, Texas).
Results:
A total of 366 responses were received (response rate of 27.1%). The majority of responses were from practicing surgeons (93.2%) affiliated with academic medical centers (70.8%). Since the introduction of this technique in 2004, more than half of respondents (54.7%) report using sutureless closure methods. Those who choose PC cite ease of procedure, decreased anesthetic requirements, avoidance of the OR, and cosmetic result as the basis for their preference. PC use is affected by temporizing methods (silos) with only 29.2% using PC after silo placement while 69.3% elect SC. Regarding location of closure, 63.5% of surgeons prefer the OR, noting equipment availability, lighting, and need for anesthesia and ancillary staff as reasons for this preference, however, 94.4% of PCs occur in the NICU. PC reduces sedation use with 17% and 31.3% of surgeons reporting no or limited use of sedation, respectively.
Conclusion:
Pediatric surgeons are increasingly familiar with PC for gastroschisis. Lack of consensus among pediatric surgeons, even in academic settings, remains. These results should foster the development of clinical trials addressing optimal surgical management of this increasingly common congenital abdominal wall defect.