S. Lin1, C. Stephens3, D. Morrow2, A. Cunningham1, N. Hamilton1 1Oregon Health and Sciences University,Pediatric Surgery,Portland, OR, USA 2Oregon Health and Sciences University,Department Of Neonatology,Portland, OR, USA 3University Of California – San Francisco,General Surgery,San Francisco, CA, USA
Introduction: Gastroschisis, defined as an anterior defect of the abdominal wall, is a common congenital anomaly affecting 1 in 2,000-4,000 live births. Both delayed (whereby the bowel is placed into a spring-loaded silo and slowly reduced) and primary (sutureless or sutured) closure methods are used to close this defect, and neither approach has been deemed superior. Given that no consensus has been reached regarding the appropriate closure technique, we aim to determine the difference in relevant clinical outcomes for patients with gastroschisis with primary closure versus delayed closure.
Methods: A retrospective cohort study of 69 patients between 2009 and 2018 undergoing primary repair (sutureless or sutured) vs. delayed repair (with silo placement) for gastroschisis was performed. Our primary outcome was length of stay. Our secondary outcomes included time to first feeds, time to full feeds, and whether closure took place in the operating room vs. the resuscitation suite.
Results: In multivariate analysis, primary closure patients on average had a shorter length of stay as compared to delayed closure (26.51 vs 34.13 days, p=.01). In univariate analysis, primary closure parents were more likely to have significantly shorter time to starting feeds, (median days of starting feeds were 11 days vs 16 days, p=.01), time to full feeds (median days to full feeds were 20 days vs 26 days, p=.01), and were more likely to be able to have their closure procedure performed in the resuscitation suite than the operating room, OR 3.83, (95% CI, 1.33 to 11.02, p=.01) vs delayed silo closure patients.
Conclusion: Patients who were able to undergo primary closure for gastroschisis were more likely to have shorter lengths of stay, shorter time to starting feeds, shorter time to full feeds, and were more likely to be able to have their procedure performed in the resuscitation suite as opposed to the operating room. This data adds clinical predictive value for patients and providers concerning clinical and deposition outcomes for patients with gastroschisis.