- Surgical management of simple gastroschisis
Surgical management of simple gastroschisis
PAEDIATRIC SURGERY.UKRAINE.2018.2(59):25-31; DOI 10.15574/PS.2018.59.25
Sliepov O., Migur M., Soroka V., Ponomarenko O.
SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv
Until now, issues regarding the appropriate way of surgical management of simple gastroschisis (GS) remain unsolved.
Objective: to investigate the rate and effectiveness of surgical treatment in the application of various types of surgical interventions as well as postoperative course in patients with simple GS.
Material and methods. A prospective study of 54 newborns with GS that were managed using the «first minute surgery» method during the period from 2006 to 2017 was conducted. To achieve the stated objective, all patients with GS were divided into two groups. Group І included children with simple GS (n=41), newborns with complicated GS were enrolled to the II group (n=13).
Results. According to the results of our study, among 54 newborns with GS, 41 (75.9%) children had simple GS. There were a significantly lower rate of postoperative surgical complications, sepsis, time duration before complete enteral nutrition administration and hospitalization (P<0.05) in newborns with simple GS. During the surgical management of the defect in these children, anterior abdominal wall (AAW) patches were used statistically rarely (p=0.03). The AAW defect repair with local tissues and minimal ventral hernia primary formation leads to a decrease in the incidence of abdominal compartment syndrome.
Conclusions. Simple GS occurs in 75.9% of newborns with this malformation. The AAW defect repair with local tissues and primary formation of the minimal ventral hernia in children with simple GS is the appropriate way of surgical management of defect with absent or moderate viscero-abdominal disproportion (VAD). The combined staged AAW plastic is indicated when severe VAD occurs.
Key words: gastroschisis, simple GS, visceral-abdominal disproportion, abdominal compartment syndrome, surgical management.
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