Paediatric Surgery (Ukraine). 2026. 2(91): 69-75. doi: 10.15574/PS.2026.2(91).6975
Hussein A. Ya.
Bint Al-Huda Teaching Hospital, Nasiriyah, Iraq

For citation: Hussein AYa. (2026). Primary direct closure of gastroschisis after skin undermining and sheath expansion using electrocautery: a retrospective case series of 21 patients. Paediatric Surgery (Ukraine). 2(91): 69-75. doi: 10.15574/PS.2026.2(91).6975.
Article received: Feb 28, 2026. Accepted for publication: Jun 15, 2026.

Gastroschisis is a congenital defect of the abdominal wall that needs immediate surgical correction. An alternative option is primary direct closure after skin undermining and sheath expansion using electrocautery, without the use of a temporary container (silo).
Aim – to assess the feasibility and short-term results of primary direct closure of gastroschisis after skin undermining and sheath expansion with electrocautery in newborns.
Materials and methods. A retrospective analysis of 21 newborns with gastroschisis who had primary direct closure performed from January to December 2024. The study followed STROBE guidelines for observational studies. The outcomes measured were the rate of primary closure, the duration of nasogastric (NG) tube, feeding milestones, and complications.
Results. Twenty-one patients were included, with a mean birth weight of 2.77 kg. Primary closure was successful in 18 patients (85.7%). Three (14.3%) patients were deemed to be unsuccessful. No patient required mechanical ventilation. Mean NG tube duration was 3.9 days. Six (28.6%) patients were able to tolerate full enteral feeding at a mean of 4.8 days after surgery. Five (23.8%) patients had complications; there was one (4.8%) fatal outcome. The unsuccessful Closure group (66.7%) had more complications compared to the successful group (16.7%).
Conclusion. Primary direct closure of gastroschisis following undermining of the skin and sheath expansion with electrocautery is a viable technique in selected patients with an 85.7% success rate. The technique provides hemostasis and accurate tissue separation. Failure of primary closure was seen in 14.3% on daily follow-up documentation.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the parents or guardians of the children for the conduct of the study.
The author declares that there is no conflict of interest.
Keywords: gastroschisis, primary closure, electrocautery, sheath expansion, case series, neonatal surgery.

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