Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium

doi:10.1016/j.jpedsurg.2020.02.017

Journal of Pediatric Surgery

Volume 55, Issue 11, November 2020, Pages 2284-2288

https://doi.org/10.1016/j.jpedsurg.2020.02.017 Get rights and content

Abstract

Purpose

To report outcomes of sutured and sutureless closure for gastroschisis across a large multi-institutional cohort.

Methods

A retrospective study of infants with uncomplicated gastroschisis at 11 children's from 2014 to 2016 was performed. Outcomes of sutured and sutureless abdominal wall closure were compared.

Results

Among 315 neonates with uncomplicated gastroschisis, sutured closure was performed in 248 (79%); 212 undergoing sutured closure after silo and 36 undergoing primary sutured closure. Sutureless closure was performed in 67 (21%); 37 primary sutureless closure, 30 sutureless closure after silo placement. There was no significant difference in gestational age, gender, birth weight, total days on TPN, and time from closure to initial oral intake or goal feeds. Sutureless closure patients had less general anesthetics, ventilator use/time, time from birth to final closure, antibiotic use after closure, and surgical site/deep space infections. Subgroup analysis demonstrated primary sutureless closure had less ventilator use and anesthetics than primary sutured closure. Sutureless closure after silo led to less ventilator use/time, anesthetics, and antibiotics compared to those with sutured closure after silo.

Conclusion

Sutureless abdominal wall closure of neonates with gastroschisis was associated with less general anesthetics, antibiotic use, surgical site/deep space infections, and decreased ventilator time. These findings support further prospective study by our group.

Level of Evidence

Level III.

Section snippets

Patients and study design

Following individual and reliance institutional review board approval, a retrospective cohort of infants with gastroschisis born between 2013 and 2016 was identified across 11 participating children's hospitals of the Midwest Pediatric Surgery Consortium (www.mwpsc.org). Patients were identified from administrative hospital databases as well as practice databases. Patients with complex gastroschisis (atresia, perforation, necrosis, death) were excluded.

Study data were collected and managed

Methods

Consensus in identifying and defining relevant data elements for collection and analysis across the 11 institutions was obtained. Sutured abdominal wall closure was defined as closure in the operating room using sutures to close the fascial defect. Sutureless closure was defined as any other closure method that did not use sutures to close the fascia, which was most commonly the technique depicted in Fig. 1. This typically placing the umbilical cord or and/or a non-adherent dressing over the

Study cohort and demographics

Over the 3-year study period, 394 infants with gastroschisis were identified. Seventy-nine patients with complex gastroschisis were excluded, leaving 315 patients for analysis (Fig. 2). The median gestational age at birth was 36 weeks (IQR 35, 37), the median birth weight was 2.4 kg (IQR 2.1, 2.8), and there were 157 males (49.8%). There were no significant differences in gestational age, birth weight, and gender between patients that had a sutured closure compared to those that had a

Discussion

In this large cohort comparison of neonates who have undergone sutureless closure, we found that infants closed with a sutureless technique had similar time to initiation of feeds and time to goal feeds; which resulted in a similar length of stay. These findings remained constant in the subgroup analysis. Patients that had sutureless closure, with or without silo, had fewer general anesthetics, less ventilator use and time, shorter time from birth to final closure, less antibiotic use after

Conclusion

The sutureless abdominal wall closure in neonates with gastroschisis is associated with fewer general anesthetics, less antibiotic use, less surgical site/deep space infections, and decreased ventilator time with similar time to initial feeds, time to goal feeds, and hospital stay in selected patients. Further longitudinal study of this cohort in planned to examine the long-term outcomes and complications. Moreover, these findings justify further prospective study of the sutureless closure

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Special Populations—Surgical Infants
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Gastroschisis in monozygotic twins: A successful approach in a developing country
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Gastroschisis is a congenital birth defect of the abdominal wall, with a high mortality rate in middle-income countries, especially among twins. We report a monozygotic twin pregnancy in a 14-year-old girl with a low socioeconomic status and living in a rural area 4 hours away from our II-III health care level hospital, which has medical expertise for handling gastroschisis, in a developing country (Mexico). Prenatal screening was performed using ultrasonography and magnetic resonance imaging, followed by close monitoring and lung maturity induction. A caesarean section was scheduled at 36 weeks, with three available operating rooms for the mother, twin 1, and twin 2, with three teams of specialists. Birth management was done under sedation and analgesia, without intubation. Primary closure was performed for twin 1 and a preformed silo was used for twin 2, who had associated arthrogryposis. Both twins underwent defect sealing with hydrocolloid dressings and sutureless closures, and subsequent neonatal intensive care unit treatment. They had 46XY chromosomes and an identical genetic profile, and were discharged on days 23 and 49, respectively. A specialized multidisciplinary team with state-of-the-art technology, adapted to the hospital conditions of a middle-income country, is paramount for the positive outcomes of twins with gastroschisis.
Abdominal Wall Defects: A Review of Current Practice Guidelines
2022, Clinics in Perinatology
Citation Excerpt :
Specific surgical management of the abdominal wall defect has 2 most common approaches, primary surgical closure of the fascia and the more recently proposed sutureless repair, using the umbilical cord as a biologic covering of the defect. In patients with sutureless closure, it has been demonstrated that patients may have less antibiotic use, less exposure to anesthetic due to bedside performance, less infectious complications, and decreased ventilator time compared with patients with primary surgical closure.17 This literature suggests a sutureless closure for gastroschisis patients proposes significant clinical benefits.
Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure
2022, Journal of Pediatric Surgery
Citation Excerpt :
Follow-up frequency and the decision to repair a peri‑umbilical hernia were at the discretion of the operating surgeon, and the primary outcome of surgical closure, spontaneous closure, or observation was determined for any documented presence of a peri‑umbilical hernia, regardless of interval time to follow-up. Findings from previous studies on this cohort are reported elsewhere [3,4]. Study data were collected and managed using REDCap (Research Electronic Data Capture) software hosted at the primary site.
We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure.
A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications.
Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure.
Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach.
Level II

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Neonatal ConditionsSutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium

Abstract

Purpose

Methods

Results

Conclusion

Level of Evidence

Section snippets

Patients and study design

Methods

Study cohort and demographics

Discussion

Conclusion

Semin Perinatol

J Pediatr Surg

J Pediatr Surg

Non-operative Management of Gastroschisis: a case-matched study

Pediatr Surg Int

Sutureless vs sutured gastroschisis closure: a prospective randomized controlled trial

J Am Coll Surg

Neonatal Conditions
Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium