Neonatal ConditionsSutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium
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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Cited by (20)
Special Populations—Surgical Infants
2023, Clinics in PerinatologyNew methods in the delayed closure of gastroschisis
2023, Anales de PediatriaAbdominal Wall Defects
2023, Avery's Diseases of the NewbornGastroschisis in monozygotic twins: A successful approach in a developing country
2022, Journal of Pediatric Surgery Case ReportsAbdominal Wall Defects: A Review of Current Practice Guidelines
2022, Clinics in PerinatologyCitation 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 SurgeryCitation 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.