Gastroschisis Publications

Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure

Fraser JA, Deans KJ, Fallat ME, Helmrath M, Kabre R, Leys CM, Markel TA, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski JE, Hirschl R, Johnson KN, Kohler JE, Landman MP, Mak GZ, Minneci PC, Rymeski B, Sato TT, Slater BJ, Peter SDS, Fraser JD; Midwest Pediatric Surgery Consortium. Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure. J Pediatr Surg. 2022 Mar 26:S0022-3468(22)00250-0. doi: 10.1016/j.jpedsurg.2022.03.019. Epub ahead of print. PMID: 35450699.

  • Abstract

    Introduction: We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure.

    Methods: 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.

    Results: 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.

    Conclusion: 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.

    Levels of evidence: Level II.

    Cite
    Fraser JA, Deans KJ, Fallat ME, Helmrath M, Kabre R, Leys CM, Markel TA, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski JE, Hirschl R, Johnson KN, Kohler JE, Landman MP, Mak GZ, Minneci PC, Rymeski B, Sato TT, Slater BJ, Peter SDS, Fraser JD; Midwest Pediatric Surgery Consortium. Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure. J Pediatr Surg. 2022 Mar 26:S0022-3468(22)00250-0. doi: 10.1016/j.jpedsurg.2022.03.019. Epub ahead of print. PMID: 35450699.

Does Use of a Feeding Protocol Change Outcomes in Gastroschisis? A Report from the Midwest Pediatric Surgery Consortium.

Dekonenko C, Fraser JD, Deans K, Fallat ME, Helmrath M, Kabre R, Leys CM, Burns RC, Corkum K, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski J, Hernandez E, Hirschl R, Johnson KN, Kohler J, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci P, Rymeski B, Sato TT, Slater BJ, Peter SSD. Does Use of a Feeding Protocol Change Outcomes in Gastroschisis? A Report from the Midwest Pediatric Surgery Consortium. Eur J Pediatr Surg. 2020 Dec 27. doi: 10.1055/s-0040-1721074. Online ahead of print.PMID: 33368085

  • Abstract

    Introduction: Gastroschisis feeding practices vary. Standardized neonatal feeding protocols have been demonstrated to improve nutritional outcomes. We report outcomes of infants with gastroschisis that were fed with and without a protocol.

    Materials and methods: A retrospective study of neonates with uncomplicated gastroschisis at 11 children's hospitals from 2013 to 2016 was performed.Outcomes of infants fed via institutional-specific protocols were compared with those fed without a protocol. Subgroup analyses of protocol use with immediate versus delayed closure and with sutured versus sutureless closure were conducted.

    Results: Among 315 neonates, protocol-based feeding was utilized in 204 (65%) while no feeding protocol was used in 111 (35%). There were less surgical site infections (SSI) in those fed with a protocol (7 vs. 16%, p = 0.019). There were no differences in TPN duration, time to initial oral intake, time to goal feeds, ventilator use, peripherally inserted central catheter line deep venous thromboses, or length of stay. Of those fed via protocol, less SSIs occurred in those who underwent sutured closure (9 vs. 19%, p = 0.026). Further analyses based on closure timing or closure method did not demonstrate any significant differences.

    Conclusion: Across this multi-institutional cohort of infants with uncomplicated gastroschisis, there were more SSIs in those fed without an institutional-based feeding protocol but no differences in other outcomes.

    Cite

    Dekonenko C, Fraser JD, Deans K, Fallat ME, Helmrath M, Kabre R, Leys CM, Burns RC, Corkum K, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski J, Hernandez E, Hirschl R, Johnson KN, Kohler J, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci P, Rymeski B, Sato TT, Slater BJ, Peter SSD. Does Use of a Feeding Protocol Change Outcomes in Gastroschisis? A Report from the Midwest Pediatric Surgery Consortium. Eur J Pediatr Surg. 2020 Dec 27. doi: 10.1055/s-0040-1721074. Online ahead of print.PMID: 33368085

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

Fraser JD, Deans KJ, Fallat ME, Helmrath MA, Kabre R, Leys CM, Burns RC, Corkum K, Dillon PA, Downard CD, Gadepalli SK, Grabowski JE, Hernandez E, Hirschl RB, Johnson KN, Kohler JE, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci PC, Rymeski B, Sato TT, Scannell M, Slater BJ, Wilkinson KH, Wright TN, St Peter SD; Midwest Pediatric Surgery Consortium. Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg. 2020 Nov. pii: S0022-3468(20)30118-4. doi: 10.1016/j.jpedsurg.2020.02.017. PMID: 32151403 [PubMed - as supplied by publisher]

  • 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.

    Cite

    Fraser JD, Deans KJ, Fallat ME, Helmrath MA, Kabre R, Leys CM, Burns RC, Corkum K, Dillon PA, Downard CD, Gadepalli SK, Grabowski JE, Hernandez E, Hirschl RB, Johnson KN, Kohler JE, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci PC, Rymeski B, Sato TT, Scannell M, Slater BJ, Wilkinson KH, Wright TN, St Peter SD; Midwest Pediatric Surgery Consortium. Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg. 2020 Nov. pii: S0022-3468(20)30118-4. doi: 10.1016/j.jpedsurg.2020.02.017. PMID: 32151403 [PubMed - as supplied by publisher]

Outcomes in gastroschisis: expectations in the postnatal period for simple vs complex gastroschisis.

Dekonenko C, Fraser JD, Deans KJ, Fallat ME, Helmrath M, Kabre R, Leys CM, Burns RC, Corkumd K, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski JE, Hernandez E, Hirschl R, Johnson KN, Kohler JE, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci PC, Rymeski B, Sato TT, Slater BJ, St Peter SD. Outcomes in gastroschisis: expectations in the postnatal period for simple vs complex gastroschisis. J Perinatol. 2021 May 25. doi: 10.1038/s41372-021-01093-8. Epub ahead of print. PMID: 34035447.

  • Abstract

    Objective: To provide generalizable estimates for expected outcomes of simple gastroschisis (SG) and complex gastroschisis (CG) patients from a large multi-institutional cohort for use during counseling.

    Study design: A retrospective study of 394 neonates with gastroschisis at 11 children's hospitals from January 2013 to March 2017 was performed. Analysis by Fisher's exact tests and Wilcoxon rank sum tests were performed. Outcomes of complex and simple gastroschisis are reported.

    Result: There were 315 (80%) SG and 79 (20%) CG. CG had increased time from birth to closure (6 vs 4.4 days), closure to goal feeds (69 vs 23 days), ventilator use (90% vs 73%), SSIs (31% vs 11%), NEC (14% vs 6%), PN use (71 vs 24 days), LOS (104.5 vs 33 days), and mortality (11% vs 0%).

    Conclusion: This study provides generalizable estimates for expected outcomes of patients with both SG and CG that can be utilized during counseling. CG has significantly worse in-hospital outcomes.

    Cite
    Dekonenko C, Fraser JD, Deans KJ, Fallat ME, Helmrath M, Kabre R, Leys CM, Burns RC, Corkumd K, Dillon PA, Downard C, Wright TN, Gadepalli SK, Grabowski JE, Hernandez E, Hirschl R, Johnson KN, Kohler JE, Landman MP, Landisch RM, Lawrence AE, Mak GZ, Minneci PC, Rymeski B, Sato TT, Slater BJ, St Peter SD. Outcomes in gastroschisis: expectations in the postnatal period for simple vs complex gastroschisis. J Perinatol. 2021 May 25. doi: 10.1038/s41372-021-01093-8. Epub ahead of print. PMID: 34035447.