Gastroschisis and sutureless abdominal wall closure
With Dr. Jason Fraser · hosted by Dr. Rod Gerardo · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster.
Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions.
In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection.
The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation.
The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates.
The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up.
In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
Sutureless closure patients had less antibiotic use compared to sutured closure patients.
Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
Sutureless closure patients had less ventilator use compared to sutured closure patients.
The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate.
Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.