Closing gastroschisis: The good, the bad, and the not-so ugly
Purpose: The diagnosis of "closing" or "closed gastroschisis" is made when bowel is incarcerated within a closed or nearly closed ring of fascia, usually with associated bowel atresia. It has been described as having a high morbidity and mortality.
Methods: A retrospective review of closing gastroschisis cases (n = 53) at six children's hospitals between 2000 and 2016 was completed after IRB approval.
Results: A new classification system for this disease was developed to represent the spectrum of the disease: Type A (15%): ischemic bowel that is constricted at the ring but without atresia; Type B (51%): intestinal atresia with a mass of ischemic, but viable, external bowel (owing to constriction at the ring); Type C (26%): closing ring with nonviable external bowel +/- atresia; and Type D (8%): completely closed defect with either a nubbin of exposed tissue or no external bowel. Overall, 87% of infants survived, and long-term data are provided for each type.
Conclusions: This new classification system better captures the spectrum of disease and describes the expected long-term results for counseling. Unless the external bowel in a closing gastroschisis is clearly necrotic, it should be reduced and evaluated later. Survival was found to be much better than previously reported.
Type of study: Retrospective case series with no comparison group.
Level of evidence: Level IV.
Journal of Pediatric Surgery
Perrone, E. E.,
Golden, J. M.,
Besner, G. E.,
Gayer, C. P.,
(2019). Closing gastroschisis: The good, the bad, and the not-so ugly. Journal of Pediatric Surgery, 54(1), 60-64.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/91