Complicated Gastroschisis Is Associated with Greater Intestinal Morbidity than Gastroschisis or Intestinal Atresia Alone
16 June 2017
28 August 2017
04 October 2017 (eFirst)
Aim of the Study The study aimed to compare outcomes and intestinal morbidity among complicated gastroschisis, isolated gastroschisis, and intestinal atresia.
Methods In this retrospective observational single institution study, outcomes and intestinal morbidity were compared among gastroschisis complicated by intestinal atresia or perinatal bowel perforation, isolated gastroschisis, and isolated intestinal atresia. We included two cohorts; the first cohort included 68 consecutive patients with complicated gastroschisis (n = 9), isolated gastroschisis (n = 34), and intestinal atresia (n = 25) managed in our center. The second cohort included 20 patients (12 referred) with intestinal failure due to these underlying etiologies managed by our intestinal rehabilitation team.
Results Patients with complicated gastroschisis had a significantly longer need for mechanical ventilation, primary hospital stay, and duration of parenteral nutrition (PN) and developed intestinal failure more often compared with other groups (p < 0.05 for all). Reoperations for surgical complications were also more frequent in patients with complicated gastroschisis (p < 0.05). Among those, who developed intestinal failure, autologous intestinal reconstruction (AIR) surgery was performed in 11 patients with comparable frequency in all groups. Repeated AIR surgery for bowel re-dilatation was required in 3/3 patients with complicated gastroschisis and 0/8 with isolated gastroschisis or intestinal atresia (p = 0.004).
Conclusion Complicated gastroschisis is associated with markedly increased intestinal morbidity, reflected by prolonged duration of PN, more frequent reoperations for intestinal complications, and bowel re-dilatation after AIR surgery, when compared with patients with isolated gastroschisis or intestinal atresia.
Keywordsintestinal failure - parenteral nutrition - intestinal dysmotility - autologous intestinal reconstruction - serial transverse enteroplasty procedure
- 1 Arnold MA, Chang DC, Nabaweesi R. , et al. Risk stratification of 4344 patients with gastroschisis into simple and complex categories. J Pediatr Surg 2007; 42 (09) 1520-1525
- 2 Kassa AM, Lilja HE. Predictors of postnatal outcome in neonates with gastroschisis. J Pediatr Surg 2011; 46 (11) 2108-2114
- 3 Phillips JD, Raval MV, Redden C, Weiner TM. Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. J Pediatr Surg 2008; 43 (12) 2208-2212
- 4 Snyder CL, Miller KA, Sharp RJ. , et al. Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg 2001; 36 (10) 1542-1545
- 5 Hoehner JC, Ein SH, Kim PC. Management of gastroschisis with concomitant jejuno-ileal atresia. J Pediatr Surg 1998; 33 (06) 885-888
- 6 Cusick E, Spicer RD, Beck JM. Small-bowel continuity: a crucial factor in determining survival in gastroschisis. Pediatr Surg Int 1997; 12 (01) 34-37
- 7 Struijs MC, Diamond IR, de Silva N, Wales PW. Establishing norms for intestinal length in children. J Pediatr Surg 2009; 44 (05) 933-938
- 8 Fleet MS, de la Hunt MN. Intestinal atresia with gastroschisis: a selective approach to management. J Pediatr Surg 2000; 35 (09) 1323-1325
- 9 Suominen PK, Pakarinen MP, Rautiainen P, Mattila I, Sairanen H. Comparison of direct and intravesical measurement of intraabdominal pressure in children. J Pediatr Surg 2006; 41 (08) 1381-1385
- 10 Skarsgard ED, Claydon J, Bouchard S. , et al; Canadian Pediatric Surgical Network. Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects. The first 100 cases of gastroschisis. J Pediatr Surg 2008; 43 (01) 30-34 , discussion 34
- 11 Weber TR, Au-Fliegner M, Downard CD, Fishman SJ. Abdominal wall defects. Curr Opin Pediatr 2002; 14 (04) 491-497
- 12 Mutanen A, Lohi J, Heikkilä P, Koivusalo AI, Rintala RJ, Pakarinen MP. Persistent abnormal liver fibrosis after weaning off parenteral nutrition in pediatric intestinal failure. Hepatology 2013; 58 (02) 729-738
- 13 Ghionzoli M, James CP, David AL. , et al. Gastroschisis with intestinal atresia--predictive value of antenatal diagnosis and outcome of postnatal treatment. J Pediatr Surg 2012; 47 (02) 322-328
- 14 Wallace AS, Burns AJ. Development of the enteric nervous system, smooth muscle and interstitial cells of Cajal in the human gastrointestinal tract. Cell Tissue Res 2005; 319 (03) 367-382
- 15 Langer JC, Longaker MT, Crombleholme TM. , et al. Etiology of intestinal damage in gastroschisis. I: Effects of amniotic fluid exposure and bowel constriction in a fetal lamb model. J Pediatr Surg 1989; 24 (10) 992-997
- 16 Auber F, Danzer E, Noché-Monnery ME. , et al. Enteric nervous system impairment in gastroschisis. Eur J Pediatr Surg 2013; 23 (01) 29-38
- 17 Zani-Ruttenstock E, Zani A, Paul A, Diaz-Cano S, Ade-Ajayi N. Interstitial cells of Cajal are decreased in patients with gastroschisis associated intestinal dysmotility. J Pediatr Surg 2015; 50 (05) 750-754
- 18 Midrio P, Faussone-Pellegrini MS, Vannucchi MG, Flake AW. Gastroschisis in the rat model is associated with a delayed maturation of intestinal pacemaker cells and smooth muscle cells. J Pediatr Surg 2004; 39 (10) 1541-1547
- 19 Molenaar JC, Tibboel D, van der Kamp AW, Meijers JH. Diagnosis of innervation-related motility disorders of the gut and basic aspects of enteric nervous system development. Prog Pediatr Surg 1989; 24: 173-185
- 20 Walker K, Badawi N, Hamid CH. , et al; Neonatal Intensive Care Units' (NICUS) Group, NSW Pregnancy and Newborn Services Network. A population-based study of the outcome after small bowel atresia/stenosis in New South Wales and the Australian Capital Territory, Australia, 1992-2003. J Pediatr Surg 2008; 43 (03) 484-488
- 21 Lap CC, Brizot ML, Pistorius LR. , et al. Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis. Early Hum Dev 2016; 103: 209-218
- 22 Bergholz R, Boettcher M, Reinshagen K, Wenke K. Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality-a systematic review and meta-analysis. J Pediatr Surg 2014; 49 (10) 1527-1532
- 23 Kong JY, Yeo KT, Abdel-Latif ME. , et al; New South Wales and Australian Capital Territory Neonatal Intensive Care Units' Data Collection. Outcomes of infants with abdominal wall defects over 18years. J Pediatr Surg 2016; 51 (10) 1644-1649
- 24 Dalton BG, Gonzalez KW, Reddy SR, Hendrickson RJ, Iqbal CW. Improved outcomes for inborn babies with uncomplicated gastroschisis. J Pediatr Surg 2017; 52 (07) 1132-1134