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 Vol. 6 No. 11, November 2005
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NeoReviews Vol.6 No.11 2005 e500
© 2005 American Academy of Pediatrics

Surgical Management of Gastroschisis

John H. T. Waldhausen, MD*

* Professor of Surgery, Children’s Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Wash

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Explain the treatment options for gastroschisis and the basis on which treatment is chosen.
  2. Describe the fluid needs of infants who have gastroschisis.
  3. Explain methods of protecting the intestine and aiding in fluid and heat retention.
  4. Delineate the causes of bowel ischemia at birth in newborns who have gastroschisis.
  5. Outline the long-term outcome for infants who have gastroschisis.


   Introduction
 
Babies who have gastroschisis typically are born at 34 to 38 weeks’ gestational age and undergo placement of a silo or primary abdominal closure within the first few hours after birth (Fig. 1). In general, affected infants do not have other life-threatening anomalies, and surgical management may be directed at repair of the intestinal herniation and abdominal wall defect. All affected infants have malrotation because the intestine failed to return to the abdominal cavity and become internally fixed. Approximately 10% have an intestinal atresia. Other anomalies are rare, in contrast to the infants who have omphalocele, in whom 50% have chromosomal with or without anatomic anomalies.


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  		Figure 1. Typical infant who has gastroschisis. Note that the defect is to the right of the umbilicus.

 

   Delivery And Postdelivery Care
 
The timing and method of delivery for infants who have gastroschisis remain somewhat controversial. One of the potential complications of the condition is the development of thickened bowel or a peel that makes safe primary closure difficult if not impossible (Fig. 2). An additional issue is shrinking of the fascial ring through which the bowel herniates during gestation, which can cause compression of the mesenteric vasculature, leading to bowel ischemia and potential loss of intestine. In rare instances, infants may be born with loss of a significant amount of intestine due to infarction from a closing fascial ring (Fig. 3). In an attempt to avoid . . . [Full Text of this Article]




E-Letters:

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Human Breast Milk May Reduce NEC Risk After Gastroschisis Repair
Steve Piecuch, MD, MPH
Neoreviews Online, 4 Dec 2005 [Full text]
Response to Dr Piecuch
John H.T. Waldhausen
Neoreviews Online, 7 Mar 2006 [Full text]

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Copyright © 2005 by the American Academy of Pediatrics.