Gastroschisis: A National Cohort Study to Describe Contemporary Surgical Strategies and Outcomes
Owen A., Marven S., Johnson P., Kurinczuk J., Spark P., Draper ES., Brocklehurst P., Knight M.
This was a survey of all the cases of gastroschisis (n = 393) managed within the 28 neonatal surgical units in the UK and Ireland (18 months in 2006-2008) from a predicted birth cohort of 1.1 million. Results: Infants were divided into simple gastroschisis (n = 336, 85.5%) and complex gastroschisis (n = 45, 11.5%) - unknown category (n =12, 3%). Virtually all were detected antenatally (n = 385, 98%). Operative primary closure (n = 170, 51%) and staged closure after a preformed silo (n = 120, 36%) were the most commonly used techniques by intension for simple gastroschisis. There were 6 (2%) neonatal deaths (all in the simple group). Outcomes for infants in the complex group were significantly worse. They were more likely to be ventilated postoperatively (risk ratio [RR], 1.21; 95% CI, 1.09-1.33), more likely to require reoperation (RR, 6.53; 95% CI, 4.70-9.09), more likely to develop intestinal failure associated liver disease (RR, 8.21; 95% CI,3.70-18.2) and more likely to receive total parenteral nutrition for >28 days (RR, 2.07; 95% CI, 1.71-2.51). Conclusions: This study provided a comprehensive picture of current UK and Ireland practice for gastroschisis and a national benchmark.