Jason D Fraser1, Katherine J Deans2, Mary E Fallat3, Michael A Helmrath4, Rashmi Kabre5, Charles M Leys6, R Cartland Burns7, Kristine Corkum5, Patrick A Dillon8, Cynthia D Downard3, Samir K Gadepalli9, Julia E Grabowski5, Edward Hernandez7, Ronald B Hirschl9, Kevin N Johnson9, Jonathan E Kohler6, Matthew P Landman7, Rachel M Landisch10, Amy E Lawrence2, Grace Z Mak11, Peter C Minneci2, Beth Rymeski4, Thomas T Sato10, Madeline Scannell8, Bethany J Slater11, Kathryn H Wilkinson10, Tiffany N Wright3, Shawn D St Peter12. 1. Department of Surgery, Children's Mercy Kansas City, Kansas City, MO. Electronic address: jdfraser@cmh.edu. 2. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Department of Surgery, University of Ohio, Columbus, OH. 3. Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY. 4. Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL. 6. Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 7. Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. 8. Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 9. Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI. 10. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 11. Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL. 12. Department of Surgery, Children's Mercy Kansas City, Kansas City, MO.
Abstract
PURPOSE: To report outcomes of sutured and sutureless closure for gastroschisis across a large multi-institutional cohort. METHODS: A retrospective study of infants with uncomplicated gastroschisis at 11 children's from 2014 to 2016 was performed. Outcomes of sutured and sutureless abdominal wall closure were compared. RESULTS: Among 315 neonates with uncomplicated gastroschisis, sutured closure was performed in 248 (79%); 212 undergoing sutured closure after silo and 36 undergoing primary sutured closure. Sutureless closure was performed in 67 (21%); 37 primary sutureless closure, 30 sutureless closure after silo placement. There was no significant difference in gestational age, gender, birth weight, total days on TPN, and time from closure to initial oral intake or goal feeds. Sutureless closure patients had less general anesthetics, ventilator use/time, time from birth to final closure, antibiotic use after closure, and surgical site/deep space infections. Subgroup analysis demonstrated primary sutureless closure had less ventilator use and anesthetics than primary sutured closure. Sutureless closure after silo led to less ventilator use/time, anesthetics, and antibiotics compared to those with sutured closure after silo. CONCLUSION: Sutureless abdominal wall closure of neonates with gastroschisis was associated with less general anesthetics, antibiotic use, surgical site/deep space infections, and decreased ventilator time. These findings support further prospective study by our group. LEVEL OF EVIDENCE: Level III.
PURPOSE: To report outcomes of sutured and sutureless closure for gastroschisis across a large multi-institutional cohort. METHODS: A retrospective study of infants with uncomplicated gastroschisis at 11 children's from 2014 to 2016 was performed. Outcomes of sutured and sutureless abdominal wall closure were compared. RESULTS: Among 315 neonates with uncomplicated gastroschisis, sutured closure was performed in 248 (79%); 212 undergoing sutured closure after silo and 36 undergoing primary sutured closure. Sutureless closure was performed in 67 (21%); 37 primary sutureless closure, 30 sutureless closure after silo placement. There was no significant difference in gestational age, gender, birth weight, total days on TPN, and time from closure to initial oral intake or goal feeds. Sutureless closure patients had less general anesthetics, ventilator use/time, time from birth to final closure, antibiotic use after closure, and surgical site/deep space infections. Subgroup analysis demonstrated primary sutureless closure had less ventilator use and anesthetics than primary sutured closure. Sutureless closure after silo led to less ventilator use/time, anesthetics, and antibiotics compared to those with sutured closure after silo. CONCLUSION: Sutureless abdominal wall closure of neonates with gastroschisis was associated with less general anesthetics, antibiotic use, surgical site/deep space infections, and decreased ventilator time. These findings support further prospective study by our group. LEVEL OF EVIDENCE: Level III.
Authors: Asta Tauriainen; Anna Hyvärinen; Arimatias Raitio; Ulla Sankilampi; Mikko Gärding; Tuomas Tauriainen; Ilkka Helenius; Kari Vanamo Journal: Pediatr Surg Int Date: 2021-09-05 Impact factor: 1.827