Primary closure of gastroschisis. Facilitation with postoperative muscle paralysis.

Although most surgeons prefer primary closure of gastroschisis, staged closure is most commonly needed because of marked visceroabdominal disproportion. We have modified the usual primary fascial closure by introducing postoperative muscle paralysis through the use of a nondepolarizing neuromuscular blocking agent. The result was a higher percentage of patients amenable to primary closure. Twenty-nine patients with gastroschisis were treated by us during a 5 1/2-year period. Primary fascial closure was possible in 20 cases (69%). In 17 of the 20 patients, postoperative paralysis was induced for two to three days to avoid the complications associated with increased intraabdominal pressure. Postoperative complications were few.