treatment

Last reviewed 01/2018

Majority of cases are diagnosed by antenatal ultrasound (1).

  • ealry delivery (around 37 weeks of gestation) is thought to be benificial in gastroschisis - by limiting bowel damage from exposure to amniotic fluid
  • there is no evidence that caesarean section improves the outcome.
  • ideally these infants should be delivered in a centre where both neonatal and surgical expertise are available.

Upon delivery, these neonates should be transferred to the neonatal unit for preoperative optimization.

Neonates with gastroschisis should be nursed in an incubator to reduce heat loss and in the right lateral position with the bowel supported. Initial post delivery management include:

  • fluid resuscitation
  • care of herniated bowel/viscera and their blood supply;
    • to reduce heat and fliud loss, the exposed bowel covered with a waterproof cellophane bowel bag.
  • bowel decompression using a nasogastric tube
  • temperature regulation.

The main objective of gastroschisis managment is to reduce the viscera safely and to close the abdominal wall defect with an acceptable cosmetic appearance. The two most commonly performed procedures are:

  • primary fascial closure
    • the exposed bowel is returned to the abdominal cavity in its entirety and a primary closure performed under general anaesthesia 
    • reduction of the herniated viscera in the neonatal unit without GA has  been carried out in some units
      • associated problems seen in GA and mechanical ventilation are prevented with this method
      • one study also showed this approach to be more cost effective. (2)
  • application of a preformed silo with delayed fascial closure
    • a staged reduction of the herniated bowel using a silastic pouch is carried out with complete closure of the defect at a later date
    • spring loaded, self-retaining silastic pouch has been developed recently which enables it to be inserted on the neonatal unit without the need for GA (1) 

Following reduction of the viscera and closure of the defect, total parenteral nutrition should be continued for 3 to 4 more weeks.

In those with associated intestinal atresia, a temporary enterostomy may be constructed at the time of initial abdominal wall repair and closed at a later date.

Refrence: