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To cite this article: Vito Briganti, Daniela Luvero, Caterina Gulia, Roberto Piergentili, Simona
Zaami, Elsa Laura Buffone, Cristina Vallone, Roberto Angioli, Claudio Giorlandino & Fabrizio
Signore (2017): A novel approach in the treatment of neonatal gastroschisis: a review of the
literature and a single-center experience, The Journal of Maternal-Fetal & Neonatal Medicine, DOI:
10.1080/14767058.2017.1311859
Article views: 86
REVIEW ARTICLE
and we describe a new type of surgical reduction performed in our center without anesthesia Accepted 23 March 2017
(GA), immediately after birth, in the delivery room. Between January 2002 and March 2013, we
enrolled all live born infants with gastroschisis referred to the third-level Division of Obstetrics KEYWORDS
and Gynecology San Camillo of Rome. Two groups of infants were identified: group 1 in which Gastroschisis defect; surgical
gastroschis reduction was performed by the traditional technique and group 2 in which reduc- reduction; abdominal wall
tion was immediately performed after birth in the delivery room without GA. Twelve infants defects; neonatal surgery
were enrolled in group 1, and seven infants in group 2. Statistical significance was observed
between the groups regarding the hospital stay, for the duration of parenteral nutrition and full
oral feeds (p .004). Survival was similar between two groups. The reduction without GA per-
formed immediately after birth in a delivery room encourages the relationship between the
mother and her child and appears to be a safe and feasible technique in a selected group of
patients with simple gastroschisis defect; for this reason, it could represent a valid alternative to
traditional approach.
CONTACT Daniela Luvero d.luvero@unicampus.it Department of Medicine, Unit of Gynaecology and Obstetrics, Universita Campus Bio-Medico di
Roma, via Alvaro del Portillo 21, Rome 00128, Italy
2017 Informa UK Limited, trading as Taylor & Francis Group
2 V. BRIGANTI ET AL.
of the classical approach, in terms of mortality and cord due to the rapid growth of the bowel tract and
morbidity. returns to the abdominal cavity before the 12th week
and a normal abdominal wall is formed
[1,10,13,2426].
Definition, epidemiology, embriology
Some theories tries to define the etiology of gastro-
Gastroschisis is an increasingly congenital anterior schisis: a thrombosis of the right omphalomesenteric
abdominal wall defect with intraperitoneal abdominal vein with the necrosis of the abdominal wall [21,27]
contents protruding to the exterior [1,7] not covered due to the use of vasoconstrictive drugs such as ephe-
by a sac. This results in herniation of the organs adja- drine, cocaine, smoking during gestation [23]. Other
cent to the normally inserted umbilical cord, usually theories include the rapidly increasing volume of the
the bowel but may also include the stomach, liver, intestine with a failure of herniation resulting in an
spleen and bladder [8] (Figure 1). abdominal wall rupture, a failure in the fusion of folds
The association with chromosomal abnormalities is in the midline and a failure of the mesoderm to form
uncommon with only unusual familial case [9], but
the anterior abdominal wall [2831]. A recent theory is
gastroschisis may be associated with structural gastro-
that the determining defect in gastroschisis is failure
intestinal anomalies such as atresia, stenosis and mal-
of the yolk sac and related vitelline structures to be
rotation in 10% of the cases [1012]. Rarely, it is also
incorporated into the umbilical stalk [32].
associated with BeckwithWiedemann syndrome
[13,14].
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the maternal serum. AFP is usually used to evaluate abdominal herniation and proceed to abdominal wall
chromosomal abnormalities and neural tube defects, closure as soon as possible after birth, in the operating
but it is also almost always markedly elevated in this theater and under general anesthesia [47,48]. The
kind of wall defects [33]. abdominal wall defect was closed by skin apposition
The prenatal diagnosis of gastroschisis allows to or prosthetic materials. Since 1998 Bianchi et al. sug-
talk with families about the condition, treatment and gested that delayed midgut reduction and umbilical
prognosis of the fetus. Moreover, an early identifica- port capping without anesthesia at bedside appeared
tion may help to identify high-risk patients in order to a safe technique and the preferred first option for this
choose a specialized center to optimize their outcome pathology. There was no additional morbidity or mor-
[1,34]. In addition, it permits to predict and prevent tality [3].
adverse events related to gastroschisis such as intra- Recent studies have showed that a delayed reduc-
uterine growth retardation (IUGR), oligohydramnios, tion can decrease the risk of developing important
premature delivery and fetal death. complications such as compartment syndrome (ACS)
In a fetus with gastroschisis, the exposed bowel is [7].
vulnerable to injuries (volvulus, atresia, inflammation Overall survival in gastroschisis condition has
or serositis) in 1015% of cases [1,12]. The most devas- improved considerably, from 50% to 60% in 1960 to
tating complication is the fetal death caused by mid- greater than 90% currently. Most of papers examine
gut volvulus or acute compromise of umbilical blood short-term outcomes associated with abdominal wall
flow by the eviscerated bowel [1]. The modality and closure. On the contrary, long-term outcomes regard-
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necrosis, atresia, infections. Delivery was vaginal or MannWhitney and Fisher tests. Statistical significance
cesarean section. was set at p < .05.
We have therefore retrospectively identified two
groups of infants: neonates in which gastroschis reduc-
Results
tion was performed by the traditional technique
(group 1: elective delayed reduction under anesthesia Twenty cases of gastroschisis were treated in the
in operating room) and a group in which we per- third-level Division of Obstetrics and Gynecology San
formed this reduction immediately after delivery in the Camillo of Rome between January 2002 and March
delivery room without analgesia or sedation (group 2). 2013. Twelve infants were treated with the traditional
Concerning group 1, in the immediate period after technique, eight infants with the other approach.
delivery, gastroschisis was managed by protecting the Based on eligibility criteria only 19 patients were
eviscerated bowel in a plastic bag, decompressing the enrolled for the final analysis (12 in group 1 and 7 in
stomach by a nasogastric tube and keeping the baby group 2).
in an incubator. The child, the status of the bowel and Table 1 summarizes baseline characteristics
mesentery and the diameter of umbilical port were between two groups. Both groups were comparable
assessed. In both cases, neonates were strictly moni- and homogeneous regarding gestational age, birth
tored (respiration, circulation). In the group 2, the weight, APGAR index and type of delivery (vaginal or
umbilical port was closed by capping with the umbil- cesarean section). Statistical significance was observed
between the two groups (Table 2) regarding the hos-
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