COMPARING THE OUTCOMES OF A MODIFIED TECHNIQUE USING A SPATULATED UMBILICAL CORD PATCH FOR A SCARLESS PRIMARY REPAIR OF GASTROSCHISIS WITH OTHER TECHNIQUES FOR PRIMARY CLOSURE, A MULTICENTER EXPERIENCE | ||
| Ain Shams Medical Journal | ||
| Article 6, Volume 70, 1,2 & 3, July 2019, Pages 151-162 PDF (1.68 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asmj.2019.145134 | ||
| Authors | ||
| Sherif M Mansour1; Osama A El-Naggar1; Thomas T Tsang2; Mosad M El-Behery1; Mohamed S El-Debeiky1; Mohamed S El-Sherbeiny1 | ||
| 1Department of Paediatric Surgery, Ain Shams University Cairo, Egypt | ||
| 2Consultant of Paediatric Surgery, Norfolk and Norwich University Hospital | ||
| Abstract | ||
| Background: The goal of the surgical management of gastroschisis is to return the bowel into the abdomen without jeopardizing the viscera. Primary fascial closure (PFC) was historically favored due to improved outcomes. Aim of the work: To prospectively analyse the outcomes of primary closure of gastroschisis using Spatulated Umbilical Cord (SUC) technique, and compare with the retrospectively-collecte outcomes of patients who underwent PFC. Patients and Methods: this pilot interventional case-control study was conducted at the Departments of Paediatric Surgery at Norfolk and Norwich University Hospital in UK and at Ain-Shams University Hospitals in Egypt during the period from February 2017 to February 2019. The “Study” group was a prospective cohort of patients with gastroschisis; in whom SUC closure technique was used. The control group was a retrospective cohort of patients; who underwent primary fascial closure. Outcome measures were success rates, post-operative ventilation, days of parenteral nutrition, time to full enteral feeds and complications. Technique: The SUC patch involved the following: the amnion layer is opened from the base at 9 O’clock position, the Wharton's jelly exposed and 'spatulated' using longitudinal incisions and then secured as a patch over the defect. Results: Whereas PFC was successful in all patients (n=10), SUC patch technique was successful in 77.8% (n=9). The duration of mechanical ventilation was statistically significantly shorter in the control group compared to the study group (1.75vs4.0 days). Time-tostart or achieve goal enteral feeding was longer in patients with SUC patch technique, but not statistically significant. Regarding complications, 2 patients in the study group needed re-laparotomy after development of abdominal hypertension. Intestinal obstruction occurred in one patient, and one patient had a persistent umbilical hernia. One patient in the control group had a laparotomy for bowel obstruction and one patient required the repair of a persistent umbilical hernia. Conclusion: Primary closure of gastroschisis using SUC is safe, feasible, cost-effective and with comparable outcomes to other wellestablished techniques. | ||
| Keywords | ||
| Gastroschisis; SUC patch; outcomes | ||
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