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

Abstract

here is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low-income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anaesthesia, and lack of neonatal parenteral nutrition. Given the complexity of care required and the high resource utilization of this patient population, there has been a call for protocol-driven care. A survey of trainees in accredited pediatric surgery residency programs reported that the overwhelming majority of institutions did not have institutional protocols and variability existed in terms of practice patterns among the attending surgeons. Protocolized care that streamlines the perioperative management of patients with gastroschisis would likely reduce the variability and improve outcomes across institutions. (107) There is no a single best technique for management of gastroschisis. There are too many factors that influence the outcomes for these patients. Hence, the choice for the closure technique should be tailored to each patient to optimize the benefit.