Gastroschisis: Epidemiology and Management in a Roumanian Tertiary Centre

Background: Gastroschisis is a ventral body wall defect trough which protrude mainly large and small intestines. The disease’s clinical course and prognosis depend on perinatal factors, surgical techniques, accompanying anomalies and complications.

Objective: The aims of this study were to evaluate the anomaly’s incidence, management and outcome of patients in our unit.

Methods: We performed a review of patients with gastroschisis admitted over a nineteen-year (2000-2018) period. The analyzed data was collected from from our hospital files and databases.

Results: The overall incidence of gastroschisis was 5.34% with an average birth gestational age of 35.87 weeks, average birth weight 2192.5 g; only 15.73% of cases had an antenatal diagnose. 16.08% of cases presented associated anomalies: 12 cases of atresia /stenosis of intestinal segments, 6 cases with renal anomalies and 5 cases with cardiac defects. Surgical techniques performed were: primary closure 35 cases (24.47%), staged closure 12 cases (8.39%), Gross technique 44 cases (30.76%) and manual reduction and closure (Bianchi procedure) 52 cases (36.36%). The mean length of stay in NICU was 32.35 days with an average period of digestive pause of 13.9 days and a median duration of parenteral nutrition of 25.2 days. The most frequent complication was late on set sepsis (37.8%) but 18.88% of cases underwent unplanned reoperation and 7 neonates (5%) remained with short bowel. The average mortality in our group was 32.8 % and constantly decreased from 84% in 2000 to 0% in 2018 . Sepsis, prematurity, low birth weight and associated defects were identified as major risk factors for an unfavorable outcome.

Conclusions: The optimal surgical management of gastroschisis has not been yet well determined and practice patterns are variable. The complex form of gastroschisis (involvement of other intestinal annomalies, ischemia, and perforations) was associated with a longer hospital lenght of stay and septicaemia was the commonest cause of death but the outcome of our patients had an obvious improvement during the studied period.

As the result, the care of these patients must involve specific antenatal ultrasound exams, an efficient multidisciplinary team and suitable surgical and nutritional protocols in order to improve neonatal survival.