Closing gastroschisis: The good, the bad, and the not-so ugly

Erin E. Perrone, Jacob Olson, Jamie M. Golden, Gail E. Besner, Christopher P. Gayer, Saleem Islam, Gerald Gollin

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Purpose: The diagnosis of “closing” or “closed gastroschisis” is made when bowel is incarcerated within a closed or nearly closed ring of fascia, usually with associated bowel atresia. It has been described as having a high morbidity and mortality. Methods: A retrospective review of closing gastroschisis cases (n = 53) at six children's hospitals between 2000 and 2016 was completed after IRB approval. Results: A new classification system for this disease was developed to represent the spectrum of the disease: Type A (15%): ischemic bowel that is constricted at the ring but without atresia; Type B (51%): intestinal atresia with a mass of ischemic, but viable, external bowel (owing to constriction at the ring); Type C (26%): closing ring with nonviable external bowel +/− atresia; and Type D (8%): completely closed defect with either a nubbin of exposed tissue or no external bowel. Overall, 87% of infants survived, and long-term data are provided for each type. Conclusions: This new classification system better captures the spectrum of disease and describes the expected long-term results for counseling. Unless the external bowel in a closing gastroschisis is clearly necrotic, it should be reduced and evaluated later. Survival was found to be much better than previously reported. Type of study: Retrospective case series with no comparison group. Level of evidence: Level IV.

Original languageEnglish
Pages (from-to)60-64
Number of pages5
JournalJournal of Pediatric Surgery
Volume54
Issue number1
DOIs
Publication statusPublished - Jan 2019
Externally publishedYes

Keywords

  • Atresia
  • Classification
  • Closed/closing
  • Gastroschisis
  • Short gut

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