Outcomes of sutureless versus sutured closure for gastroschisis: A systematic review and meta-analysis

Objective & background: Sutureless closure is a minimally invasive alternative to traditional sutured repair for gastroschisis, yet, uncertainty persists regarding its safety and outcomes. This systematic review and meta-analysis aimed to compare treatment outcomes of sutured and sutureless gastroschisis closure. Methods: We searched the PubMed, Embase, Scopus, and ClinicalTrials.gov repositories for studies comparing outcomes of sutureless versus sutured gastroschisis closure from inception to June 2025. Outcome included mortality, feeding milestones, anesthesia outcomes, hernia outcomes, hospital stay, and postoperative complications. A random-effects model was applied and meta-regression was also conducted. Results: Twenty-three studies (2646 infants; 821 sutureless, 1825 sutured) were included. Sutureless repair did not increase mortality risk [Risk ratio (RR) = 1.11; 95 % CI = 0.61, 2.03), or delay feeding milestones [time to full feeds mean difference (MD) = -1.62 days; 95 % = CI: −4.61, 1.38], although regional analyses favored faster feeding with sutureless repair (p < 0.01). Sutureless closure was associated with significantly reduced utilization of general anesthesia (RR = 0.23; 95 % CI = 0.15, 0.36; p < 0.00001), shortened ventilation duration (MD = −1.96 days; 95 % CI = −2.66, −1.26; p < 0.01), and reduced surgical site infection risk (RR = 0.60; 95 % CI = 0.43, 0.83; p = 0.003). However, umbilical hernia incidence (RR = 2.50; 95 % CI = 1.57, 3.98) and hernia repair (RR = 2.66; 95 % CI = 1.65, 4.27) were higher following sutureless closure. Hospital stay showed no overall difference, and sutureless repair did not increase the risk for postoperative complications. Meta-regression identified regional practices, sex distribution, and case mix as key modifiers, highlighting the influence of center-level practices and the observational nature of the data. Conclusion: Sutureless closure offers substantial perioperative advantages but carries a higher umbilical hernia risk. However, these findings arise predominantly from observational studies and may be influenced by confounding by indication and institutional practice patterns. While the overall evidence supports sutureless closure as a safe approach, structured follow-up and family counseling are warranted.