You are here:   About  > Gastroschisis
  |  Login

 


  What is Gastroschisis?

Gastroschisis is the most common congenital defect of the anterior abdominal wall, (~1 per 2500 pregnancies) and is usually detected by routine maternal serum and ultrasound screening. This defect of unknown origin results in the extrusion of part or all of the intestines in utero alongside the umbilical cord and into the amniotic space. Prenatal care involves follow-up ultrasound imaging and an arranged delivery at a perinatal centre. Treatment after birth consists of either early or delayed primary surgical closure of the defect, followed by hospitalization in a neonatal intensive care unit (NICU) for several weeks. Infants usually require ventilatory support, nutritional support, antibiotics and other pharmacological therapies. Post-operative survival now approaches 90%. The most problematic complication of Gastroschisis post-operatively is intestinal injury and/or "failure". Intestinal injury occurs as a result of bowel damage sustained in utero, when the developing bowel is exposed to amniotic fluid.

There is considerable controversy regarding the perinatal care of fetuses with antenatally diagnosed GS. Since intestinal injury is believed to occur before birth, many recommend planned preterm delivery, in the belief that any potential consequence of prematurity is offset by reduction in intestinal injury achieved by early delivery. However, others report no advantage to early delivery. Route of delivery (vaginal versus Cesarean section) is also controversial. Some pediatric surgeons and obstetricians have advocated planned cesarean delivery, believing that conditions favouring primary abdominal wall closure are optimal immediately after birth. Primary repair of the Gastroschisis defect occurs immediately following birth in the delivery room. Yet others recommend routine placement of a plastic silo for bowel protection and delayed primary repair. Still others advocate selective, primary awake repair using analgesia (where patient is conscious but feels no pain), rather than repair under general anesthesia (patient completely unconscious), since the latter often results in a potentially avoidable period of mechanical ventilation. As such, it is extremely evident that there is currently no consensus on what the "best" surgical care is for these patients.

  In This Section: