The outcomes of treatment between primary closure and staged closure in gastroschisis in the pre and post era of the bedside wound retractor silo placement technique
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In brief
In brief
This retrospective study compares primary versus staged closure techniques for gastroschisis repair across two eras, before and after introduction of bedside wound retractor silo placement. Results show that staged closure with bedside silo technique achieves comparable early feeding outcomes to primary closure, making it a viable alternative when primary repair is not feasible.
- Primary closure achieved higher early enteral feeding rates than staged closure in the pre-BSC era (OR 21.98), but no difference post-BSC.
- Bedside wound retractor silo placement (BSC) improved staged closure outcomes to match primary closure for early feeding success.
- Staged closure with BSC is a safe alternative when primary closure is not feasible, with comparable complication rates.
- Overall early enteral feeding success was 42% across all gastroschisis patients, with primary closure at 52.2% vs staged at 22.2%.
- BSC technique represents a significant advancement in gastroschisis management, making staged closure a viable first-line option.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aimed to compare the treatment outcomes of the closure methods between pre and post-eras of bedside wound retractor silo placement technique (BSC).
Methods
This retrospective cohort study included infants diagnosed with gastroschisis from 2006–2013, pre-BSC era, and from 2014–2021, BSC era. Infants who had fetal anomalies did not survive before receiving treatment and were treated with the delayed closure method were excluded. Pretreatment covariates were adjusted using propensity score in the multivariable logistic regression.
Results
From 170 patients, 5 were excluded. 111 patients underwent primary closure (PC), 54 patients were staged closure (SC). Successful early enteral feeding was achieved in 70(42%) of patients. Among these patients, 52.2% were in the PC group, and 22.2% in the SC group. PC had a significantly higher rate of successful early enteral feeding compared to SC in the pre-BSC era (OR 21.98, 95%CI 2.59–186.51, p-value 0.005). The BSC era, there was no significant difference between the groups (OR 2.04, 95%CI 0.41–1.20, p-value 0.386). There were no differences in complications between PC and SC.
Conclusions
SC was not inferior in terms of achieving early feeding compared with PC. BSC is an acceptable procedure when a PC was not appropriate and accessible.