Does general anesthesia improve the chances of primary closure in gastroschisis?

Infographic · Aug 2022 · 1 min read

In brief

Systematic review comparing gastroschisis closure with versus without general anesthesia found no significant difference in primary closure success, mortality, or recovery outcomes. Bedside closure without intubation may be a safe alternative approach, potentially reducing time to feeds and hospital stay in appropriately selected patients.

Primary bedside closure of gastroschisis without general anesthesia achieves similar success rates to closure under GA (no significant difference).
Avoiding GA for gastroschisis closure does not increase mortality risk compared to traditional intubation and general anesthesia.
Bedside closure without GA may reduce time to enteral feeding and hospital length of stay compared to OR-based closure under anesthesia.
Limited comparative evidence exists; only 5 studies with 192 patients directly compared GA vs non-GA approaches for gastroschisis closure.
Selective use of bedside closure without GA is a safe alternative that may improve feeding outcomes without compromising closure success.

Written by the GCMD Library team from the infographic.

The infographic uses a left-to-right flow design with a grayscale illustration of an infant with gastroschisis on the left, followed by two comparison pathways in the center showing spontaneous ventilation versus general anesthesia with endotracheal tube (illustrated with simple icons), leading to outcome statistics on the right. Blue arrows indicate the flow to success rates, and a scale icon represents the statistical comparison showing non-significant difference.

Purpose

Over the last few decades, several articles have examined the feasibility of attempting primary reduction and closure of gastroschisis without general anesthesia (GA). We aimed to systematically evaluate the impact of forgoing routine intubation and GA during primary bedside reduction and closure of gastroschisis.

Methods

The primary outcome was closure success. Secondary outcomes were mortality, time to enteral feeding, and length of hospital stay.

Results

12 studies were included: 5 comparative studies totalling 192 patients and 7 descriptive case studies totalling 56 patients. Primary closure success was statistically equivalent between the two groups, but trended toward improved success with GA/intubation (RR = 0.86, CI 0.70–1.03, p = 0.08). Mortality was equivalent between groups (RR = 1.26, CI 0.26–6.08, p = 0.65). With respect to time to enteral feeds and length of hospital stay, outcomes were either equivalent between the two groups or favored the group that underwent primary closure without intubation and GA.

Conclusion

There are few comparative studies examining the impact of performing primary bedside closure of gastroschisis without GA. A meta-analysis of the available data found no statistically significant difference when forgoing intubation and GA. Foregoing GA also did not negatively impact time to enteral feeds, length of hospital stay, or mortality.

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