Highlights
- •Peri-umbilical hernia after successful gastroschisis closure is a consequence rather than complication, regardless of method.
- •Repair may be reasonably delayed, and safely observed, similar to umbilical hernias in the pediatric population.
- •Like pediatric umbilical hernias, spontaneous closure occurs with minimal complications.
Abstract
Introduction
We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after
sutured or sutureless gastroschisis closure.
Methods
A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent
closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters
were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time
to spontaneous closure or repair, and associated complications.
Results
Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%).
A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia
incidence after gastroschisis closure was 22.7% overall within a median follow-up
of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who
underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while
16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0%
vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of
17 months [9,26] and most frequently observed in those who underwent a sutureless
primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair
within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or
repair were similar between the sutured and sutureless closure groups, with no difference
between those who underwent primary vs. silo assisted closure.
Conclusion
Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely
observed similar to congenital umbilical hernias as spontaneous closure occurs, with
minimal complications and no additional risk with either closure approach.
Levels of evidence
Level II
Keywords
Abbreviations:
IQR (interquartile range)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Non-operative management of gastroschisis: a case-matched study.Pediatr Surg Int. 2008; 24: 767-771https://doi.org/10.1007/s00383-008-2153-5
- Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit.J Pediatr Surg. 2012; 47: 1516-1520https://doi.org/10.1016/j.jpedsurg.2012.01.010
- Sutureless vs sutured abdominal wall closure for gastroschisis: operative characteristics and early outcomes from the midwest pediatric surgery consortium.J Pediatr Surg. 2020; 55: 2284-2288https://doi.org/10.1016/j.jpedsurg.2020.02.017
- Does use of a feeding protocol change outcomes in gastroschisis? A report from the midwest pediatric surgery consortium.Eur J Pediatr Surg. 2020; (Epub ahead of print)https://doi.org/10.1055/s-0040-1721074
- Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation.Eur J Pediatr Surg. 2015; 25: 34-40https://doi.org/10.1055/s-0034-1395487
- Umbilical hernia following gastroschisis closure: a common event?.Pediatr Surg Int. 2016; 32: 811-814https://doi.org/10.1007/s00383-016-3906-1
- Surgical strategies in complex gastroschisis.Semin Pediatr Surg. 2018; 27: 309-315https://doi.org/10.1053/j.sempedsurg.2018.08.003
- Evaluation of clinical outcomes of sutureless vs sutured closure techniques in gastroschisis repair.JAMA Surg. 2019; 154: 33-39https://doi.org/10.1001/jamasurg.2018.3216
- Management of asymptomatic pediatric umbilical hernias: a systematic review.J Pediatr Surg. 2017; 52: 1723-1731https://doi.org/10.1016/j.jpedsurg.2017.07.016
- Outcomes of plastic closure in gastroschisis.Surgery. 2011; 150: 177-185https://doi.org/10.1016/j.surg.2011.05.001
- Flap versus fascial closure for gastroschisis: a systematic review and meta-analysis.J Pediatr Surg. 2016; 51: 718-725https://doi.org/10.1016/j.jpedsurg.2016.02.010
- Contemporary trends in the use of primary repair for gastroschisis in surgical infants.Am J Surg. 2015; 209: 901-906https://doi.org/10.1016/j.amjsurg.2015.01.012
- Fifty-three-year experience with pediatric umbilical hernia repairs.J Pediatr Surg. 2011; 46: 2151-2156https://doi.org/10.1016/j.jpedsurg.2011.06.014
Article info
Publication history
Published online: March 26, 2022
Accepted:
March 21,
2022
Received in revised form:
March 11,
2022
Received:
January 18,
2022
Footnotes
This study was presented as an oral presentation at the 2021 American College of Surgeons (ACS) Clinical Congress virtual meeting, October 23–27, 2021.
Dr. James A Fraser has a research fellowship position that is supported by the Avery’s Angels Foundation, an organization that supports gastroschisis research–the organization had no role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
