Ускладнені форми гастрошизису та їх хірургічне лікування

Abstract

Treatment of complicated gastroschisis (GS) is associated with high morbidity and mortality. At present, there are still existing significant discrepancies in surgical tactics in newborns with complicated GS. Aim. The purpose of our study was to investigate the incidence rate and nature of complicated GS, its influence on the outcome of surgical treatment, as well as the effectiveness of various surgical treatment modalities. Materials and methods. A retrospective analysis of medical records of 53 neonates with GS who were operated in our clinic using «first minute surgery» protocol from 2006 to 2017 was conducted. For the purpose of the study, all patients were divided into two groups. Group I included children with simple GS (n=40). Group II included newborns, who were diagnosed with complicated GS (n=13). Results. Overall, 53 newborns with GS underwent surgical treatment, 13 (24.5%) children had complicated GS. Intestinal complications consisted of midgut atresia, stenosis or necrosis. We observed significant increase in the postoperative surgical complications rate (p=0.02), sepsis (p=0.03), term of full enteral nutrition (p<0.001) and hospital stay (p<0.001) in children with complicated GS. In newborns with complicated GS, patch repair of the anterior abdominal wall was used significantly more often (p=0.03). Conclusions. Intestinal complications significantly affecting the outcome of surgical treatment of GS. The surgical approach depends on the degree of viscero-abdominal disproportion, the type of intestinal malformation and the presence of peel. A meta-analysis should be conducted to determine the optimal method of surgical treatment for these patients. Level of evidence. Level III. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an institution. The informed consent of the patient was obtained for conducting the studies.