Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele

M Haghshenas,U Rolle,T M Theilen,M Hutter

doi:10.1007/s00383-021-04977-0

M Haghshenas, U Rolle + Show 2 more

Open Access

https://doi.org/10.1007/s00383-021-04977-0

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Abstract

PurposeThis study aims to define the extent of additional surgical procedures after abdominal wall closure (AWC) in patients with gastroschisis (GS) and omphalocele (OC) with special focus on gastrointestinal related operations.MethodsA retrospective chart review was performed including all operations in GS and OC patients in the first year after AWC (2010–2019). The risk for surgery was calculated using the one-year cumulative incidence (CI).Results33 GS patients (18 simple GS, 15 complex) and 24 OC patients (12 without (= OCL), 12 OC patients with liver protrusion (= OCL +)) were eligible for analysis. 43 secondary operations (23 in GS, 20 in OC patients) occurred after a median time of 84 days (16–824) in GS and 114.5 days (12–4368) in OC. Patients with complex versus simple GS had a significantly higher risk of undergoing a secondary operation (one-year CI 64.3% vs. 24.4%; p = 0.05). 86.5% of surgical procedures in complex GS and 36.3% in OCL + were related to gastrointestinal complications. Complex GS had a significantly higher risk for GI-related surgery than simple GS. Bowel obstruction was a risk factor for surgery in complex GS (one-year CI 35.7%).ConclusionComplex GS and OCL + patients had the highest risk of undergoing secondary operations, especially those with gastrointestinal complications.

Highlights

The two most common congenital wall defects are gastroschisis (GS) and omphalocele (OC)
The latter received a Schuster’s abdominoplasty but died on day four of life due to cardiorespiratory failure. This patient and another patient with simple GS who were lost to follow-up after transfer to another hospital were omitted from the analysis of the surgical procedures after abdominal wall closure
Only secondary operations directly related to bowel or abdominal wall complications were analyzed. When we extracted these indications for surgery from our data, we found rates of 21.2% for GS patients (11.1% in simple GS and 33.3% in complex GS) and 6.2% for OC patients (12.5% in OCL +, none in OCL − patients) in the first year after abdominal wall closure

Summary

Introduction

The two most common congenital wall defects are gastroschisis (GS) and omphalocele (OC). In cases of multistage closure and surgical repairs of associated malformations, patients are at risk of accumulating a higher number of operative procedures in their early days of life. A subset of patients suffers from secondary diseases such as transient or sustained bowel dysmotility, necrotizing enterocolitis (NEC; 3.8–8.2%), volvulus (0.5–3.0%), intestinal necrosis (4.5%), and vanishing gastroschisis (< 1.0%) [5,6,7,8,9] These conditions can lead to long-term complications such as intolerance of enteral feeds, short gut syndrome (3.2–11.4%), intestinal failure, and adhesive bowel obstruction (20.4–27.0%) [3,4,5, 10, 11]

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