Intra-Operative Total Bowel Washing: A New Method to Improve the Outcome of Gastroschisis Primary Repair

Abstract

Background: Gastroschisis is an abdominal wall defect that is managed by surgical reduction of herniated bowel into the abdominal cavity and abdominal wall reconstruction. Loss of abdominal domain is the main challenge that may complicate the process of gastroschisis management. Objectives: This article is about innovative manure called total bowel washing (TBW) that may improve the outcome of gastroschisis primary repair. Methods: All neonates with gastroschisis who met the study inclusion criteria between 2006 - 2019 were enrolled and divided into two groups of conventional and TBW method of gastroschisis management. In TBW group, bowls were washed with warm saline and after a gentle enterolysis, the whole gastrointestinal tract was irrigated via a gastric tube and evacuated completely from thick meconium until the watery stool started to come out of anus slightly. Primary abdominal wall closure was performed after loop by loop bowel reduction. Gastroschisis management outcome was compared between the two groups. Results: 15 neonates were allocated in each group. Demographic and anthropometric variables were compared and any significant difference wasn’t reported between the two groups. We observed a significantly better outcome in terms of faster GI rehabilitation, shorter time to oral feeding tolerance, less need to silo placement and shorter NICU and hospital stay in TBW method. Operation time was slightly longer in TBW group while the difference was not significant statistically. Conclusions: Total bowel washing and complete evacuation of gastrointestinal tract from thick meconium will increase the success rate of primary repair and improve the outcome of gastroschisis management.