PII: S0022-3468(03)80006-4

Abstract

We read the article entitled “Esophageal ligature in experimental gastroschisis” by Lagausie et al in the August 2002 issue (pp 1160-1164). Lagausie et al hypothesized that esophageal ligation would prevent regurgitation of the gastrointestinal contents into the amniotic fluid (AF), thus, preventing intestinal damage encountered in gastroschisis. However, esophageal ligation did not prevent intestinal damage but increased it in their sheep gastroschisis model. This increase in intestinal damage can be explained by the fact that meconium present in the AF is responsible for the intestinal damage in gastroschisis. 1 Akgür FM Özdemir T Olguner M et al. An experimental study investigating the effects of intraperitoneal human neonatal urine and meconium on rat intestines. Res Exp Med. 1998; 198: 207-213 Crossref PubMed Scopus (44) Google Scholar , 2 Olguner M Akgür FM Api A et al. The effects of intraamniotic human neonatal urie and meconium on intestines of chick embryo with gastroschisis. J Pediatr Surg. 2000; 35: 458-461 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Lagausie et al could have prevented intestinal damage by ligating rectum or anus instead of esophagus. Correia-Pinto et al 3 Correia-Pinto J Tavares ML Baptista MJ et al. Meconium dependence of bowel damage in gastroschisis. J Pediatr Surg. 2002; 37: 31-35 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar have ligated anus in a rat gastroschisis model and could prevent intestinal damage. Ligation of the anus stops meconium discharge and, thus, prevents intestinal damage in gastroschisis. Esophageal ligation increases AF meconium concentration because intraamniotic meconium is cleared by fetal swallowing. Swallowed AF is absorbed from the intestinal mucosa leaving unabsorbable ingredients within intestinal lumen. By esophageal ligation this clearance mechanism is distrupted, thus, leading to increased intraamniotic meconium concentration. Increased AF meconium concentration as a result of esophageal ligation is probably the reason Lagausie et al obtained worse intestinal damage in the esophageal ligation group as evidenced by greatest intestinal wall thickness and AF ferritin levels.