Pediatric Surgery

Pediatric Surgery

Gastroschisis

Gastroschisis is the protrusion of abdominal contents, usually including the stomach and intestine, through a hole (defect) in the abdominal wall that is just to the right of the umbilical cord. A gastroschisis is distinguished from an omphalocele in that in omphaloceles, the defect in the abdominal wall is central and the abdominal contents are covered by a membrane. Omphaloceles are frequently associated with chromosomal or cardiac anomalies while babies with gastroschisis rarely have associated problems, except for intestinal atresia.

The incidence of gastroschisis varies from 1:6,300 to 1:40,000.

Baby

Baby with gastroschisis at birth--stomach and small intestine can be seen protruding from the abdomen

Diagnosis

Frequently, gastroschisis is diagnosed prenatally. This allows parents the opportunity to discuss their baby's condition with both their obstetrician and a pediatric surgeon. We appreciate the chance to talk with parents and other family members about what to expect when their baby is born and how we approach management of the gastroschisis. We also arrange for parents to tour the neonatal intensive care unit here at Loma Linda University Children's Hospital and talk with the nursing staff who will be caring for their baby.

Delivery

The timing and type (vaginal, C-section) of delivery is a decision which should be made by parents and their obstetrician. Once the baby is delivered, the neonatal team will stabilize the baby and place intravenous catheters as necessary. One of the pediatric surgeons will usually be present at the delivery to inspect the bowel and assure that it is protected.

Closure of gastroschisis

Depending upon the condition of the infant, the condition of the exposed intestine and the judgment of the pediatric surgeon, the abdominal wall defect will either be closed within a few hours of birth or a "silo" will be placed, which allows the exposed bowel to be pushed back into the abdomen over several days.

When the defect is closed, whether at birth or at a later time after a silo was placed, the muscle and skin of the abdominal wall are closed separately. Efforts are made to minimize the resulting cosmetic deformity by preserving the umbilicus, when possible. It is often possible to close the defect without leaving a scar in the skin at all.

Baby - abdominal area

Abdominal wall 28 days after closure of gastroschisis.

Non-absorbable stitches are buried beneath the skin, and usually do not require removal. A watertight clear dressing may used to cover the incision and your surgeon will instruct you when this outer dressing can be removed. During the operation, parents are asked to wait in the Children' s Hospital waiting area located on the lobby level. After the operation, your baby will be immediately returned to the neonatal intensive care unit (3700) and be recovered there.

The surgeon may decide to place the exposed bowel in a "silo", which is a bag made from silastic. This pouch is then suspended from the top of the baby's bed, allowing gravity to slowly return the intestines to the abdominal cavity, aided by sequentially tying the end of the bag, like a tube of toothpaste. The surgery team will closely monitor the baby and gently squeeze the pouch every day until almost all the contents have returned to the abdomen. This process usually takes two to five days. The baby will then be taken to the operating room to have the defect closed.

Baby - silo

Infant with a "silo" in place for gradual reduction of abdominal contents

 

The hospital stay

Nurses will make every effort to keep your baby comfortable and pain-free. The pediatric surgery team will make rounds as a group daily. We are available to answer any questions you may have concerning the progress of your baby.

Survival rates for gastroschisis are as high as 90 percent. Despite advances in surgical technique and intensive care management, associated intestinal complications continue to place these infants at significant risk. Babies with gastroschisis may have an associated atresia of the small intestine, meaning that part of the intestine is congenitally missing. Even if this is recognized at the initial operation, the bowel will not be reconstructed for about six weeks. Even when the bowel is intact, it frequently takes several weeks for feedings to be tolerated, due to poor bowel contractility. This can be the limiting factor for discharge home from the hospital. Babies are usually started on intravenous feedings which are continued until oral feedings are tolerated.

Follow-up

A clinic appointment needs to be scheduled one to two weeks after discharge. Please call (909) 796-4848 to schedule this appointment.

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