Gastroschisis management and outcome in Guntur Medical College Hospital – A Retrospective study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 5657-5669
AbstractBACKGROUND: Gastroschisisisacongenitalparamedian full-thickness abdominal wall fusion defectwitheviscerationofabdominalcontents, mostly contains small and large intestines without sac. Defect is usually to the right side of the umbilical cord. The bowel is non-rotated, without secondary fixation to the posterior abdominal wall. No genetic association reported
MATERIALS AND METHODS: During the studyperiod,ninety-sixpatients were treated; studied as two groups, Simple gastroschisis andcomplex gastroschisisdepending upon presence or absence of intestinal perforation, necrosis, stenosis, malrotation and volvulus and intestinal atresia.Simple gastroschisiscases74(77.08%), complex gastroschisis cases 22 cases(22.91%) studied.Primary reduction ofeviscerated bowel and fascial layer closerof abdominal wallwas selected as initial surgical procedure in patients withstable general condition and smaller size of the eviscerated bowl masswhich can be accommodated in abdominal cavity.Primary surgical procedure done in 46 patients, Silo construction and later repair done in 28 patients in simple gastroschisisgroup.Complex gastroschisisgroup22 cases, (12 intestinal atresia cases, three perforations, necrosis of small bowl in three cases, volvulus with impending gangrene due tonarrow stalk with small defect in three cases,one patient total gangrene of midgut).
RESULTS:Total number of cases were 96 from 2015 to 2021. Simplegastroschisisgroup 46 primary surgical repairsand 28 silos,Complex gastroschisisgroup surgical repair in 11cases, remaining11cases both surgical and silo used. Silo was not used as exclusive method of managementin our institute due to local prevailing conditions.Simple gastrostomiesgroup 74 cases,46patients underwent primary surgical repair,41 patients (89.13%) survived, Five deaths(10.86%),28 patients underwentsilo construction,19 patients survived(67.85%),Nine deaths(32.14%).Over allsimplegastroschisisgroup 60 patients survived(81.08%),14 deaths(18.91%)recorded.Complex gastroschisis group22 patients,13(59.09%)patients survived,9 deaths(40.90%). Total patients survivedin both groups 73,out of 96 patients (76.04%)with overall deaths 23 (23.95%).
CONCLUSION:Retrospective study of gastroschisis patients admitted in our hospital from 2015to2021. Total number of patients were 96; Simple gastroschisis74 cases,46 primary surgical repairs 41 (89.13%) survived,28 silos with19 patients survived(67.85%).Complex gastroschisisgroup22 cases, 13(59.09%)patients survived.Total patients survived 73( 76.04%)out of 96 patients with overall deaths 23 (23.95%).Most of the deaths occurreddue to sepsis and prematurity with low birth weight. With limited facilities, Simple gastroschisis group survival good 81.08%and overall survival rate of 76.04% couldbeachieved in the department
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