There has been a substantial increase in the incidence of
gastroschisis in the last few years, and
total parenteral nutrition has enabled many of these neonates to survive the long post-operative course. From 1969 to 1976 inclusive, 44 neonates with
gastroschisis were treated with either primary closure or the application of a
Silon pouch. Fifteen neonates were managed by primary closure. Three of these neonates developed clinical
sepsis, but no other intraabdominal complications ensued. There were two deaths (13%) in the early postoperative period, due to CNS
hemorrhage and aspiration. This gorup of 15 babies had 17 abdominal operations and the survivors averaged 32 days of parenteral intravenous nutrition before complete oral alimentation could be successfully started. Two
ventral hernias required late repair. Twenty-nine neonates were managed primarily with a
Silon pouch. Eighteen of these newborns developed
sepsis, three
Silon sacs had to be removed because of necrotic bowel within, and two other infants developed small bowel fistulae. There were 12 deaths (35%). These 12 infants had prolonged intestinal malfunction that lasted an average of 67 days. This group of 29 babies had 64 abdominal operations and the survivors averaged 46 days of parenteral intravenous nutrition prior to full oral feeds. Four
ventral hernias required later repair. The comparison of results in these two groups of newborns reveals a striking difference in their post-operative course and survival. Although the
Silon sac has until now become the accepted
surgical procedure for
gastroschisis, these results conclusively indicate the advantage of primary reduction and closure of the abdominal wall defect.