Unsatisfactory experience with 'minimal intervention management' for gastroschisis.
J Pediatr Surg
; 35(10): 1437-9, 2000 Oct.
Article
en En
| MEDLINE
| ID: mdl-11051145
PURPOSE: The authors report, for cautionary reasons, their trial with "minimal intervention management" for gastroschisis. After the successful innovative experience with this approach, which Bianchi and Dickson described, they utilized it in 4 consecutive patients. METHODS: In the delivery room a plastic bag was placed over the intestines, which rested in a dependent position to reduce edema. The stomach was decompressed and the patients kept warm. Intravenous fluid at a maintenance rate was given. After about 5 hours an attempt at closure was undertaken in the newborn intensive care unit without anesthesia. An assistant lifted the anterior abdominal wall by applying upward traction on the umbilical cord. Over about 25 minutes the intestines were placed in the coelom, which was closed with a single suture. RESULTS: The outcome was uncomplicated in the first of 4 consecutive patients. The second patient had abdominal compartment syndrome requiring a silo and subsequent resection and has chronic malabsorption 16 months later. The third had an enterocutaneous fistula at 5 weeks that required a small bowel resection. Bedside closure was abandoned in the final case because too much resistance was encountered. She underwent primary repair in the operating room and eventually died of sepsis with intestinal dysmotility. CONCLUSIONS: The "minimal intervention approach" can be effective in some patients who have gastroschisis. This experience suggests that selection criteria are needed before this method can be recommended.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Procedimientos Quirúrgicos del Sistema Digestivo
/
Procedimientos Quirúrgicos Mínimamente Invasivos
/
Gastrosquisis
Límite:
Female
/
Humans
/
Male
/
Newborn
Idioma:
En
Revista:
J Pediatr Surg
Año:
2000
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Estados Unidos