[Evaluation of surgical treatment in gastroschisis based on personal experience]. / Ocena postepowania chirurgicznego w wytrzewieniu wrodzonym na podstawie badan wlasnych.

ABSTRACT

UNLABELLED The ultimate goal of surgical treatment is the reduction of eviscerated bowel and full fascial closure of the abdominal defect; the sooner it is done -- the better, otherwise the risk of sepsis is overwhelming. On the other hand, however, forcible, one-step reduction may cause the development of the abdominal compartment syndrome. AIM OF THE STUDY To summarize the personal experience concerning the surgical treatment of gastroschisis and to suggest the optimal procedure in this anomaly. MATERIAL AND METHODS: The analysis of the treatment of 67 neonates with gastroschisis who were operated on in our Department from 1994 through 2004 has been presented. In 51 of them, who were born in this Department, the diagnosis of gastroschisis had been established prenatally, in the remaining 16 -- postnatally. RESULTS: Prenatal diagnosis allows to undertake prenatal intervention, if indicated, and monitor the progress of anomaly and possible decision of earlier delivery. We found such indications in 8 of our patients in whom earlier delivery by caesarean section was performed and 9 others were given amnioinfusion. In the presented series -- in the years 1994-2000 multistep procedures with silo formation were performed more often, whereas in the years 2001-2004 we shifted our preference towards primary reduction of gastroschisis. The feasibility of primary reduction depends on the condition of eviscerated bowel and intra-abdominal pressure (monitored indirectly in the urinary bladder). In 8 cases (12%) coinciding bowel atresia was diagnosed. CONCLUSIONS: Prenatal diagnosis is of practical importance -- it allows for in utero treatment and if indicated earlier delivery. One step reduction of eviscerated bowel, if feasible is the treatment of choice. Otherwise, gradual reduction, with the use of silo is recommended.