Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure.
Document Type
Article
Publication Date
12-2022
Identifier
DOI: 10.1016/j.jpedsurg.2022.03.019
Abstract
INTRODUCTION: We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure.
METHODS: A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications.
RESULTS: Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure.
CONCLUSION: Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach.
LEVELS OF EVIDENCE: Level II.
Journal Title
Journal of pediatric surgery
Volume
57
Issue
12
First Page
786
Last Page
791
MeSH Keywords
Humans; Infant; Infant, Newborn; Child; Gastroschisis; Hernia, Umbilical; Retrospective Studies; Treatment Outcome
Keywords
Congenital abdominal wall defect; Gastroschisis; Sutured closure; Sutureless closure
Recommended Citation
Fraser JA, Deans KJ, Fallat ME, et al. Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure. J Pediatr Surg. 2022;57(12):786-791. doi:10.1016/j.jpedsurg.2022.03.019
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