Gastroschisis repair

Alternative names:

adbominal wall defect repair; gastroschisis closure

Definition:

A surgery to correct a congenital defect in which all or parts of the small intestine, and other internal organs are on the outside of the abdomen. See also omphalocele repair.

Gastroschisis is an abdominal wall defect to the side of the umbilical cord (umbilicus); the infant is born with intestines protruding through the defect and no protective sac is present. Gastroschisis is rarely associated with other birth defects.

Gastroschisis and omphalocele are frequently diagnosed by ultrasound examinations before birth.

Description:

Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen.

Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A tube is inserted into the stomach (nasogastric tube, also called NG tube) to keep the stomach empty to prevent choking on or breathing in (aspiration) stomach contents into the lungs. The surgery is done as soon as the infant is stable.

While the baby is deep asleep and pain-free (under general anesthesia) an incision is made to enlarge the hole in the abdominal wall. The bowel is examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges stitched together. A tube is inserted into the stomach (gastrostomy tube) and out through the skin. The organs are replaced into the abdominal cavity and the incision closed, if possible.

If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch will be made from a sheet of plastic to cover and protect the organs. Complete closure may be done over a few weeks. Surgery may be necessary to repair the abdominal muscles at a later time.

The infant's abdomen may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties. The infant may require the use of a breathing tube and machine (ventilator) for a few days or weeks until the swelling of the abdominal organs has decreased and the size of the abdomen has increased.

Indications:

Gastroschisis is a life-threatening event requiring immediate intervention.