Manual ward reduction of gastroschisis without anesthesia, a safe procedure – 8 years experience

Abstract

Introduction: Gastroschisis is the most common type of abdominal wall defect at birth. Various modalities of treatment have been proposed ranging from primary closure to the staged closure using prosthetic materials under general anesthesia. One of the modalities is manual ward reduction with primary repair of gastroschisis without anesthesia. We are reporting our 8 years of experience with manual ward reduction of gastroschisis with primary repair without anesthesia.

Materials and methods: It is a retrospective analysis of all patients of gastroschisis who presented in our institution from January 2008 to June 2016. The data were analyzed for antenatal diagnosis, sex, day of presentation, weight of baby, associated anomalies, management by manual reduction without anesthesia and post reduction morbidity and mortality.

Results: Out of a total of 68 patients, 28 were females and 40 were males. Fifty-five cases (80.8%) were antenatally diagnosed. Fifty-nine patients (86.7%) presented within 24 hours of birth while the rest had delayed presentation. Preterms (< 37 weeks) were 18 (26.4%). Cases of simple gastroschisis were 22 while those complicated were 46. The average birth weight was 1.88 kg with the lowest weight of 1 kg who was a 27-week preterm. In 60 patients (88.2%), bedside manual reduction without anesthesia and primary closure was possible while in 8 patients it could not be done owing to delayed presentation and complications. The mortality in these patients was 40%.

Conclusion: Manual reduction and primary closure of gastroschisis without anesthesia is a safe procedure. It requires no ventilator support and can be managed with antibiotics, total parenteral nutrition (TPN) and continuous positive airway pressure (CPAP) in the post-reduction period.