Pediatric Surgery International

, Volume 34, Issue 11, pp 1171–1176 | Cite as

Single center protocol driven care in 150 patients with gastroschisis 1998–2017: collaboration improves results

  • Richard H. PearlEmail author
  • Joseph R. Esparaz
  • Ryan T. Nierstedt
  • Breanna M. Elger
  • Nerina M. DiSomma
  • Michael R. Leonardi
  • Kamlesh S. Macwan
  • Paul M. Jeziorczak
  • Anthony J. Munaco
  • Ravindra K. Vegunta
  • Charles J. Aprahamian
Original Article



The treatment of gastroschisis (GS) using our collaborative clinical pathway, with immediate attempted abdominal closure and bowel irrigation with a mucolytic agent, was reviewed.


A retrospective review of the past 20 years of our clinical pathway was performed on neonates with GS repair at our institution. The clinical treatment includes attempted complete reduction of GS defect within 2 h of birth. In the operating room, the bowel is evaluated and irrigated with mucolytic agent to evacuate the meconium and decompress the bowel. No incision is made and a neo-umbilicus is created. Clinical outcomes following closure were assessed.


150 babies with gastroschisis were reviewed: 109 (77%) with a primary repair, 33 (23%) with a spring-loaded silo repair. 8 babies had a delayed closure and were not included in the statistical analysis. Successful primary repair and time to closure had a significant relationship with all outcome variables—time to extubation, days to initiate feeds, days to full feeds, and length of stay.


Early definitive closure of the abdominal defect with mucolytic bowel irrigation shortens time to first feeds, total TPN use, time to extubation, and length of stay.


Gastroschisis Primary closure Timing of delivery Mucolytic irrigation 



We thank Jeremey S. McGarvey, statistician, OSF Healthcare Analytics, for assistance with analysis.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interests.


  1. 1.
    Jones AM, Isenburg J, Salemi JL, Arnold KE, Mai CT, Aggarwal D et al (2016) Increasing prevalence of gastroschisis—14 States, 1995–2012. Morb Mortal Wkly Rep 65(2):23–26CrossRefGoogle Scholar
  2. 2.
    Eggink BH, Richarson CJ, Malloy MH, Angel CA (2006) Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas. J Pediatr Surg 41(6):1103–1108CrossRefGoogle Scholar
  3. 3.
    Kidd JN, Jackson RJ, Smith SD, Wagner CW (2003) Evolution of staged versus primary closure of gastroschisis. Ann Surg 237(6):758–765Google Scholar
  4. 4.
    Driver CP, Bruce J, Bianchi A, Doig CM, Dickson AP, Bowen J (2000) The contemporary outcome of gastroschisis. J Pediatr Surg 35(12):1719–1723CrossRefGoogle Scholar
  5. 5.
    Lansdale N, Hill R, Gull-Zamir S, Drewett M, Parkinson E, Davenport M et al (2009) Staged reduction of gastroschisis using preformed silos: practicalities and problems. J Pediatr Surg 44(11):2126–2129CrossRefGoogle Scholar
  6. 6.
    Allotey J, Davenport M, Njere I, Charlesworth P, Greenough A, Ade-Ajayi N et al (2007) Benefit of preformed silos in management of gastroschisis. Pediatr Surg Int 23(11):1065–1069CrossRefGoogle Scholar
  7. 7.
    Owen A, Marven S, Jackson L, Antao B, Roberts J, Walker J et al (2006) Experience of bedside preformed silo staged reduction and closure for gastroschisis. J Pediatr Surg 41(11):1830–1835CrossRefGoogle Scholar
  8. 8.
    Chiu B, Lopoo J, Hoover JD, Almond PS, Arensman R, Madonna MB (2006) Closing arguments for gastroschisis: management with silo reduction. J Perinat Med 34(3):243–245CrossRefGoogle Scholar
  9. 9.
    Schlatter M, Norris K, Uitvlugt N, DeCou J, Connors R (2003) Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach. J Pediatr Surg 38(3):459–464CrossRefGoogle Scholar
  10. 10.
    Tsai MH, Huang HR, Chy SM, Yang PH, Lien R (2010) Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair. Pediatr Neonatol 51(6):320–325CrossRefGoogle Scholar
  11. 11.
    Owen A, Marven S, Johnson P, Kurinczuk J, Spark P, Draper ES et al (2010) Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 45(9):1808–1816CrossRefGoogle Scholar
  12. 12.
    Baud D, Lausman A, Algaraj MA, Seaward G, Kingdom J, Windrim R et al (2013) Expectant management compared with elective delivery at 37 weeks for gastroschisis. Obstet Gynecol 121(5):990–998CrossRefGoogle Scholar
  13. 13.
    Cain MA, Salemi JL, Paul Tanner J, Mogos MF, Kirby RS, Whiteman VE et al (2014) Perinatal outcomes and hospital costs in gastroschisis based on gestational age at delivery. Obstet Gynecol 124(3):543–550CrossRefGoogle Scholar
  14. 14.
    Overcash RT, DeUgarte DA, Stephenson ML, Gutkin RM, Norton ME, Parmar S et al (2014) Factors associated with gastroschisis outcomes. Obstet Gynecol 124(3):551–557CrossRefGoogle Scholar
  15. 15.
    Yang EY, Davies LM, Buchanan P, Kling C, Banyard DA, Ramones T (2014) Spontaneous onset of labor, not route of delivery, is associated with prolonged length of stay in babies with gastroschisis. J Pediatr Surg 49(12):1776–1781CrossRefGoogle Scholar
  16. 16.
    Baerg J, Kaban G, Tonita P, Pahwa P, Reid D (2003) Gastroschisis: a sixteen-year review. J Pediatr Surg 38(5):771–774CrossRefGoogle Scholar
  17. 17.
    Moir CR, Ramsey PS, Ogbum PL, Johnson RV, Ramini KD (2004) A prospective trial of elective preterm delivery for fetal gastroschisis. Am J Perinatol 21(5):289–294CrossRefGoogle Scholar
  18. 18.
    Charlesworth P, Njerea I, Allotey J, Dimitrou G, Ade-Ajayi N, Devane S et al (2007) Postnatal outcome in gastroschisis: effect of birth weight and gestational age. J Pediatr Surg 42(5):815–818CrossRefGoogle Scholar
  19. 19.
    Langer JC, Longaker MT, Crombleholme TM, Bond SJ, Finkbeiner WE, Rudolph CA et al (1989) Etiology of intestinal damage in gastroschisis I; effects of amniotic fluid exposure and bowel constriction in a fetal lamb model. J Pediatr Surg 24(10):992–997CrossRefGoogle Scholar
  20. 20.
    Sydorak RM, Nijagal A, Sbragia L, Hilrose S, Tsao K, Phibbs RH et al (2002) Gastroschisis: small hole, big cost. J Pediatr Surg 37(12):1669–1672CrossRefGoogle Scholar
  21. 21.
    Islam S, St. Peter S, Downard CD, Qureshi F, Bruch S, Renaud E et al (2014) Immediate vs. silo closure in gastroschisis: results from a large multicenter study. In: American academy of pediatrics section on surgery national conference, October 2014Google Scholar
  22. 22.
    Stanger J, Mohajerani N, Skarsgard ED (2014) Practice variation in gastroschisis: factors influencing closure technique. J Pediatr Surg 49(5):720–723CrossRefGoogle Scholar
  23. 23.
    Banyard D, Ramones T, Phillips SE, Leys CM, Rauth T, Yang EY (2009) Method to our madness: an 18-year retrospective analysis on gastroschisis. J Pediatr Surg 45:579–584CrossRefGoogle Scholar
  24. 24.
    Boutros J, Regier M, Skarsgard ED (2009) Is timing everything? The influence of gestational age, birth weight, route, and intent of delivery on outcome in gastroschisis. J Pediatr Surg 44(5):912–917CrossRefGoogle Scholar
  25. 25.
    Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohomed E et al (2014) Is early delivery beneficial in gastroschisis? J Pediatr Surg 49:928–933CrossRefGoogle Scholar
  26. 26.
    Harris J, Poirier J, Sellip D, Pillai S, Shah AN, Jackson C et al (2015) Early closure of gastroschisis after silo placement correlates with earlier enteral feeding. J Neonatal Surg 4(3):28PubMedPubMedCentralGoogle Scholar
  27. 27.
    Shaw A (1969) Safety of N-acetylcysteine in treatment of meconium obstruction of the newborn. J Pediatr Surg 4(1):119–124CrossRefGoogle Scholar
  28. 28.
    Burke R et al (2002) New strategies in nonoperative management of meconium ileus. J Pediatr Surg 37(5):760–764CrossRefGoogle Scholar
  29. 29.
    Gurien LA, Dassinger MS, Burford JM, Saylors ME, Smith SD (2017) Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database. J Pediatr Surg 52(11):1741–1754Google Scholar
  30. 30.
    Kornhauser M, Schneiderman R (2010) How plans can improve outcomes and cut costs for preterm infant care. Manag Care 19:28–30PubMedGoogle Scholar
  31. 31.
    Youssef F, Gorgy A, Arbash G, Puligandla PS, Baird RJ (2016) Flap versus fascial closure for gastroschisis: a systematic review and meta analysis. J Pediatr Surg 51:718–725CrossRefGoogle Scholar
  32. 32.
    Logghe HL, Mason GC, Thornton JG, Stringer MD (2005) A randomized controlled trial of elective preterm delivery of fetuses with gastroschisis. J Pediatr Surg 40:1726–1731CrossRefGoogle Scholar
  33. 33. (2016) Gastroschisis outcomes of delivery (GOOD) study. Accessed 16 Aug 2016

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Richard H. Pearl
    • 1
    • 2
    Email author
  • Joseph R. Esparaz
    • 1
  • Ryan T. Nierstedt
    • 2
  • Breanna M. Elger
    • 2
  • Nerina M. DiSomma
    • 3
  • Michael R. Leonardi
    • 4
  • Kamlesh S. Macwan
    • 2
    • 5
  • Paul M. Jeziorczak
    • 1
    • 2
  • Anthony J. Munaco
    • 1
    • 2
  • Ravindra K. Vegunta
    • 6
  • Charles J. Aprahamian
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of Illinois College of MedicinePeoriaUSA
  2. 2.Children’s Hospital of Illinois, OSF Saint Francis Medical CenterPeoriaUSA
  3. 3.University of Illinois College of MedicinePeoriaUSA
  4. 4.Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyUniversity of Illinois College of MedicinePeoriaUSA
  5. 5.Division of Neonatal MedicineChildren’s Hospital of IllinoisPeoriaUSA
  6. 6.Department of Pediatric SurgeryBanner Desert Medical CenterMesaUSA

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