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Pediatric Surgery International

, Volume 35, Issue 1, pp 107–116 | Cite as

Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis

  • Hiromu Miyake
  • Shogo Seo
  • Joshua S. O’Connell
  • Maarten Janssen Lok
  • Agostino PierroEmail author
Original Article
  • 98 Downloads

Abstract

Purpose

Recently, plastic closure of abdominal defect in infants with gastroschisis has been used. Timing of gastroschisis closure can be mainly divided into two groups: primary closure and delayed closure after silo forming. Safety and usefulness of plastic closure in gastroschisis remains unclear. We aimed to evaluate the current evidence for plastic closure in infants with gastroschisis.

Methods

The analysis was done for primary closure as well as closure after silo. Outcomes were mortality, wound infection, duration of ventilation, time to feeding, and length of hospital stay (LOS). The quality of evidence was summarized using the GRADE approach.

Results

In the “primary” group, there was no significant difference in mortality, time to feeding initiation and LOS. In the “silo” group, wound infection was significantly lower in plastic closure (Odds ratio 0.24, 95%CI 0.09–0.69, p = 0.008). Duration of ventilation, time to feeding initiation and LOS were significantly shorter after plastic closure (Ventilation; mean difference (MD) − 5.76, p = 0.03. Feeding initiation; MD − 9.42, p < 0.0001. LOS; MD − 14.06, p = 0.002). Quality of evidence was very low for all outcomes.

Conclusions

Current results suggest that plastic closure may be beneficial for infants with gastroschisis requiring silo formation. However, this evidence is suboptimal and further studies are needed.

Keywords

Gastroschisis Plastic closure Sutureless closure Silo Primary closure 

Notes

Acknowledgements

Dr. Agostino Pierro was supported by the endowment of the Robert M. Filler Chair of Surgery, The Hospital for Sick Children, and by the Canadian Institutes of Health Research (CIHR) Foundation Grant.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.

References

  1. 1.
    Gamba P, Midrio P (2014) Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 23:283–290CrossRefGoogle Scholar
  2. 2.
    Owen A, Marven S, Johnson P et al (2010) Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 45:1808–1816CrossRefGoogle Scholar
  3. 3.
    Sandler A, Lawrence J, Meehan J et al (2004) A “plastic” sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 39:738–741CrossRefGoogle Scholar
  4. 4.
    Youssef F, Gorgy A, Arbash G et al (2016) Flap versus fascial closure for gastroschisis: a systematic review and meta-analysis. J Pediatr Surg 51:718–725CrossRefGoogle Scholar
  5. 5.
    Kunz SN, Tieder JS, Whitlock K et al (2013) Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg 48:845–857CrossRefGoogle Scholar
  6. 6.
    Allin BSR, Tse WHW, Marven S et al (2015) Challenges of improving the evidence base in smaller surgical specialties, as highlighted by a systematic review of gastroschisis management. PLos One 10:e0116908CrossRefGoogle Scholar
  7. 7.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of intervention. http://www.handbook.cochrane.org. Accessed 1 Nov 2018
  8. 8.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. J Clin Epidemiol 62:1006–1012CrossRefGoogle Scholar
  9. 9.
    Miyake H, Seo S, O’Connell J et al (2018) Safety and utility of plastic/sutureless closure for the infants with gastroschisis in different timing of repair: a systematic review and meta-analysis. International prospective register of systematic reviews, PROSPERO. CRD42018086513Google Scholar
  10. 10.
    Guyatt GH, Oxman AD, Schunemann HJ et al (2011) GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 64:380–382CrossRefGoogle Scholar
  11. 11.
    Balshem H, Helfand M, Schunemann HJ et al (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406CrossRefGoogle Scholar
  12. 12.
    Guyatt GH, Oxman AD, Vist G et al (2011) GRADE guidelines: 4. Rating the quality of evidence-study limitations (risk of bias). J Clin Epidemiol 64:407–415CrossRefGoogle Scholar
  13. 13.
    Guyatt GH, Oxman AD, Montori V et al (2011) GRADE guidelines: 5. Rating the quality of evidence-publication bias. J Clin Epidemiol 64:1277–1282CrossRefGoogle Scholar
  14. 14.
    Guyatt GH, Oxman AD, Kunz RE et al (2011) GRADE guidelines: 6. Rating the quality of evidence-imprecsion. J Clin Epidemiol 64:1283–1293CrossRefGoogle Scholar
  15. 15.
    Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 7. Rating the quality of evidence-inconsistency. J Clin Epidemiol 64:1294–1302CrossRefGoogle Scholar
  16. 16.
    Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol 64:1303–1310CrossRefGoogle Scholar
  17. 17.
    Guyatt GH, Oxman AD, Sultan S et al (2011) GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 64:1311–1316CrossRefGoogle Scholar
  18. 18.
    Sterne JAC, Hernan MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRefGoogle Scholar
  19. 19.
    Dupont WD, Plummer WD (1990) Power and sample size calculations: a review and computer program. Control Clin Trial 11:116–128CrossRefGoogle Scholar
  20. 20.
    The GRADE working group. https://gradepro.org/ Accessed 30 Aug 2018
  21. 21.
    Kandasamy Y, Whitehall J, Gill A et al (2010) Surgical management of gastroschisis in North Queensland from 1988 to 2007. J Pediatr Child Health 46:40–44CrossRefGoogle Scholar
  22. 22.
    Orion KC, Krein M, Liao J et al (2011) Outcomes of plastic closure in gastroschisis. Surgery 150:177–185CrossRefGoogle Scholar
  23. 23.
    McNamara WF, Hartin CW, Escobar MA et al (2011) Outcome differences between gastroschisis repair methods. J Surg Res 165:19–24CrossRefGoogle Scholar
  24. 24.
    Machida M, Takamizawa S, Yoshizawa K et al (2013) Effectiveness of sutureless abdominal wall closure for gastroschisis. Shinshu Igaku 61:27–31Google Scholar
  25. 25.
    Schlueter RK, Azarow KS, Hines AG et al (2015) Identifying strategies to decrease infectious complications of gastroschisis repair. J Pediatr Surg 50:98–101CrossRefGoogle Scholar
  26. 26.
    Dariel A, Poocharoen W, de Silva N et al (2015) Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation. Eur J Pediatr Surg 25:34–40Google Scholar
  27. 27.
    Choi WW, McBride CA, Bourke C et al (2012) Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit. J Pediatr Surg 47:1516–1520CrossRefGoogle Scholar
  28. 28.
    Bruzoni M, Jaramillo JD, Dunlap JL et al (2017) Sutureless vs sutured gastroschisis closure: a prospective randomized controlled trial. J Am Colloid Surg 224:1091–1096CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Hiromu Miyake
    • 1
    • 2
  • Shogo Seo
    • 1
  • Joshua S. O’Connell
    • 1
  • Maarten Janssen Lok
    • 1
  • Agostino Pierro
    • 1
    Email author
  1. 1.General and Thoracic Surgery, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Department of Pediatric SurgeryShizuoka Children’s HospitalShizuokaJapan

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