LONG-TERM RESULTS FOLLOWING REPAIR OF NEONATAL ABDOMINAL-WALL DEFECTSWITH GORE-TEX

Animal studies and clinical experience in adults suggest that the Gore -Tex patch, because of its strength and lack of reactivity, is superio r to other synthetic materials as a fascial replacement. We report our experience with Gore-Tex for the repair of neonatal abdominal wall de fects when direct fascial closure was not possible. Between January 19 85 and July 1992, 84 patients underwent repair of an omphalocele or ga stroschisis. Ten of these were repaired with a Gore-Tex patch. Follow- up averaged 2.2 years (range 13-63 months). Data collected were graft life (time from insertion to removal), patch-related complications suc h as exteriorization (exposure of the patch due to dehiscence of the o verlying skin), presence or absence of local and/or systemic infection , and patch separation (separation of the sutured edge of the patch fr om the fascia). The ease of removal as well as the appearance of the w ound after patch removal was documented. Patch-related complications w ere divided into early (less than or equal to 30 days postoperatively) , and late (>30 days). All ten patients required graft removal because of patch-related complications. The median time to removal was 90 day s (range 20-540). There were a total of 12 complications in the ten pa tients. Three had early complications; three had exteriorized patches and two had concomitant local infections. Seven patients had late comp lications. Exteriorization was less common in this group, occurring in two cases. Local infections occurred in five of seven patients. Patch removal was necessary to clear the infection in all cases. No patient developed systemic sepsis or enteric fistulae. The patch was removed easily and there were no bowel-to-patch adhesions. Fascial closure was successfully accomplished in all patients regardless of the size of t he initial defect. In no case did removal of the patch and secondary c losure of the abdominal wall result in a ventral hernia. This study de monstrates that: (1) Gore-Tex patch closure of neonatal abdominal wall defects is associated in all cases with either early or late exterior ization and/or infection; (2) removal is easy and complication-free be cause it does not incorporate into the tissue and is relatively non-re active; and (3) following removal of the patch it is possible to succe ssfully close the abdominal wall defect. We conclude that Gore-Tex is a useful synthetic material for closure of neonatal abdominal wall def ects, but should be considered a temporary bridge to subsequent fascia l closure.