DELIVERY ROOM REPAIR OF GASTROSCHISIS

Background. Outcome for most abdominal wall defects is related to the presence or absence of additional anomalies or prematurity. In gastros chisis, outcome is almost as closely related to the severity of the in flammatory ''peel'' on bowel that is thought to result from direct con tact with amniotic fluid. Improving eviscerated bowel quality would be expected to reduce morbidity in these patients. Methods. From 1986 to 1991, 32 patients with the antenatal diagnosis of gastroschisis were treated. All were delivered by cesarean section; 13 surgical repairs w ere made immediately in the delivery room. Surgical repairs in 19 pati ents were made at less than 6 hours of age after transfer from the del ivering hospital to the pediatric surgery center. Results. Thirty perc ent of infants who underwent surgical repair in delivery room and 32% of infants who underwent urgent surgical repair were either premature or had significant associated anomalies, Seventy-three percent of deli very room repair group had fascial repairs compared with 3 7% in the t ransferred group. When infants more than 34-weeks' gestation without a ssociated anomalies are compared with transferred infants, delivery ro om repair group underwent more frequent fascial repair (8 of 9 vs 5 of 13, p < 0.03), were extubated sooner (2.9 vs 7.4 days, p < 0.04), tol erated enteral feedings earlier (8.1 vs 22.2 days, p < 0.009), and req uired fewer hospital days (13.6 vs 31.3 days, p < 0.01). Eviscerated b owel of infants who underwent immediate surgical repair lacked the cha racteristic matted, edematous, and fibrinous coated appearance seen in transferred patients. Conclusions. Immediate delivery room repair of gastroschisis results in increased fascial repairs and earlier extubat ion, feeding, and hospital discharge. These benefits appear to be due to the minimal reactive peel on eviscerated bowel at birth.