SMALL-BOWEL CONTINUITY - A CRUCIAL FACTOR IN DETERMINING SURVIVAL IN GASTROSCHISIS

A retrospective analysis of a series of 63 cases of gastroschisis mana ged over an 11-year period distinguished a single statistically signif icant prognostic factor. There were 6 (9.5%) deaths, of which 4 occurr ed in the 8 infants with small-bowel atresia/stenosis (P <0.005, Fishe r's exact test). One died at 48 h and the remaining 3 of liver disease related to total parenteral nutrition. Of the 4 survivors, 1 develope d a late biliary stricture necessitating hepaticoenterostomy but is al ive and well aged 4 years. The remaining 3, following initially prolon ged hospitatisations and multiple operations, are alive and well after 2, 4 and 7 years. In 3 patients the atresia was not detected at the p rimary operation. The small number of cases of gastroschisis associate d small-bower atresia seen in any one unit may conceal the importance of the problem, and limits experience in the approach to management.