Unsatisfactory experience with 'minimal intervention management' for gastroschisis

Purpose: The authors report, for cautionary reasons, their trial with "mini mal intervention management" for gastroschisis, After the successful innova tive experience with this approach, which Bianchi and Dickson described, th ey utilized it in 4 consecutive patients. Methods: In the delivery room a plastic bag was placed over the intestines, which rested in a dependent position to reduce edema. The stomach was deco mpressed acid the patients kept warm. Intravenous fluid at a maintenance ra te was given. After about 5 hours an attempt at closure was undertaken in t he newborn intensive care unit without anesthesia. An assistant lifted the anterior abdominal wall by applying upward traction on the umbilical cord. Over about 25 minutes the intestines were placed in the coelom, which was c losed with a single suture. Results: The outcome was uncomplicated in the first of 4 consecutive patien ts. The second patient had abdominal compartment syndrome requiring a silo and subsequent resection and has chronic malabsorption 16 months later. The third had an enterocutaneous fistula at 5 weeks that required a small bowe l resection. Bedside closure was abandoned in the final case because too mu ch resistance was encountered. She underwent primary repair in the operatin g. room and eventually died of sepsis with intestinal dysmotility. Conclusions: The "minimal intervention approach" can be effective in some p atients who have gastroschisis. This experience suggests that selection cri teria are needed before this method can be recommended. J Pediatr Surg 35:1 437-1439. Copyright (C) 2000 by W.B. Saunders Company.