Management of intestinal atresia in patients with gastroschisis

Background Purpose: Intestinal atresia occurs in approximately 10% to 20% o f children with gastroschisis and may be missed at the initial closure if a thick peel obscures the bowel. Some investigators have identified intestin al atresia as a significant contributor to morbidity and mortality. The aut hors reviewed their experience with gastroschisis and intestinal atresia in an attempt to answer the following questions. What is the incidence of thi s association? How often is the intestinal atresia unrecognized as a result of the peel? What is the optimal management for infants with atresia and g astroschisis, and does the atresia affect morbidity or mortality? Methods: The hospital charts and medical records of all patients with gastr oschisis treated at our institution from 1969 to present were reviewed thor oughly. Parameters analyzed included gestational age (GA), birth weight (BW ), antenatal diagnosis, mode of delivery, type of closure, era of repair, p resence of other major anomalies, and development of necrotizing enterocoli tis. Morbidity and mortality rates were examined. Characteristics of patien ts with and without atresia were compared. Chi-squared was used for crossta bular analysis. Sample parameters were compared with Student's t test. P va lues of less than .05 were considered significant. Results: A total of 199 babies had gastroschisis and 25 (12.6%) had intesti nal atresia. Intestinal atresia was initially unrecognized in 3 patients. M ost patients (80%) underwent primary closure of the abdominal wall. Initial stoma formation and delayed anastomosis was performed in 12 (48%) patients , none of whom required prosthetic material for abdominal wall closure. Ini tial stomas were avoided in 5 patients who required SILASTIC (R) (Dow Corni ng, Midland, MI) silos. Skin closure alone was used in 2 babies. The level of the atresia was most commonly jejunoileal (20 of 25, 80%). Mean hospital stay was increased in babies with intestinal atresia, 36.2 versus 63.1 day s (P < .001). Conclusions: Although patients with intestinal atresia did have feeding del ays, an increased incidence of adhesive intestinal obstruction, and prolong ed hospitalization, neither nor logistic regression analysis showed any cor relation with mortality. Intestinal repair at the first operation is someti mes possible and depends on the severity of the peel. Delayed repair of the atresia after a period of bowel decompression and parenteral nutrition is preferred, but in certain situations (colonic atresia, necrotic intestine, complicated atresia) may not be possible. The combination of stomas and pro sthetic material can be avoided in almost all patients. A management algori thm for patients with atresia and gastroschisis is discussed. Copyright (C) 2001 by W.B. Saunders Company.