Conference PaperPDF Available

Short-term outcome of patients with gastroschisis treated at the Clinical Hospital Center in Zagreb -a ten-year review

Authors:

Abstract

Objectives and Study: Gastroschisis is a congenital malformation characterised by prolapse of the abdominal organs through the anterior abdominal wall defect. Although the survival rate of patients in the present age exceeds 90%, some patients have significant short-term complications that are largely determined by associated malformations and the degree of damage of the prolapsed bowel. The aim of this study was to analyse the short-term outcomes (up to hospital discharge) of a cohort of patients with gastroschisis and to examine whether the outcome was related to the associated intestinal malformations /complications. Methods: This is a retrospective analysis of patients with gastroschisis treated during a ten-year period (2007-2017) at UHC Zagreb. Depending on the condition of the gastrointestinal tract after delivery and the existence of associated malformations of the intestine, we categorised the patients into complex (intestinal atresia, volvulus, perforation/necrosis) and simple forms of gastroschisis (intact intestine). We compared the characteristics of each group. During the 10 year period we have treated 31 patient. Four were excluded because of unavailable medical history (all survived). The maternal age was 22 (± 4.7) years. 80% were prenatally diagnosed with a median GA 20.5w (8-37), fifteen (56%) were born prematurely. Only two (7.4%) patients had associated extraintestinal anomalies (hypospadia, bilateral hydronephrosis, polypsplenia, double gallbladder). Results: 19 patients had simple and 8 complex form of gastroschisis (intestinal atresia, n=6, ischemia and / or necrosis, n=5, perforation, n=1). The median age at time of surgery was 3.4 (2-11) hours. The abdominal wall was primarily closed in 30%. During the initial closure of the cavity, resection of the bowel and formation of a stoma were performed in 6 (22.2%) patients. By the end of hospitalisation, 22 (82%) patients were reoperated, most often due to ileus (n = 25). 26 (96%) patients survived. The duration of complete parenteral nutrition was 30 (7-157) days, the time to establish complete enteral intake took 51 (19-448) days and the length of hospitalisation 107 (25-470) days. Among survivors, full enteral intake was established during hospitalisation in 25 (96.2%) patients (median 51 days), including three out of four patients with short bowel syndrome. Patients with complex gastroschisis were more immature, BW < 10p, more frequently reoperated and required longer time to achieve complete enteral intake. Though treatment lasted longer in patients with complex gastroschisis (196 vs. 76 days, P = 0.08), it did not reach statistical significance. In the analysis of the factors affecting the length of hospitalisation the number of reoperations was significant. Conclusion: The survival of our patients (97%) is consistent with the results of other centres. However, the time to establish full enteral intake and duration of hospitalisation is significantly longer, what is consistent with the established practice of our department which prefers that every patient achieves full enteral nutrition during hospital stay, including those with a complex form of gastroschisis for which associated anomalies complicate the clinical course of the disease. Contact
Volume 68, Supplement 1, May 2019 332
GASTROENTEROLOGY - Gastroenterology other
G-P-193
Short-term outcome of patients with gastroschisis treated at the Clinical Hospital Center in
Zagreb - a ten-year review
Tomislav Caleta1, Ivana Todoric2, Mirna Natalija Anicic2, Lana Omerza2, Irena Senecic-Cala2, Duska
Tjesic-Drinkovic2, Anko Antabak3, Tomislav Luetic3, Dorotea Ninkovic1, Vesna Benjak1, Boris Filipovic-
Grcic1, Andrea Dasovic Buljevic1, Ruza Grizelj1, Jurica Vukovic2
1University Hospital Centre Zagreb, Department of Pediatrics, Division of Neonatology and Neonatal
Intensive Care, Zagreb, Croatia
2University Hospital Centre Zagreb, Department of Pediatrics, Division of Pediatric Gastroenterology,
Hepatology and Nutrition, Zagreb, Croatia
3University Hospital Centre Zagreb, Department of Surgery, Division of Pediatric Surgery, Zagreb,
Croatia
Objectives and Study: Gastroschisis is a congenital malformation characterised by prolapse of the
abdominal organs through the anterior abdominal wall defect. Although the survival rate of patients in
the present age exceeds 90%, some patients have significant short-term complications that are largely
determined by associated malformations and the degree of damage of the prolapsed bowel. The aim
of this study was to analyse the short-term outcomes (up to hospital discharge) of a cohort of patients
with gastroschisis and to examine whether the outcome was related to the associated intestinal
malformations /complications.
Methods: This is a retrospective analysis of patients with gastroschisis treated during a ten-year
period (2007-2017) at UHC Zagreb. Depending on the condition of the gastrointestinal tract after
delivery and the existence of associated malformations of the intestine, we categorised the patients
into complex (intestinal atresia, volvulus, perforation/necrosis) and simple forms of gastroschisis (intact
intestine). We compared the characteristics of each group. During the 10 year period we have treated
31 patient. Four were excluded because of unavailable medical history (all survived). The maternal
age was 22 (± 4.7) years. 80% were prenatally diagnosed with a median GA 20.5w (8-37), fifteen
(56%) were born prematurely. Only two (7.4%) patients had associated extraintestinal anomalies
(hypospadia, bilateral hydronephrosis, polypsplenia, double gallbladder).
Results: 19 patients had simple and 8 complex form of gastroschisis (intestinal atresia, n=6, ischemia
and / or necrosis, n=5, perforation, n=1). The median age at time of surgery was 3.4 (2-11) hours. The
abdominal wall was primarily closed in 30% . During the initial closure of the cavity, resection of the
bowel and formation of a stoma were performed in 6 (22.2%) patients. By the end of hospitalisation,
22 (82%) patients were reoperated, most often due to ileus (n = 25). 26 (96%) patients survived. The
duration of complete parenteral nutrition was 30 (7-157) days, the time to establish complete enteral
intake took 51 (19-448) days and the length of hospitalisation 107 (25-470) days. Among survivors, full
enteral intake was established during hospitalisation in 25 (96.2%) patients (median 51 days),
including three out of four patients with short bowel syndrome. Patients with complex gastroschisis
were more immature, BW < 10p, more frequently reoperated and required longer time to achieve
complete enteral intake. Though treatment lasted longer in patients with complex gastroschisis (196
vs. 76 days, P = 0.08), it did not reach statistical significance. In the analysis of the factors affecting
the length of hospitalisation the number of reoperations was significant.
Conclusion: The survival of our patients (97%) is consistent with the results of other centres.
However, the time to establish full enteral intake and duration of hospitalisation is significantly longer,
what is consistent with the established practice of our department which prefers that every patient
achieves full enteral nutrition during hospital stay, including those with a complex form of gastroschisis
for which associated anomalies complicate the clinical course of the disease.
Contact e-mail address: caleta.tomislav@gmail.com
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.