2. Material and methods

Although numerous articles considering the optional management of gastroschisis are available in the professional literature, it still remains controversial. There are two preferable methods in operative approaches: primary closure and staged closure using customized silo [15]. Primary surgical repair is the method of choice of gastroschisis treatment at our Institution, whenever it is feasible. During the last decade, we have moved toward staged reduction of the herniated intestines (without intestinal anomalies) into the abdominal cavity using a silo (Figure 3), which is then followed by elective abdominal wall closure (Figure 4). We also reviewed differences of the outcome of newborn with simple and complex gastroschisis treated at our Institution over the past 15 years and tried to identify factors associated with mortality [9]. In majority of published studies reported mortality of gastroschisis is less than 10%, which is mostly the result of development of the modern neonatal intensive care, advanced pediatric surgery, and new prenatal diagnostic procedures [4, 16]. All this provides better results in overcoming the gastroschisis-associated complications such as extensive intestinal loss, short bowel syndrome, prolonged total parenteral nutrition, liver failure, sepsis, and

Several studies have examined the different outcomes in fetuses with gastroschisis [14], but most of them have included all abdominal wall defects, not just gastroschisis [17, 18]. In future, more researches should be focused on discovering the factors which could indicate the presence of complex gastroschisis. Besides, new studies should provide improvement of prenatal

early baby death.

diagnosis and postnatal management.

234 Congenital Anomalies - From the Embryo to the Neonate

Figure 3. Eviscerated organs placed into silastic bag.

We performed a retrospective cohort study where we included all the patients treated at the Institute for Mother and Child Health Care of Serbia "Dr. Vukan Čupić" in period 2001–2017 with the diagnosis of gastroschisis (n = 70). The exclusion parameters were prematurity (<34 weeks of gestation) and birth weight less than 1500 g, so the five patients were excluded (n = 5). We used patient records and neonatal intensive care unit database to obtain infant birth history, demographic and clinical parameters that were necessary for this research.

Antenatal data included extra-abdominal bowel dilatation (EABD) (bowel diameter ≥ 18 mm) and in particular intra-abdominal bowel dilatation (IABD). Perinatal data included birth age, gestational age, sex, and birth weight. Surgical records included presence of intestinal atresia, necrosis, perforation, strictures, and method of closure. Outcome data included duration of mechanical ventilation, duration of total parenteral nutrition, pseudoobstruction, sepsis (central line infection), reoperations, length of hospital stay, and mortality rates.

We defined patients with complex gastroschisis as cases with gastroschisis and one or more of the following anomalies: intestinal perforation, intestinal atresia, strictures, and ischemic bowel. Total length of hospital stay was defined as the number of days from first admission to first discharge or transfer to another hospital.
