3. Results

We identified 70 patients with gastroschisis between 2001 and 2017. Five patients were excluded from study (babies with birth weight less of 1500 g and premature infants (<34 weeks of gestation)), so that 65 patients were analyzed. The characteristics of all analyzed patients are presented in Table 1. There were 15 patients (23.07%) with complex gastroschisis. Statistically significant difference was not identified between the simple and the complex gastroschisis groups in gestational age (36.1 1.4 versus 36.16 1.6; p = 0.173) and birth weight (2248.4 507.6 versus 2351.33 633.8; p = 0.319). There were 39 males and 26 female patients (65 in total). In both groups, majority of patients were males: 54% and 80% in simple and complex gastroschisis group, respectively.

Forty-four patients (67.69%) received primary fascial repair (primary closure). Twenty-one patients (32.30%) received delayed fascial closure using silastic bag. All the patients with complex gastroschisis (n = 15) were treated with primary fascial repair.

The overall incidence of intestinal atresia was 7.69% (n = 5) in our patient population. Ischemic complications such as stenosis, strictures, necrosis, and perforation were the main complication in nine cases (60%) of the complex gastroschisis group. Closing gastroschisis was presented in one case (6.66%) with circumferential closure of the ring around the protruding bowel associated with midgut necrosis.


Table 1. Patient characteristics of simple and complex gastroschisis groups.

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

We compared the incidence of simple gastroschisis (defined as gastroschisis with intact bowel that is not compromised) and complex gastroschisis (defined as gastroschisis with presence of one or more of the following criteria: intestinal atresia, perforation or intestinal necrosis or strictures), in fetuses with gastroschisis with and without evidence of bowel dilatation.

Also, we compared outcomes in infants with simple gastroschisis and those with complex gastroschisis using nonparametric methods. An outcome analysis was performed regarding antenatal bowel dilatation (bowel diameter ≥ 18 mm) and in particular intra-abdominal bowel dilatation (IABD), birth weight, gestational age, sex, mode of the closure of the defect, presence of intestinal necrosis or perforation, pseudoobstruction, reoperation, duration of mechanical ventilation, and total parenteral nutrition. Outcome data included presence of sepsis, total length of hospital stay, and mortality rates. We used χ<sup>2</sup> test and Mann-Whitney U test for data analysis; p values <0.05 were considered significant. SPSS version 12 was used for carrying out

We identified 70 patients with gastroschisis between 2001 and 2017. Five patients were excluded from study (babies with birth weight less of 1500 g and premature infants (<34 weeks of gestation)), so that 65 patients were analyzed. The characteristics of all analyzed patients are presented in Table 1. There were 15 patients (23.07%) with complex gastroschisis. Statistically significant difference was not identified between the simple and the complex gastroschisis groups in gestational age (36.1 1.4 versus 36.16 1.6; p = 0.173) and birth weight (2248.4 507.6 versus 2351.33 633.8; p = 0.319). There were 39 males and 26 female patients (65 in total). In both groups, majority of patients were males: 54% and 80% in simple and complex gastroschisis

Forty-four patients (67.69%) received primary fascial repair (primary closure). Twenty-one patients (32.30%) received delayed fascial closure using silastic bag. All the patients with

The overall incidence of intestinal atresia was 7.69% (n = 5) in our patient population. Ischemic complications such as stenosis, strictures, necrosis, and perforation were the main complication in nine cases (60%) of the complex gastroschisis group. Closing gastroschisis was presented in one case (6.66%) with circumferential closure of the ring around the protruding

complex gastroschisis (n = 15) were treated with primary fascial repair.

to first discharge or transfer to another hospital.

236 Congenital Anomalies - From the Embryo to the Neonate

2.1. Data analyses

all analyses.

3. Results

group, respectively.

bowel associated with midgut necrosis.

Antenatal IABD (including stomach dilatation) was detected at any time during pregnancy in 55 patients, resolving in 4 after 1 ultrasound scan. In 27 patients IABD persisted until the last ultrasound scan in 32% of simple and 73% of complex cases. In these 27 patients, there were cases in both groups (simple and complex) where IABD was present earlier than 30 gestational weeks. All intra-abdominal bowel dilatation (IABD) are summarized in Tables 2 and 3. IABD was never present in seven simple cases and in three complex cases (2 atresia and 1 perforation).

All extra-abdominal bowel dilatation (EABD) are summarized in Table 4. There were 55 patients with extra-abdominal bowel dilatation (with precise EABD diameter). We have not identified statistically significant difference in EABD between the group of patients with complex gastroschisis [15 (15–31) mm] and the group of patients with simple gastroschisis [40 (13–50) mm], p = 0.91. EABD with the diameter ≥ 18 mm was documented in 72% of patients with simple gastroschisis as well as in 82% of patients with complex gastroschisis.

Patients with simple gastroschisis were put on enteral feeding earlier than patients with complex gastroschisis and received less parenteral nutrition: [(13.64 10) vs. (53.1 42.6) days; p = 0.000019 (p < 0.001)]. Also, they had shorter duration of ventilation support: [(7 6.54) vs. (24 14.2) days; p = 0.000003 (p < 0.001)]. Patients with simple gastroschisis had a shorter hospital stay: [(32 15) vs. (91 64) days; p = 0.000198 (p < 0.001)].

In complex gastroschisis group, the finding always dictated the method of closure, and all of these patients (n = 15) were closed primarily. In the simple gastroschisis group primary fascial closure was performed in 29 patients (58%). Our data show that the way of treatment of these


Three patients with complex gastroschisis (20%) did not survive to be discharged. We identified one patient (6.66% of complex gastroschisis and 1.53% of all gastroschisis) with closing gastroschisis—a boy born in 34th gestational week with birth weight of 1900 g. The abdominal wall defect was located to the left side of the umbilicus. This patient had jejunal atresia 20 cm distal to the ligament of Treitz. We identified midgut volvulus progressing to complete midgut necrosis of entire extra-abdominal bowel mass in the first day of life. We performed a midgut resection, jejunocolic anastomosis, and abdominal fascial closure. The procedure was successful. However, the baby died due to multiple organ dysfunction caused by sepsis in the 20th

Gastroschisis: Prenatal Diagnosis and Outcome http://dx.doi.org/10.5772/intechopen.74270 239

Additional complications were identified in 21 (32.3%) of the 65 patients. A bowel pseudoobstruction and feeding problems were most frequent gastrointestinal complications: 9 (18%) of the patients with simple gastroschisis vs. 12 (80%) patients with complex gastroschisis (p = 0.00067). In 10 (20%) patients with simple gastroschisis and in 10 (66.7%) patients with complex gastroschisis (p = 0.00122) reoperation was necessary. Sepsis was the most common extraintestinal complication: in 19 (38%) and 12 (80%) patients with the simple and complex

Forty-six (92%) patients with simple gastroschisis survived to be discharged and four (8%) patients died in the hospital. Twelve (80%) patients with complex gastroschisis survived to be

Recent studies have shown significant increase in the incidence of gastroschisis during the past 20 years [19]. The incidence of gastroschisis is as high as 4.4 per 10,000 live births, and it is proved that it depends on the mother's age [1, 20]. In fact, the incidence is several times higher

In our study, we classified gastroschisis cases into simple and complex, according to the presence of associated bowel damage such as atresia, perforation, and necrosis, as these factors may have influence on the way of treatment and outcomes. Reviews in large national databases in Great Britain and the United States have shown that complex gastroschisis represents 11.5% and 10.9% of all cases, respectively [21]. The prevalence of complex gastroschisis in recent publications has been reported as 11–31% [21, 22]. In our cohort study, 77% of infants had simple gastroschisis, in other words almost 1 in 4 patients had complex gastroschisis. Researchers have proved that the only factor that has been consistently shown to predict poorer outcomes of this anomaly is the presence of complex gastroschisis [23, 24]. The results we obtained in our study show the same. Also, the presence of complex gastroschisis could lead to prolonged duration of total parenteral nutrition, ventilation support, and hospital stay. On the other hand, in our study, as well in some others, mortality did not differ significantly between simple and complex gastroschisis [9, 10, 22]. Some previous researches, on contrary, claim that intestinal complications are associated with higher mortality, as high as 28% [10, 11].

discharged and three (20%) patients died in the hospital (p = 0.338).

in women younger than 20 years than in women 25–29 years old [1].

day of life.

4. Discussion

gastroschisis, respectively (p = 0.0043).

Table 2. All intra-abdominal bowel dilatation (IABD).


Table 3. Degree of intra-abdominal bowel dilatation (IABD).


Table 4. Degree of extra-abdominal bowel dilatation (EABD).

patients depended primarily on characteristics of each case, which were quite heterogeneous. Routine silastic bag closure was performed in 21 patients (42%) with simple gastroschisis, and 19 patients (90.47%) of them had no complications.

Four patients with simple gastroschisis (8%) did not survive to be discharged. We identified gangrene of the bowels which were placed into silastic bag in two patients. Abdominal compartment syndrome was documented in two patients who were treated with primary closure. The need for repeated laparotomies was a result of various complications: sepsis, persistent metabolic acidosis, respiratory compromise, low urine output, and poor perfusion.

Three patients with complex gastroschisis (20%) did not survive to be discharged. We identified one patient (6.66% of complex gastroschisis and 1.53% of all gastroschisis) with closing gastroschisis—a boy born in 34th gestational week with birth weight of 1900 g. The abdominal wall defect was located to the left side of the umbilicus. This patient had jejunal atresia 20 cm distal to the ligament of Treitz. We identified midgut volvulus progressing to complete midgut necrosis of entire extra-abdominal bowel mass in the first day of life. We performed a midgut resection, jejunocolic anastomosis, and abdominal fascial closure. The procedure was successful. However, the baby died due to multiple organ dysfunction caused by sepsis in the 20th day of life.

Additional complications were identified in 21 (32.3%) of the 65 patients. A bowel pseudoobstruction and feeding problems were most frequent gastrointestinal complications: 9 (18%) of the patients with simple gastroschisis vs. 12 (80%) patients with complex gastroschisis (p = 0.00067). In 10 (20%) patients with simple gastroschisis and in 10 (66.7%) patients with complex gastroschisis (p = 0.00122) reoperation was necessary. Sepsis was the most common extraintestinal complication: in 19 (38%) and 12 (80%) patients with the simple and complex gastroschisis, respectively (p = 0.0043).

Forty-six (92%) patients with simple gastroschisis survived to be discharged and four (8%) patients died in the hospital. Twelve (80%) patients with complex gastroschisis survived to be discharged and three (20%) patients died in the hospital (p = 0.338).
