Gastroschisis repair

Alternative names

Definition

This surgery corrects a congenital defect called gastroschisis, in which all or parts of the small intestine, and other internal organs protrude outside of the abdomen. Gastroschisis is an abdominal wall defect located to the side of the umbilical cord (umbilicus). The infant is born with intestines protruding through this defect and no protective sac is present.

Gastroschisis is rarely associated with other birth defects. Gastroschisis and omphalocele (a similar defect) are frequently diagnosed by ultrasound examinations before birth. See also omphalocele repair .

Description

Surgical repair of abdominal wall defects involves placing the abdominal organs back into the abdomen through the defect and repairing the defect if possible. If immediate replacement is not possible, a sterile pouch is created to protect the intestines while they are gradually pushed back into the abdomen over a period of time.

Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A nasogastric tube (NG tube) is inserted through the baby's nose or mouth into the stomach to keep the stomach empty to prevent choking on or breathing stomach contents into the lungs ( aspiration ). The surgery is done as soon as the infant is stable.

While the baby is under general anesthesia (unconscious and pain-free) an incision is made to remove the sac membrane. The intestine is examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges are stitched together.

A tube may be inserted into the stomach ( gastrostomy tube ) and out through the skin. The organs are replaced into the abdominal cavity and the incision closed, if possible.

If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch called a silo will be made from a sheet of plastic to cover and protect the organs. Complete closure may be done over a few weeks. Surgery may be necessary to repair the abdominal muscles at a later time.

The baby's abdomen may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties . The infant may require the use of a breathing tube and machine (ventilator) for a few days or weeks until the swelling of the abdominal organs has decreased and the size of the abdomen has increased.

Indications

Risks

Expectations after surgery

Convalescence

The infant will be cared for postoperatively in a neonatal intensive care unit. The baby is placed in an isolette (incubator) to keep warm and prevent infection. Oxygen is given and mechanical ventilation is often required. Intravenous fluids, antibiotics, and pain medication will be given.

A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement.

Update Date: 11/19/2002