WOFAPS 2025 8th World Congress of Pediatric Surgery

Dmitrii Morozov, Nadezhda Erokhina, Vasiliy Shumikhin, Olga Mokrushina

Pirogov Russian National Research Medical University, Moscow, Russia

Introduction

Children with complicated forms of gastroschisis, characterized by the presence of associated intestinal abnormalities. The most severe form of this condition is closing/closed gastroschisis (CGS), which occurs in about 6% of cases of gastroschisis. There is no currently accepted treatment strategy for CGS patients, who often require step-by-step surgery, as well as a timing of each surgical stage remains unclear.

Materials and Methods

We present five clinical cases of patients with CGS who have been treated at our clinic over the past two years. Two patients had CGS type B, one had CGS type C, one had CGS type D and else one had unclassified form (C?).

Results

The 2/3 patients, who had antenatal signs of intestinal obstruction after the 30th week of gestation, had viable intestinal loops after birth (type B CGH). In 2/2 patients with necrotic eviscerated intestine (type C and D), we noted an earlier appearance of signs of intestinal obstruction (16 and 19 weeks of gestation). In 2/2 patients with type B CGS we performed staged surgical treatment which allowed to preserve all parts of gastrointestinal tract. Children with CGS type C and D remain a severe group of patients with short-bowel syndrome.

Conclusions

The appearance of antenatal signs of intestinal obstruction in the second trimester could be a predictor of a high risk of further development of significant disruption of blood supply to the eviscerated intestine. Staged surgical treatment in patients with CGS type B allows to save the maximum bowel length.