WOFAPS 2025 8th World Congress of Pediatric Surgery

Ingrid Hernandez Flores, Alejandro Alberto Peñarrieta-Daher, Kin Yollotl Galvan-Morales, Katherine Bautista-Jimenez, Cristian Ruben Zalles-Vidal

Neonatal Surgery Department, Hospital Infantil de México Federico Gómez, Mexico City

Introduction:
Gastroschisis is the most common congenital defect of the abdominal wall. Sutureless-closure is increasingly used due to its benefits: it avoids general anesthesia, reduces mechanical ventilation, and lowers the risk of surgical site infections. However, published literature on aesthetic outcomes is limited.

Objective:
Evaluate the umbilical aesthetic result in gastroschisis patients treated with sutureless-closure and compare it with no surgery and laparoscopic surgery patients.

Methods:
An ambispective study was performed. Standardized photographs (taken from 30cm) of three patient groups—sutureless closure, unoperated, and laparoscopic—were analyzed. Two pediatric surgeons blindly evaluated aesthetics using a 5-item Likert scale (depth, width, length, shape, and natural appearance; score 5–25). Parents of sutureless patients were also surveyed.

Results:
From 160 patients, 86 sutureless-closure, 78 unoperated, and 45 laparoscopic scars were evaluated. Survey from parents was obtained in 38/121 cases. The sutureless group had a median parental score of 22/25 (range 11–25), while surgeons of 12 (range 5–20). Unoperated umbilicus received the highest scores (median 18, range 5–25), followed by laparoscopic ones (median 12, range 5–24). In the sutureless subgroup, neonates ≤1500g and <34 weeks had lower scores (6 and 5), while those >2000g and >37 weeks had higher scores (9.4 and 10.4).

Discussion:
There is a significant discrepancy between parents and specialists, despite this, sutureless closure results were highly acceptable to parents. Interestingly, some sutureless cases received scores similar to unoperated umbilici. Low birth weight and prematurity were associated with lower aesthetic scores.

Conclusion:
Aesthetic evaluation remains subjective, even with validated scales. Some sutureless closures showed outcomes comparable to unoperated umbilicus. This is the first study to show that neonates over 1500g and 34 weeks gestation achieve better aesthetic results, which could guide future clinical decisions.