WOFAPS 2025 8th World Congress of Pediatric Surgery

Paolo Bragagnini, Paulina Vargova, Yurema Gonzalez, Carolina Corona, Ricardo Escartin

Hospital Miguel Servet

Aim of the Study

This study evaluates a minimally invasive protocol for the management of gastroschisis, which includes vaginal delivery from 36 weeks, bedside progressive reduction, sutureless closure of the abdominal defect, and the use of near-infrared spectroscopy (NIRS) to monitor intra-abdominal pressure.

Methods

A retrospective study was conducted on patients diagnosed with gastroschisis between 2008 and 2024. The cohort was divided into two groups: Group 1 (prior to protocol implementation) and Group 2 (after protocol implementation).

Main Results

A total of 20 patients with gastroschisis were included: 10 in Group 1 and 10 in Group 2. The mean gestational age was 36+4 weeks. The rate of vaginal delivery increased from 40% in Group 1 to 88.8% in Group 2.The average time required for complete reduction of the bowel into the abdominal cavity was 4.2 days, and skin closure was achieved at an average of 24.5 days.

The duration of mechanical ventilation was significantly shorter in Group 2. There were no significant differences in the initiation of enteral nutrition or the duration of parenteral nutrition between the groups.

In the new protocol group, there was an increased incidence of umbilical hernia, but none required surgical repair during follow-up. Mortality was zero in Group 2, despite the presence of two cases of complex gastroschisis.

Conclusions

The implementation of a minimally invasive protocol for gastroschisis management demonstrated several advantages, including an increased rate of vaginal delivery, avoidance of initial intubation and surgical intervention in cases of simple gastroschisis, and a shorter duration of mechanical ventilation. Additionally, morbidity and mortality were reduced, even in cases of complex gastroschisis.