Umbilical Cord as Temporary Coverage in Gastroschisis

Abstract

Introduction: Although the early definitive closure of gastroschisis is possible in many cases, there is an ongoing discussion about the advantages of staged reduction. Different strategies and materials have been described to wrap the bowel for protection and reduce heat and fluid loss. The variety of devices ranges from prosthetic patches to biomaterials. We present use of the umbilical cord for temporary coverage in primarily irreducible gastroschisis.

Method: After revision and reduction of as much gut as possible under constant monitoring of the bladder pressure, the remaining eviscerated intestine is covered by the longitudinally split umbilical cord. Over the following days the continued reduction of the bowel relies on gravity, assisted by progressive compression by the shrinking umbilical cord tissue. At 10 days after performing the umbilical cord flap, it is possible to close the fascia without complications using gentle pressure.

Results: Since 1991 we have used this umbilical cord flap for staged reduction in 17 infants (10 females, 7 males) with giant gastroschisis. There were no complications related to use of the umbilical cord flap, no infections or NEC episodes, and no mortality. Length of hospital stay was 5 weeks on average. In 3 patients the course was complicated by associated defects or an underlying malformation.

Conclusion: Our experience confirms the advantage of a staged reduction in giant gastroschisis. The use of autogenic material such as the umbilical cord has advantages such as low infection rates and easy availability.

Key words

gastroschisis - umbilical cord - staged reduction - abdominal wall defect - chylothorax

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