Comparison of the main types of surgical closure in newborns with gastroschisis in Bahia, Brazil
Afiliação
(1) Hospital Universitário Professor Edgard Santos, Pós-Graduação em Medicina e Saúde, Universidade Federal Bahia (UFBA), Salvador, Brazil.
(2) Hospital Universitário Professor Edgard Santos, Pós-Graduação em Medicina e Saúde, Universidade Federal Bahia (UFBA), Salvador, Brazil. Electronic address: gabriel.medicina.umss@gmail.com.
Resumo
Dear editor, Gastroschisis is a congenital malformation of the anterior abdominal wall due to the extrusion of abdominal viscera into the amniotic cavity and without the presence of the amniotic membrane cover. Its prevalence varies according to ethnicity/race and the treatment of gastroschisis requires intensive care soon after birth, surgical correction in the first hours of life and parenteral nutrition. The surgical approach can be by primary reduction (PR) or the placement of a Silo prosthesis. PR can be sutureless or immediate, and the Silo approach is performed by progressive visceral reduction followed by a posterior procedure. We accompanied all the newborns with gastroschisis in two fetal medicine reference centers, Hospital Geral Roberto Santos and Climério de Oliveira Maternity, Bahia in the Brazilian Northeast, between 2017 and 2018. The DATASUS (Department of the Unified System of Health), reported 203,396 deliveries, 38 newborns with abdominal wall malformations, in our reference center 29 gastroschisis were treated, 2 gastroschisis incompatible with life and 7 omphaloceles, which meant that the hospitals in our study treated 100% of newborns with gastroschisis. We present prospective data from newborns with gastroschisis and describe the baseline, surgical and clinical characteristics of two types of surgical approaches: Silo and PR, since there is no consensus on the best approach or criteria to favor one method over another. We found a prevalence of gastroschisis of 1.42 per 10,000 newborns, the majority were non-white (82.8%) and 55.2% were male. Both hospitalization time and mechanical ventilation time were shorter in the PR group compared to the Silo group. Multiple surgical reinterventions (surgeries not related to the gastroschisis correction technique) were higher in the Silo group. These data may suggest worse results in the Silo group. The Brazilian cesarean section rate is high and there is a routine practice in newborns to the detriment of the literature that describes that there is no benefit of cesarean section in relation to vaginal delivery, hence the cesarean section rate found. We found a mortality rate of 48.3%, data similar to those reported in Brazil, ranging from 10.3% to >50%.1 In our study, newborns treated with PR had a 12.6% lower mortality rate than those treated with Silo, but with no statistical difference. Sepsis stood out as the main cause of death in both groups, since PR theoretically has an advantage because it is associated with less manipulation of the loops with the external environment. Our results show a higher survival of newborns with more days of partial parenteral nutrition and enteral nutrition compared to death newborns, data that coincides with S. Arnon et al that reports the benefit of early enteral nutrition (first 24 h of life), which translates into a shorter hospital stay, however, their prolonged use is associated with a higher risk of infections and adverse effect. Our findings show that treatment with primary reduction required less time for mechanical ventilation and multiple surgical reinterventions. Mortality of newborns with gastroschisis seems to depend mainly on nutritional status and mechanical ventilation.