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Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis

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Abstract

Purpose

Recently, plastic closure of abdominal defect in infants with gastroschisis has been used. Timing of gastroschisis closure can be mainly divided into two groups: primary closure and delayed closure after silo forming. Safety and usefulness of plastic closure in gastroschisis remains unclear. We aimed to evaluate the current evidence for plastic closure in infants with gastroschisis.

Methods

The analysis was done for primary closure as well as closure after silo. Outcomes were mortality, wound infection, duration of ventilation, time to feeding, and length of hospital stay (LOS). The quality of evidence was summarized using the GRADE approach.

Results

In the “primary” group, there was no significant difference in mortality, time to feeding initiation and LOS. In the “silo” group, wound infection was significantly lower in plastic closure (Odds ratio 0.24, 95%CI 0.09–0.69, p = 0.008). Duration of ventilation, time to feeding initiation and LOS were significantly shorter after plastic closure (Ventilation; mean difference (MD) − 5.76, p = 0.03. Feeding initiation; MD − 9.42, p < 0.0001. LOS; MD − 14.06, p = 0.002). Quality of evidence was very low for all outcomes.

Conclusions

Current results suggest that plastic closure may be beneficial for infants with gastroschisis requiring silo formation. However, this evidence is suboptimal and further studies are needed.

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Acknowledgements

Dr. Agostino Pierro was supported by the endowment of the Robert M. Filler Chair of Surgery, The Hospital for Sick Children, and by the Canadian Institutes of Health Research (CIHR) Foundation Grant.

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Authors and Affiliations

  1. General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada

    Hiromu Miyake, Shogo Seo, Joshua S. O’Connell, Maarten Janssen Lok & Agostino Pierro

  2. Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan

    Hiromu Miyake

Authors
  1. Hiromu Miyake
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  2. Shogo Seo
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  3. Joshua S. O’Connell
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  4. Maarten Janssen Lok
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  5. Agostino Pierro
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Correspondence to Agostino Pierro.

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Miyake, H., Seo, S., O’Connell, J.S. et al. Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis. Pediatr Surg Int 35, 107–116 (2019). https://doi.org/10.1007/s00383-018-4381-7

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  • DOI: https://doi.org/10.1007/s00383-018-4381-7

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