Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis
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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.
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.
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.
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.
KeywordsGastroschisis Plastic closure Sutureless closure Silo Primary closure
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.
Compliance with ethical standards
Conflict of interest
The authors report no conflicts of interest.
- 7.Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of intervention. http://www.handbook.cochrane.org. Accessed 1 Nov 2018
- 9.Miyake H, Seo S, O’Connell J et al (2018) Safety and utility of plastic/sutureless closure for the infants with gastroschisis in different timing of repair: a systematic review and meta-analysis. International prospective register of systematic reviews, PROSPERO. CRD42018086513Google Scholar
- 20.The GRADE working group. https://gradepro.org/ Accessed 30 Aug 2018
- 24.Machida M, Takamizawa S, Yoshizawa K et al (2013) Effectiveness of sutureless abdominal wall closure for gastroschisis. Shinshu Igaku 61:27–31Google Scholar
- 26.Dariel A, Poocharoen W, de Silva N et al (2015) Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation. Eur J Pediatr Surg 25:34–40Google Scholar