Pediatric Surgery International

, Volume 35, Issue 1, pp 107–116 | Cite as

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

  • Hiromu Miyake
  • Shogo Seo
  • Joshua S. O’Connell
  • Maarten Janssen Lok
  • Agostino PierroEmail author
Original Article



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.


Gastroschisis 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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hiromu Miyake
    • 1
    • 2
  • Shogo Seo
    • 1
  • Joshua S. O’Connell
    • 1
  • Maarten Janssen Lok
    • 1
  • Agostino Pierro
    • 1
    Email author
  1. 1.General and Thoracic Surgery, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Department of Pediatric SurgeryShizuoka Children’s HospitalShizuokaJapan

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