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Gastroschisis: A Successful, Prospectively Evaluated Treatment Model in a Middle-Income Country

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Abstract

Background

This research adopted a care protocol from high-income countries in a level II/III hospital in a middle-income country to decrease morbidity and mortality associated with gastroschisis.

Methods

We established a multidisciplinary protocol to treat patients with gastroschisis prospectively from November 2012 to November 2018. This included prenatal diagnosis, presence of a neonatologist and pediatric surgeon at birth, and either performing primary closure on the patients with an Apgar score of 8/9, mild serositis, and no breathing difficulty or placing a preformed silo, when unable to fulfill these criteria, under sedation and analgesia (no intubation) in the operating room or at the patients’ bedside. The subsequent management took place in the neonatal intensive care unit. The data were analyzed through the Mann–Whitney and Student’s t-distribution for the two independent samples; the categorical variables were analyzed through a chi-square distribution or Fisher’s exact test.

Results

In total, 55 patients were included in the study: 33 patients (60%) were managed with a preformed silo, whereas 22 patients (40%) underwent primary closure. Prenatal diagnosis (P = 0.02), birth at the main hospital (P = 0.02), and the presence of a pediatric surgeon at birth (P = 0.04) were associated with successful primary closure. The primary closure group had fewer fasting days (P < 0.001) and a shorter neonatal intensive care unit length of stay (P = 0.025). The survival rate was 92.7% (51 patients).

Conclusion

The treatment model modified to fit the means of our hospital proved successful.

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Acknowledgments

We would like to express our sincere gratitude to Dr. Juan-Carlos Duarte-Valencia for his assistance in writing the protocol, Lourdes Velasco-Vazquez for the statistical analysis, Aurora Aramburo-Papayanopulos for the writing of this study, and Mr. Joel Ayala-Huerta and Francisco Barajas-Martinez for collating all the records.

Funding

No funding was secured for this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Centro de Alta Especialidad Dr. Rafael Lucio, Av Adolfo Ruiz Rortines 2903, col. Unidad Magisterial, Xalapa, Veracruz, Mexico

    Pastor Escarcega-Fujigaki & Guillermo Hernandez-Peredo-Rezk

  2. King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK

    Naomi J. Wright

  3. Department of Medical Pediatrics, Centro de Alta Especialidad Dr. Rafael Lucio, Xalapa, Veracruz, Mexico

    Ahtziri Del Carmen Cardenas-Paniagua & Jose Luis Diaz-Luna

  4. Department of Neonatology, Centro de Alta Especialidad Dr. Rafael Lucio, Xalapa, Veracruz, Mexico

    Haydee Velez-Blanco & Lorenzo Saavedra-Velez

  5. Department of Radiology, Centro de Alta Especialidad Dr. Rafael Lucio, Xalapa, Veracruz, Mexico

    Celine Gutierrez-Canencia

  6. Department of Gynecology, Centro de Alta Especialidad Dr. Rafael Lucio, Xalapa, Veracruz, Mexico

    Berenice Venegas-Espinoza

  7. Department of Anesthesiology, Centro de Alta Especialidad Dr. Rafael Lucio, Xalapa, Veracruz, Mexico

    Miguel Castro-Ramirez

Authors
  1. Pastor Escarcega-Fujigaki
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  2. Guillermo Hernandez-Peredo-Rezk
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  3. Naomi J. Wright
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  4. Ahtziri Del Carmen Cardenas-Paniagua
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  6. Celine Gutierrez-Canencia
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  7. Lorenzo Saavedra-Velez
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  8. Berenice Venegas-Espinoza
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  9. Jose Luis Diaz-Luna
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Corresponding author

Correspondence to Pastor Escarcega-Fujigaki.

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Escarcega-Fujigaki, P., Hernandez-Peredo-Rezk, G., Wright, N.J. et al. Gastroschisis: A Successful, Prospectively Evaluated Treatment Model in a Middle-Income Country. World J Surg 46, 322–329 (2022). https://doi.org/10.1007/s00268-021-06357-0

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