Safety and Usefulness of Plastic Closure in Infants with Gastroschisis: a Systematic ….

Miyake H, Seo S, O’Connell JS, Janssen Lok M, Pierro A. Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis. Pediatr Surg Int. 2019 Jan;35(1):107-116. doi: 10.1007/s00383-018-4381-7. Epub 2018 Nov 3. PubMed PMID: 30392129.

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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