Gastroschisis repair

Definition

Gastroschisis repair is a procedure done on an infant to correct a birth defect that causes an opening in the skin and muscles covering the belly (abdominal wall). The opening allows the intestines and sometimes other organs to bulge outside the belly.

Alternative Names

Abdominal wall defect repair - gastroschisis

Description

The goal of the procedure is to place the organs back into the baby's belly and fix the defect. Repair may be done right after the baby is born. This is called primary repair. Or, the repair is done in stages. This is called staged repair. Surgery for primary repair is done in the following way:

Staged repair is done when your baby isn't stable enough for primary repair. It may also be done if the baby's intestine is very swollen or there is a large amount of intestine outside the body. Or, it is done when the baby's belly isn't large enough to contain all of the intestine. The repair is performed the following way:

More surgery may be needed at a later time to repair the muscles in your baby's belly.

Why the Procedure Is Performed

Gastroschisis is a life-threatening condition. It needs to be treated soon after birth so that the baby's organs can develop and be protected in the belly.

Risks

Risks for anesthesia and surgery in general are:

Risks for gastroschisis repair are:

Before the Procedure

Gastroschisis is usually seen on ultrasound before the baby is born. The ultrasound may show loops of bowel freely floating outside the baby's belly.

After gastroschisis is found, your baby will be followed very closely to make sure he or she is growing.

Your baby should be delivered at a hospital that has a neonatal intensive care unit (NICU) and a pediatric surgeon. A NICU is set up to handle emergencies that occur at birth. A pediatric surgeon has special training in surgery for babies and children. Most babies who have gastroschisis are delivered by cesarean section.

After the Procedure

After surgery, your baby will receive care in the NICU. The baby will be placed in a special to keep your baby warm.

Your baby may need to be on a breathing machine until organ swelling has decreased and the size of the belly area has increased.

Other treatments your baby will probably need after surgery are:

Feedings are started through the NG tube as soon as your baby's bowel starts functioning after surgery. Feedings by mouth will start very slowly. Your baby may eat slowly and may need feeding therapy, lots of encouragement, and time to recover after a feeding.

The average stay in the hospital is a few weeks up to a few months. You may be able to take your baby home once he or she is taking all foods by mouth and gaining weight.

Outlook (Prognosis)

After you go home, your child may develop a blockage in the intestines (bowel obstruction) due to a kink or scar in the intestines. The doctor can tell you how this will be treated.

Most of the time, gastroschisis can be corrected with one or two surgeries. How well your baby does will depend on how much damage there was to the intestine.

After recovering from surgery, most children with gastroschisis do very well and live normal lives. Most babies who are born with gastroschisis do not have any other birth defects.

References

Chung DH. Pediatric surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 66.

Islam S. Congenital abdominal wall defects. In: Holcomb GW, Murphy JP, Ostlie DJ, eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier; 2014:chap 48.