Gastroschisis repair

Definition

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

Alternative Names

Abdominal wall defect repair

Description

The goal of surgery is to place the organs back into the baby's belly and fix the defect, if possible.

The surgeon will wait until your baby is stable enough to have surgery. This may take a 7 to 10 days. During this time, a plastic pouch called a silo will be used to return most of your baby's intestines and other organs into the belly.

When ready for surgery, your baby will receive general anesthesia. This will make your baby asleep and pain-free during the operation.

Why the Procedure Is Performed

Gastroschisis is a life-threatening birth defect. It needs to be treated as soon as possible after a baby is born.

Risks

Risks for any anesthesia are:

Risks for any surgery are:

Other risks of 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. Most babies who have gastroschisis are delivered by Cesarean section.

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.

Immediately after birth, any organs that are outside your baby's body will be covered with a warm, moist, sterile dressing or a sterile plastic bag. A nasogastric (NG) tube will be inserted through your baby's nose or mouth into the stomach to drain fluids and keep the stomach empty. This prevents the baby from choking and breathing stomach contents into the lungs.

After the Procedure

After surgery, your baby will receive care in the hospital's neonatal intensive care unit. The baby will be placed in a special bed called an isolette. This bed has an incubator 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 4 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.

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

Ledbetter DJ. Gastroschisis and omphalocele. Surgical Clinics of North America. April 2006;86(2).