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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. The surgeon places the organs back inside the belly and closes the belly wall.
See also:
- Gastroschisis
- Omphalocele (a similar defect)
- Omphalocele repair
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 week 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.
- The surgeon will examine your baby's intestine (bowel) closely for signs of damage or other birth defects. Unhealthy parts will be removed, and the healthy edges will be stitched together.
- The surgeon will place all abdominal organs that are outside the belly back into the belly.
- The opening in the wall of the belly will be repaired, if possible.
- 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 birth defect. It needs to be treated as soon as possible after a baby is born.
Risks
Risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery are:
- Bleeding
- Infection
- Blood clots
Other risks of gastroschisis repair are:
- Breathing problems if the baby's belly area (abdominal space) is smaller than normal. The baby may need a breathing tube and breathing machine for a few days or weeks after surgery.
- Inflammation of tissues that line the wall of the abdomen and cover the abdominal organs
- Organ injury
- Problems with digestion and absorbing nutrients from food, if a baby has a lot of damage to the small bowel
- Temporary paralysis (muscles stop moving) of the small bowel
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:
- A nasogastric (NG) tube placed through the nose to drain the stomach and keep it empty.
- Antibiotics
- Fluids and nutrients given through a vein
- Oxygen
- Pain medicines
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).
Cooney D. Defects of the abdominal wall. Pediatr Surg. 1998;2:1045-1070.
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
