Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure
Authors
James A. Fraser, Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City MO 64108, United States. Electronic address: jafraser@cmh.edu.
Katherine J. Deans, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.Follow
Mary E. Fallat, Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States.
Michael Helmrath, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Rashmi Kabre, Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, United States.
Charles M. Leys, Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Troy A. Markel, Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States.
Patrick A. Dillon, Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States.
Cynthia Downard, Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States.
Tiffany N. Wright, Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States.
Samir K. Gadepalli, Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
Julia E. Grabowski, Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, United States.
Ronald Hirschl, Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
Kevin N. Johnson, Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
Jonathan E. Kohler, Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
Matthew P. Landman, Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States.
Grace Z. Mak, Advocate Aurora Health
Peter C. Minneci, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.
Beth Rymeski, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Thomas T. Sato, Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
Bethany J. Slater, Advocate Aurora HealthFollow
Shawn D. Peter, Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City MO 64108, United States.
Jason D. Fraser, Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City MO 64108, United States. Electronic address: jdfraser@cmh.edu.
Recommended Citation
Fraser JA, Deans KJ, Fallat ME, et al. Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure. J Pediatr Surg. 2022;57(12):786-791. doi:10.1016/j.jpedsurg.2022.03.019
Abstract
Introduction:We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure.
Methods:A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications.
Results:Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure.
Conclusion:Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach.
