Primary fascial closure of gastroschisis remains controversial. Some surgeons routinely place a prosthetic silo over the exposed bowel, planning a staged closure. From August 1987 to August 2004, 129 cases of gastroschisis were treated at the Pediatric Surgical Unit, Department of Surgery, Ratchaburi Hospital. There were 61 boys and 68 girls. One hundred and seven mothers were primigravida. Associated anomalies were present in 13 patients. One hundred and twelve patients underwent primary fascial closure. The success of this technique depends on enlarging the abdominal cavity and decreasing the volume of the bowel that must be replaced in the peritoneal cavity. Thorough preoperative rectal irrigation should evacuate all meconium. Seventeen patients required staged prosthetic pouch with final closure. The duration of post-operative ileus and length of hospital stay were shorter in infants who underwent primary fascial closure. Death occurred in 15 patients with primary fascial closure (13.4%) and 6 patients with staged prosthetic closure (35.3%). The present study indicated that primary fascial closure should be the treatment of choice whenever possible.
Keyword : Gastroschisis, Primary fascial closure, Staged prosthetic closure