PAEDIATRIC SURGERY.UKRAINE.2019.2(63):50-56; DOI 10.15574/PS.2019.63.50

Sliepov O. K., Ponomarenko O. P., Migur M. Yu., Grasyukova N. I.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of the National Academy of Medical Sciences of Ukraine», Kyiv
Mykolaiv Regional Children's Hospital, Ukraine

Gastroschisis (GS) remains one of the most severe highly-fatal developmental defects in newborns. There is a large number of anatomical and pathophysiological features of this defect that have not yet been classified. This fact necessitates the creation of a comprehensive anatomical and pathophysiological classification of GS.

Aim: based on the retrospective analysis of clinical material, with the study of the nature and frequency of anatomical and pathophysiological features of the defect and developmental abnormalities and diseases associated with it, to develop a comprehensive classification of GS.

Materials and methods. A retrospective analysis of medical records of 119 newborns with GS, who were treated in the department of surgical correction of congenital malformations in children in SI «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of the National Academy of Medical Sciences of Ukraine» from 1987 to 2018 (n=89) and in Mykolaiv Regional Children's Hospital from 1987 to 2005 (n=30).

Results. Isolated GS was detected in 67.2% (n=80) of patients. Associated GS, associated with concomitant malformations or other intrauterine pathology, was diagnosed in 34.8% (n=39) of patients, and 10.1% (n=12) with multiple malformations. Complicated GS was diagnosed in 18.5% (n=22). «Open» (typical) GS was diagnosed in 98.3% (n=117) of babies, «closed» – in 1.7% (n=2). Intrauterine growth retardation was detected in 38.7% (n=46) of babies with GS, and viscero-abdominal disproportion – in 90.7% (n=108).

Conclusions. The proposed GS classification reveals main anatomical and pathophysiological features of the defect and associated with it developmental abnormalities and intrauterine diseases affecting its prognosis; it gives an opportunity to develop optimal tactics and strategy of surgical treatment of this pathology and improve the results of treatment.

Key words: gastroschisis, classification, treatment.

REFERENCES

1. Bisaliev BN, Tsap NA. (2011). Sovremennyiy vzglyad na gastroshizis: ot antenatalnogo perioda do ishoda lecheniya (obzor literaturyi). Rossiyskiy vestnik detskoy hirurgii, anesteziologii i reanimatsii. 2:45–52.

2. Kartseva EV, Schetinin VV, Arapova AV i dr. (2001). Gryizha pupochnogo kanatika i gastroshizis u novorozhdennyih. Akusherstvo i ginekologiya.1:50–52.

3. Palamarchuk YuP. (2010). Khirurhichna korektsiia vistsero-abdominalnoi dysproportsii u novonarodzhenykh ditei z pryrodzhenymy defektamy perednoi cherevnoi stinky. Vinnytsia:20.

4. Sliepov OK, Grasyukova NI, Veselsky VL et al. (2014). The frequency of intrauterine growth retardation and its impact on the course and prognosis of gastroschisis. Perinatologiya i pediatriya. 2(58). doi 10.15574/PP.2014.58.16

5. Sliepov OK, Migur MYu, Gordienko IYu et al. (2017). A case of small bowel obstruction of a rare etiology in a newborn with gastroschisis. Paediatric Surgery.Ukraine. 2(55):34–38. https://doi.org/10.15574/PS.2017.55.27

6. Sliepov O, Migur M, Soroka V, Ponomarenko O. (2018). Surgical management of simple gastroschisis. Paediatric Surgery.Ukraine. 2(59):25–31. https://doi.org/10.15574/PS.2018.59.25

7. Fofanov OD. (2011). Likuvannia novonarodzhenykh ta ditei rannoho viku z vrodzhenoiu obstruktyvnoiu patolohiieiu travnoho traktu. Vinnytsia: 36.

8. Auber F, Danzer E, Noche-Monnery ME, Sarnacki S, Trugnan G, Boudjemaa S, Audry G. (2013, Feb.). Enteric nervous system impairment in gastroschisis. Eur J Pediatr Surg. 23(1):29–38. https://doi.org/10.1055/s-0032-1326955; PMid:23100056

9. Bergholz R, Boettcher M, Reinshagen K, Wenke K. (2014, Oct.). Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality – a systematic review and meta-analysis. J Pediatr Surg. 49(10):1527–32. https://doi.org/10.1016/j.jpedsurg.2014.08.001; PMid:25280661

10. Bernstein P. (1940). Gastroschisis, rare teratological condition in the newborn. Arch. Pediatr. 57:505–513.

11. Bittencourt DG, Barreto MW, Franca WM, Goncalves A, Pereira LA, Sbragia L. (2006, Mar.). Impact of corticosteroid on intestinal injury in a gastroschisis rat model: morphometric analysis. J Pediatr Surg.41(3):547–53. https://doi.org/10.1016/j.jpedsurg.2005.11.050; PMid:16516633

12. D.Antonio F, Viragone C, Risso G et al. (2015). Prenatal risk factors and outcomes in gastroschisis: a meta-analysis. Pediatrics. 136:159–169. https://doi.org/10.1542/peds.2015-0017; PMid:26122809

13. Emil S, Canvasser N, Chen T, Friedrich E, Su W. (2012, Aug.). Contemporary 2-year outcomes of complex gastroschisis. J Pediatr Surg.47(8):1521–8. https://doi.org/10.1016/j.jpedsurg.2011.12.023; PMid:22901911

14. Feng C, Graham CD, Connors JP, Brazzo J 3rd, Pan AH, Hamilton JR, Zurakowski D, Fauza DO. (2016, Jan.). Transamniotic stem cell therapy (TRASCET) mitigates bowel damage in a model of gastroschisis. J Pediatr Surg.51(1):56–61. https://doi.org/10.1016/j.jpedsurg.2015.10.011; PMid:26548631

15. Ghionzoli M, James CP, David AL et al. (2012). Gastroschisis with intestinal atresia-predictive value of antenatal diagnosis and outcome of postnatal treatment. Pediatr Surg. 47(2):322–328. https://doi.org/10.1016/j.jpedsurg.2011.11.022; PMid:22325384

16. Hakguder G, Ateş O, Olguner M, Api A, Ozdoğan O, Değirmenci B, Akgur FM. (2002). Induction of fetal diuresis with intraamniotic furosemide increases the clearance of intraamniotic substances: An alternative therapy aimed at reducing intraamniotic meconium concentration. J Pediatr Surg Sep. 37(9):1337–42. https://doi.org/10.1053/jpsu.2002.35004; PMid:12194128

17. Hass HJ, Krause H, Herrmann K, Gerloff C, Meyer F. (2009, Dec.). Colon triplication associated with ileum atresia in laparoschisis. Zentralbl Chir.134(6):550–2. https://doi.org/10.1055/s-0028-1098762; PMid:19708012

18. Hijkoop A, IJsselstijn H, Wijnen RMH et al. (2017). Prenatal markers and longitudinal follow-up in simple and complex gastroschisis Archives of Disease in Childhood – Fetal and Neonatal Edition Published Online First: 14 June. https://doi.org/10.1136/archdischild-2016-312417; PMid:28615305

19. Jorge Correia-Pinto, Marta L. Tavares, Maria J Baptista et al. (2006). Meconium dependence of bowel damage in gastroschisis. 41;5:897–900.

20. Kimble RM, Blakelock R, Cass D. (1999). Vanishing gut in infants with gastroschisis. Pediatr Surg Int. 15(7):483–5. https://doi.org/10.1007/s003830050644; PMid:10525904

21. Kronfli R, Bradnock TJ, Sabharwal A. (2010, Sep.). Intestinal atresia in association with gastroschisis: a 26-year review. Pediatr Surg Int. 26(9):891–4.

22. Kumar T, Vaughan R, Polak MA. (2013, Feb.). Рroposed classification for the spectrum of vanishing gastroschisis. Eur J Pediatr Surg. 23(1):72–5.

23. Lao OB, Larison C, Garrison MM et al. (2010). Outcomes in neonates with gastroschisis in US children’s hospitals. Am J Perinatol. 27:97–101. https://doi.org/10.1055/s-0029-1241729; PMid:19866404 PMCid:PMC2854024

24. Long AM, Court J, Morabito A et al. (2011). Antenatal diagnosis of bowel dilatation in gastroschisis is predictive of poor postnatal outcome. J Pediatr Surg. 46(6):1070–1075. https://doi.org/10.1016/j.jpedsurg.2011.03.033; PMid:21683200

25. Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA et al. (2001). Gastroschisis: a plea for risk categorization. J Pediatr Surg. 36:51–5. https://doi.org/10.1053/jpsu.2001.20004; PMid:11150437

26. Ogunyemi D. (2001). Gastroschisis Complicated by Midgut. Atresia, Absorption of Bowel, and Closure of the Abdominal Wall Defect. Fetal Diagn Ther.16:227–230. https://doi.org/10.1159/000053915; PMid:11399884

27. Rachael T Overcash, Daniel A DeUgarte, Megan L et al. (2014). Factors Associated With Gastroschisis Outcomes Obstet Gynecol. 124(3):551–557. https://doi.org/10.1097/AOG.0000000000000425; PMid:25162255 PMCid:PMC4147679

28. Santos MM, Tannuri U, Maksoud JG. (2003, Oct.). Alterations of enteric nerve plexus in experimental gastroschisis: is there a delay in the maturation? J Pediatr Surg. 38(10):1506–11. https://doi.org/10.1016/S0022-3468(03)00504-9

29. Schib K, Schumacher M, Meuli M et al. (2018). Eur Prenatal and Postnatal Management of Gastroschisis in German-Speaking Countries: Is There a Standardized Management? J Pediatr Surg. 28(2):183–193. https://doi.org/10.1055/s-0037-1598103; PMid:28183146

30. Shannon M. Koehler, Aniko Szabo, Matt Loichinger et al. (2017). The significance of organ prolapse in gastroschisis. Journal of Pediatric Surgery. 52:1972–1976. https://doi.org/10.1016/j.jpedsurg.2017.08.066; PMid:28951014

31. Snyder CL, Miller KA, Sharp RJ et al. (2001, Oct.). Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg.36(10):1542–5. https://doi.org/10.1053/jpsu.2001.27040; PMid:11584405

32. Suominen J, Rintala R. (2018). Medium and long-term outcomes of gastroschisis. Semin Pediatr Surg. 27(5):327–329. https://doi.org/10.1053/j.sempedsurg.2018.08.008; PMid:30413265

33. Vargun R, Aktug T, Heper A, Bingol-kologlu M. (2007, May). Effects of intrauterine treatment on interstitial cells of Cajal in gastroschisis. J Pediatr Surg. 42(5):783–7. https://doi.org/10.1016/j.jpedsurg.2006.12.062; PMid:17502183

34. Zachary Bauman, Victor Nanagas Jr. (2015). The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn. Case Reports in Pediatrics Volume, Article ID 129098, 4 pages. https://doi.org/10.1155/2015/129098; PMid:26180651 PMCid:PMC4477220

Article received: Feb 12, 2019. Accepted for publication: May 04, 2019.