Gastroschisis Repair—Child

Definition

Gastroschisis repair is a surgical procedure to close a gap in the abdominal wall. The gap is caused by a birth defect.

A gastroschisis may be small and only involve a section of intestines or be large and involve other abdominal organs. It may also be associated with abnormal development of the intestine called intestinal atresia.

Reasons for Procedure    TOP

With a gastroschisis, the muscles and skin of the abdominal wall do not close completely during fetal development. As a result, abdominal tissue and organs can pass to the outside of the body.

Gastroschisis repair is necessary for the baby’s survival. It is done soon after birth. Multiple procedures may be needed to complete this process.

Normal Anatomy of the Abdominal Organs

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Possible Complications     TOP

Problems from the procedure depend on the size of the defect. The doctor will review potential problems, like:

What to Expect    TOP

Prior to Procedure

Supportive steps will be taken after birth and before the surgery including:

  • Wrapping the exposed tissue in a plastic device to protect the organs
  • IV fluids and nutrition
  • Nasogastric tube to help reduce the size of the exposed tissue

Anesthesia

General anesthesia is used. The baby will be asleep during the procedure.

Description of the Procedure     TOP

The extent of the surgery depends on the size of the gastroschisis. General steps may include:

  • Opening a larger hole in the abdomen to examine the area and make room for the exposed tissue
  • Removing any damaged intestine. If parts of the intestine are removed the healthy ends will be connected together
  • Placing organs and other exposed tissue back into their proper place; the abdominal wall is repaired and stitched

Intestines may be swollen and difficult to place back into the abdominal cavity or there may not be enough room to fit them all in at first. Some intestine may be left outside of the abdomen and covered in a protective plastic device. The device will gradually push the intestines back into the abdomen as the swelling goes down or the abdominal cavity enlarges. Later, surgeries will complete the repairs and close the skin.

Immediately After Procedure     TOP

The baby will be taken to a recovery room and monitored.

How Long Will It Take?     TOP

It depends on how much repair is needed.

How Much Will It Hurt?     TOP

Anesthesia prevents pain during surgery. Additional medication will be given to relieve pain or soreness during recovery.

Average Hospital Stay     TOP

The length of stay depends on the extent of the repair needed. Proper feeding, weight gain, and bowel function are needed before the baby can go home. This may take several days or weeks.

Post-procedure Care     TOP

At the Hospital

A neonatal intensive care unit will monitor blood pressure, pulse, and breathing. Recovery may also include:

  • Pain medications
  • Antibiotics to prevent infection
  • IV fluids and nutritional support
  • Oxygen therapy
  • Mechanical ventilation

The hospital staff will take steps to reduce the chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your baby’s incisions covered

There are also steps you can take to reduce your baby’s chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding their healthcare providers to wear gloves or masks
  • Not allowing others to touch your baby’s incisions

At Home

Recovery may take some time and require a special diet. The doctor will monitor the baby’s growth and overall health to make sure the baby is getting adequate nutrition.

Call Your Doctor     TOP

Contact your child's doctor if your child's recovery is not progressing as expected or your child develops complications such as:

  • Signs of infection, including fever or chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • New or worsening symptoms

Call for emergency medical service right away if your baby has:

  • Difficulty breathing or signs of bowel obstruction, such as:
    • High fever
    • Localized abdominal tenderness
    • Abdominal swelling or hardness
    • Green or yellow vomit

If you think your baby has an emergency, call for emergency medical services right away.

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES:

March of Dimes Canada
http://www.marchofdimes.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

About Gastroschisis. The Children’s Hospital of Philadelphia website. Available as:
...(Click grey area to select URL)
February 01, 2012. Accessed May 3, 2016.
Facts About Gastroschisis. Center for Disease Control and Prevention website. Available as:
...(Click grey area to select URL)
November 12, 2015. Accessed May 3, 2016.
Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg. 2014 Oct;23(5):283-90.
Skarsgard ED. Management of gastroschisis. Curr Opin Pediatr. 2016 Jun;28(3):363-369.
Last reviewed June 2016 by Michael Woods, MD
Last Updated: 6/14/2016

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