STAGED ABDOMINAL CLOSURE USING ALEXIS® WOUND RETRACTOR IN GASTROSCHISIS: REVIEW OF OUR EXPERIENCE

Objective: Gastroschisis is a rare anomaly with a prevalence in Belgium of 1/10.000 births. We use the Alexis® wound protector-retractor (Applied Medical, USA) for newborns in whom the viscera could not be reduced at birth. The aim of this study was to evaluate the clinical outcomes of patients where a staged closure of gastroschisis with the Alexis® was performed, compared to the ones where primary closure of the defect could be achieved. Methods: Retrospective, bicentric study of 11 consecutive patients born with gastroschisis from 2012 to 2019. In six infants, primary closure of the abdominal wall could be achieved. Five needed a staged closure. In the latter, one of the rings of an Alexis® (size XS) was placed intra-abdominally after bringing the eviscerated organs inside the bag, under general anesthesia. Traction on the bag was daily applied in order to achieve further reduction of the viscera. The abdominal wall was closed in a second operation 5-8 days afterwards. Results: The median ventilation time was double as long when secondary closure was necessary: 10 days [9,15] versus 5.5 days [3,8]. Median start of enteral feeding commenced later when delayed closure was performed: 21 days [11,25] versus 10.5 days [6,27]. Full enteral feeding was accomplished on a median of 29 days [4,17] almost similar to primary closure: 31 days [19,60]. Median discharge time from NICU was after 34 days [25,48] and 31 days [19,60], respectively. One patient died due to volvulus 33 days postoperatively. Conclusions: Although infants who underwent delayed closure of gastroschisis had a longer need for mechanical ventilation, and enteral feeding was initiated later, the medium-term clinical outcomes are comparable to those of infants in which the defect was closed primarily. Staged closure with Alexis® Wound-Retractor is an easy, safe and reliable technique and does not complicate medium term prognosis.