Modern approaches to treatment and rehabilitation of children with gastroschisis
DOI:
https://doi.org/10.15574/PS.2017.55.32Keywords:
gastroschisis, newborn children, abdominal wall plastics, visceral-abdominal disproportionAbstract
Objective – to optimize the treatment and rehabilitative measures in children with gastroschisis.
Material and methods. The results of complex treatment and rehabilitation of 76 children with gastroschisis were analyzed. Combined malformations were detected in 43 patients (56.6%). All patients underwent sugery. In newborns with a viscero-abdominal disproportion, grade I, the tight layered closure of abdominal cavity was provided. In the case of visceral-abdominal disproportion, grade II-III, the surgical management of patients was divided into two stages. The first stage included a modified Gross or Z-plastic repair surgery of the anterior abdominal wall with the autodermal patches. The second stage comprised the elimination of the ventral hernia and the plastic reconstruction of the anterior abdominal wall.
Results and discussion. Complications in the postoperative period were mainly septic (peritonitis, destructive pneumonia, purulent meningitis, acute hematogenous osteomyelitis) and occurred in 46 children (60.5%). In 2 patients (2.6%) against the background of the diffuse purulent peritonitis and suppuration of the operating wound in the early postoperative period, there was an event of eventration. The overall mortality rate made up 53.9%. The high mortality rates in newborns with gastroschisis are observed due to septic complications and the presence of combined birth defects that were diagnosed in almost all the deceased. In 10 (28.6%) cases of 35 discharged patients iatrogenic ventral hernia was formed. All patients with ventral hernia during the period of 6 to 9 months from the time of primary surgery (or birth) underwent the Sapezhko plastic reconstraction of the anterior abdominal wall with a good surgical outcomes.
Conclusions. The quality of life of patients with gastroschisis who completed a full course of treatment and rehabilitation and did not have the other birth defects is quite high. Most of these children are fully functioning people of society.
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