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Tytuł oryginału: Changeable views on the treatment of gastroschisis.
Autorzy: Chilarski Andrzej, Bułhak-Guz Hanna, Grochulska-Cerska Hanna
Źródło: Surg. Childh. Int. 2002: 10 (1) s.18-22, il., tab., bibliogr. 24 poz.
Sygnatura GBL: 313,040

Hasła klasyfikacyjne GBL:
  • pediatria
  • gastroenterologia

    Typ dokumentu:
  • praca kliniczna
  • tytuł obcojęzyczny

    Wskaźnik treści:
  • ludzie
  • noworodki
  • płeć męska
  • płeć żeńska

    Streszczenie angielskie: The mortality rate associated wtih gastroschisis has declined markedly over the last two decades due to many factors such as prenatal diagnosis, neonatal intensive care, improved surigcal techinique, total parenteral nutrition. The aim of this study was to analyze clinical material comprising patients with gastroschisis in its prenatal and postanatal aspects. Out of 36 fetuses, the diagnosis of gastroschisis was established prenatally in 27 (75 p.c.). There are two conditions found on US examination that may imply the need for prenatal intervention: severe oligohydramnion and indications for amnioinfusion and signs of closing gastroschisis, an indication for emergency cesarean section. As far as postanatal tretment is concerned, there are three options: - simple reduction of the eviscerated bowel (5 patients in our series), - open reduction, with ensuing fascial closure (9 patients in our series), - multistage procedure (22 patients in our series). There is some confusion in the literature as regards the choice of the appropriate option. The ultimate goal is to achieve full fascial closure. In order to complete this in one step and to avoid compartemnt syndrome, some conditions must be fulfilled: - the eviscerated bowel must be relatively unchanged, with no ischemia nor necrosis, - the with of abdominal defect must enable the reduction, - complicated gastroschisis (e. g. with atresia, perforation) has to be excluded from this procedure, - intraabdominal pressure should be monitored intra- and postoperatratively. We have been using a system of monitoring of intraabdominal pressure based upon measurement of intrabladder pressure by means of a simple mobile device. Tegmentum has been used in all of the newborns that were evaluated as candidates for a multistage procedure (22). It is based on a polyethylene mesh covered with a polyurethane layer.

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