Flap versus fascial closure for gastroschisis: a systematic review and meta-analysis.

Abstract:

BACKGROUND:Flap closure represents an alternative to fascial closure for gastroschisis. We performed a systematic review and meta-analysis of outcomes comparing these techniques. METHODS:A registered systematic review ( PROSPERO:CRD42015016745) of comparative studies was performed, querying multiple databases without language or date restrictions. Gray literature was sought. Outcomes analyzed included: mortality, ventilation days, feeding parameters, length of stay (LOS), wound infection, resource utilization, and umbilical hernia incidence. Multiple reviewers independently assessed study eligibility and literature quality. Meta-analysis of outcomes was performed where appropriate (Revman 5.2). RESULTS:Twelve studies met inclusion criteria, of which three were multi-institutional. Quality assessment revealed unbiased patient selection and exposure, but group comparability was suboptimal in four studies. Overall, 1124 patients were evaluated, of which 350 underwent flap closure (210 immediately; 140 post-silo). Meta-analysis revealed no significant differences in mortality, LOS, or feeding parameters between groups. Flap patients had less wound infections (OR 0.40 [95%CI 0.22-0.74], P=0.003). While flap patients had an increased risk of umbilical hernia, they were less likely to undergo repair (19% vs. 41%; P=0.01). CONCLUSIONS:Flap closure has equivalent or superior outcomes to fascial closure for patients with gastroschisis. Given potential advantages of bedside closure and reduced sedation requirements, flap closure may represent the preferred closure strategy.

journal_name

J Pediatr Surg

authors

Youssef F,Gorgy A,Arbash G,Puligandla PS,Baird RJ

doi

10.1016/j.jpedsurg.2016.02.010

subject

Has Abstract

pub_date

2016-05-01 00:00:00

pages

718-25

issue

5

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(16)00073-7

journal_volume

51

pub_type

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