Closing/Closed Gastroschisis (CGS): Antenatal Predictors and Surgical Strategies in Cases of Unique Anatomy from a Case Series

TL;DR

This study identifies antenatal sonographic signs of intestinal obstruction as predictors of severe gastroschisis types and suggests staged surgery for better outcomes.

Contribution

The study introduces sonographic signs in the second trimester as a novel predictor for severe CGS and advocates for a staged surgical approach for type B.

Findings

Sonographic signs of intestinal obstruction in the second trimester predict severe CGS types (C and D) due to bowel vascular compromise.

Staged surgical approaches for CGS type B improve bowel length preservation and clinical recovery.

Patients with CGS types C and D had a 60% incidence of short bowel syndrome.

Abstract

What are the main findings?
•The appearance of sonographic signs of intestinal obstruction in the second trimester may be a predictor for a high risk of subsequent significant vascular compromise of the eviscerated bowel, potentially leading to the more severe types of CGS (C and D).•For patients with CGS type B, a staged surgical approach is advisable to maximize bowel length preservation.

The appearance of sonographic signs of intestinal obstruction in the second trimester may be a predictor for a high risk of subsequent significant vascular compromise of the eviscerated bowel, potentially leading to the more severe types of CGS (C and D).

For patients with CGS type B, a staged surgical approach is advisable to maximize bowel length preservation.

What are the implications of the main findings?
•This research could enable the development of clear guidelines for intensified ultrasound screening, timing of early delivery, and even the consideration of fetal surgery to prevent extensive intestinal loss.•Improving outcomes for patients with closing/closed gastroschisis by preserving the entire gastrointestinal tract

This research could enable the development of clear guidelines for intensified ultrasound screening, timing of early delivery, and even the consideration of fetal surgery to prevent extensive intestinal loss.

Improving outcomes for patients with closing/closed gastroschisis by preserving the entire gastrointestinal tract

Background: Closing/closed gastroschisis (CGS) accounts for approximately 6% of gastroschisis cases globally. Currently, no consensus exists regarding: antenatal predictors of CGS types, optimal antenatal management (ultrasound screening frequency, indications for early delivery), or standardized surgical strategies tailored to CGS type (staging/timing of procedures, enterostomy necessity/level). Methods: Five neonates with CGS were enrolled and classified according to Perrone’s classification: two patients with type B (40%), one with type C (20%), one with type D (20%), one patient was classified as unclear (20%). Gender distribution—80% female (n = 4), 20% male (n = 1); gestational age—median 35 weeks (IQR 35–38); preterm birth rate—80% (n = 4); birth weight—median 2620 g (IQR 2310–3850). Results: Three patients (60%) developed antenatal intestinal obstruction signs at the third trimester, including two who postnatally demonstrated viable intestinal loops. Two patients (40%) with necrosis of eviscerated intestine demonstrated onset of antenatal intestinal obstruction signs at the second trimester. Patients with CGS type B were managed using a staged surgical approach; patients with types C and D received single-stage repair. Patient with CGS type B achieved complete clinical recovery. Three patients (60%) with CGS types C and D developed short bowel syndrome. Conclusions: The appearance of sonographic signs of intestinal obstruction in the second trimester may be a predictor for a high risk of subsequent significant vascular compromise of the eviscerated bowel, leading to more severe types of CGS (C and D). For patients with CGS type B, a staged surgical approach is advisable to maximize bowel length preservation.

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