Editorials

Gastroschisis

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7124 (Published 15 November 2011) Cite this as: BMJ 2011;343:d7124
  1. Peter F Nichol, section chief of pediatric surgery
  1. 1Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
  1. nichol{at}surgery.wisc.edu

Limited evidence of better outcomes with certain surgical techniques needs further study

Gastroschisis continues to be a challenging congenital anomaly. The defect results from a disruption at the junction of the right side of the umbilicus and abdominal wall, presumably during the late first trimester.1 The intestines herniate out of the abdominal cavity into the amniotic cavity. Animal models suggest that exposure to the amniotic environment substantially reduces intestinal length and delays the maturation of the enteric nervous system.2 3

Not surprisingly, the onset of normal intestinal function in neonates with gastroschisis can take weeks. Thereafter, these patients can have chronic problems with intestinal motility and absorption of nutrients.4 No doubt many surgeons and neonatologists have wondered how such a simple defect in the abdominal wall can cause so much trouble. In the linked cohort study (doi:10.1136/bmj.d6749), Bradnock and colleagues describe one year outcomes for a national cohort of infants with gastroschisis.5

The incidence of gastroschisis is increasing worldwide.6 7 The incidence varies for each country, but doing some simple calculations using an incidence of 1/2889,8 a world population of 7bn, and a crude birth rate of 20.3 …

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