Elective delayed midgut reduction-No anesthesia for gastroschisis: Selection and conversion criteria.

BACKGROUND/PURPOSE: In 1998 Bianchi and Dickson published their proposal for elective delayed midgut reduction without anaesthesia (EDMR-No GA). The study has been prospectively extended to develop "selection and conversion criteria" to ensure safe application of the technique.

METHODS

In a prospective study from 1993 to date, EDMR-No GA was considered as first-line postnatal management in 35 children. The protocol and technique were those described by Bianchi and Dickson in 1998.

RESULTS

EDMR-No GA was completed successfully in 25 children, of whom, 23 are normal with an aesthetic, scarless abdomen. Two children had bowel necrosis and died of short bowel state. A trial EDMR-No GA was converted to a staged silo reduction in 2 children who are both alive and well. EDMR-No GA was considered contraindicated in 8. Five had an elective, staged silo reduction, 2 had EDMR under anesthesia, and one 27-week-gestation baby died of severe hypothermia and acidosis before any procedure.

CONCLUSIONS

No single technique is applicable in all circumstances, and "selection and conversion criteria" are relevant to safe EDMR-No GA. These include poor general condition, significant vital organ anomaly, bowel-to-abdomen disproportion and "at risk" bowel circulation. The development of distress and progressive metabolic acidosis during and after EDMR-No GA, are indications for urgent conversion to avoid serious bowel injury. Experience with EDMR-No GA hones the surgeon's sensitivity in assessing abdominal.