Reappraisal of skin flap closure for neonatal gastroschisis.

During the past 11 years, 18 infants with gastroschisis abdominal wall defects have undergone surgical repair at the UCLA Hospital. Sixteen infants had skin flap closure in infancy. A gastrostomy was performed on all infants, and peripheral intravenous hyperalimentation was used in 14 of the 18 infants. Sixteen of the 18 infants (89%) lived more than one year after surgical repair. Of these, 12 have undergone second-stage closure of the ventral hernia. Operative repair was greatly facilitated by forceful stretching of the abdominal musculature and milking of the bowel contents proximally into the stomach and distally out through the anus. The low morbidity and mortality of gastroschisis repair by primary skin closure, supplemented by intravensou hyperalimentation with late secondary ventral hernia repair, appear to justify continued use of this technique. Prosthetic materials probably should be reserved for reconstructing more complex abdominal wall defects.