Journal of pediatric surgery · 2026
Mortality, Bowel Preservation, and Surgical Strategy in Closing and Closed Gastroschisis: A Systematic Review and Individual Participant Data Meta-analysis.
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Chawla Dikshit, Belet Adin, Pessoa Tályta, Singh Sehajnoor, Yu Leo, Pimpalwar Ashwin
Аннотация
BACKGROUND: Closing and closed gastroschisis represent the most severe end of the gastroschisis spectrum, carrying high mortality and risk for short bowel syndrome (SBS). No individual participant data (IPD) meta-analysis exists, and the choice for opting an optimal surgical strategy, intracorporeal parking versus primary resection, is unresolved.
METHODS: We systematically searched PubMed, EMBASE, and the Cochrane Library (inception to June 2026) for studies reporting patient-level data on closing, closed, or vanishing gastroschisis, following the PRISMA-IPD guidelines. Individual data were pooled in one-stage generalized linear mixed models with each study as a random intercept. The primary outcome was survival to discharge. (PROSPERO CRD420261448853) RESULTS: Ninety-four patients from 36 IPD studies across 17 countries were analyzed; 3 further studies contributed aggregate data. Closing was defined as Perrone Types A-C (n = 67) and closed as Type D (n = 27). Overall mortality was 28.6%. Mortality rose across Perrone types A to D (0%, 3.6%, 27.3%, 59.3%; OR 5.30 per type; 95% CI 2.23-12.6; P = .0002). Closing (versus closed) gastroschisis (OR 0.10), residual bowel preservation (OR 0.03), greater residual bowel length, and intracorporeal parking (OR 0.13) were univariably associated with survival; male sex with death (OR 5.58). Intracorporeal parking was associated with lower mortality (10.5% versus 35.9%) and less SBS (31.6% versus 59.4%) than resection.
CONCLUSIONS: In this first IPD meta-analysis of closing and closed gastroschisis, the Perrone classification strongly predicted mortality, and bowel-preserving intracorporeal parking was associated with better outcomes. Prospective international registries with standardized outcome definitions are needed.
PROSPERO REGISTRATION NUMBER: CRD420261448853 REPORTING GUIDELINE: Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data (PRISMA-IPD, 2015).
METHODS: We systematically searched PubMed, EMBASE, and the Cochrane Library (inception to June 2026) for studies reporting patient-level data on closing, closed, or vanishing gastroschisis, following the PRISMA-IPD guidelines. Individual data were pooled in one-stage generalized linear mixed models with each study as a random intercept. The primary outcome was survival to discharge. (PROSPERO CRD420261448853) RESULTS: Ninety-four patients from 36 IPD studies across 17 countries were analyzed; 3 further studies contributed aggregate data. Closing was defined as Perrone Types A-C (n = 67) and closed as Type D (n = 27). Overall mortality was 28.6%. Mortality rose across Perrone types A to D (0%, 3.6%, 27.3%, 59.3%; OR 5.30 per type; 95% CI 2.23-12.6; P = .0002). Closing (versus closed) gastroschisis (OR 0.10), residual bowel preservation (OR 0.03), greater residual bowel length, and intracorporeal parking (OR 0.13) were univariably associated with survival; male sex with death (OR 5.58). Intracorporeal parking was associated with lower mortality (10.5% versus 35.9%) and less SBS (31.6% versus 59.4%) than resection.
CONCLUSIONS: In this first IPD meta-analysis of closing and closed gastroschisis, the Perrone classification strongly predicted mortality, and bowel-preserving intracorporeal parking was associated with better outcomes. Prospective international registries with standardized outcome definitions are needed.
PROSPERO REGISTRATION NUMBER: CRD420261448853 REPORTING GUIDELINE: Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data (PRISMA-IPD, 2015).