A Study of Intraabdominal Pressure in Patients with Gastroschisis Before and After Closure of Abdominal Wall Defects
Keywords:
Gastroschisis, intraabdominal pressure, intraabdominal hypertension, abdominal compartment syndrome, primary closure procedure, staged closure procedureAbstract
Background: Ordinary treatments in patients with gastroschisis are primary and staged closure of abdominal wall defects (AWDs). The goal of treatment is to return the visceral organs into the abdominal cavity and minimize risks of increased intraabdominal pressure (IAP). Abdominal compartment syndrome (ACS) is the serious complication which induces to develop renal failure, bowel ischemia, respiratory compromise and death. IAP over 10 mmHg is defined as intraabdominal hypertension (IAH) and may induce to develop ACS.
Purpose: The aim of this study is to analyse IAP before and after closure of AWDs in patients with gastroschisis and investigate the factor affected increment of IAP. Materials and Methods: The patients with gastroschisis who were treated at Queen Sirikit National Institute of Child Health from January 2017 to December 2017 were enrolled into the study. IAP was measured by using of urinary bladder pressure between before and after closure of AWDs in both primary and staged closure procedures. Demographic data, IAP and complications were collected in order to demonstrate the relationship by using statistical analysis with SPSS program. The level of p-value less than 0.5 was considered statistical significance.
Results: Twenty-six patients (15 males, 11 females) were enrolled in the study. The patients were treated by primary closure procedure in 3 cases and staged closure procedure in 23 cases. In the primary closure group, median IAP before treatment was 8.09 mmHg (range 4.41-8.09 mmHg), whereas median IAP after closure of AWDs was 10.3 mmHg (range 4.41-20.96 mmHg). In the staged closure group, median IAP before treatment was 5.88 mmHg (range 2.21-22.07 mmHg), whereas median IAP after closure of AWDs was 8.46 mmHg (range 2.94-22.07 mmHg). Of the total 26 patients, 8 cases (30.76%) had IAH after closure of AWDs with the IAPs ranging from 10.3 to 22.07 mmHg. Two of the 8 cases with IAH (7.69% of all the patients) cases developed ACS with acute respiratory insufficiency, one case in the primary closure group (IAP 20.96 mmHg) and the other one in the staged closure group (IAP 22.07 mmHg). Both cases were treated by endotracheal intubation and respiratory support until they recovered within 3 days. There was not statistically significant in comparing of IAP between primary and staged closure procedures in the periods of before and after closure of AWDs (p > 0.05). Demographic data, type of operative procedures and complications were not associated to high IAP (> 10 mmHg) in this study.
Conclusion: Comparison between primary and staged closure procedures, there was no statistically significant of IAP in patients with gastroschisis before and after closure of AWDs. However, approximately 8 % of the patients developed ACS immediately postoperative closure of AWDs. Demographic data, type of operative procedures and comorbidities were not statistically associated with IAH after closure of AWDs.
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