Gastroschisis repair

Description:
Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen.

Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A tube is inserted into the stomach (nasogastric tube, also called NG tube) to keep the stomach empty to prevent choking on or breathing in ( aspiration ) stomach contents into the lungs. The surgery is done as soon as the infant is stable.

While the baby is deep asleep and pain-free (under general anesthesia) an incision is made to enlarge the hole in the abdominal wall. The bowel is examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges stitched together. A tube is inserted into the stomach ( gastrostomy tube ) and out through the skin. The organs are replaced into the abdominal cavity and the incision closed, if possible.

If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch will be made from a sheet of plastic to cover and protect the organs. Complete closure may be done over a few weeks. Surgery may be necessary to repair the abdominal muscles at a later time.

The infant's abdomen may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties . The infant may require the use of a breathing tube and machine (ventilator) for a few days or weeks until the swelling of the abdominal organs has decreased and the size of the abdomen has increased.

Indications:
Gastroschisis is a life-threatening event requiring immediate intervention.


What to Expect After:
The defect can be corrected with surgery in most cases. The outcome depends on the amount of damage to or loss of intestine.

Convalescence:
The infant is cared for post-operatively in a neonatal intensive care unit. He is placed in an isolette (incubator) to keep warm and prevent infection. He will be given oxygen and often require mechanical ventilation. Intravenous fluids and antibiotics and pain medication will be given. A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement.

Risks:
Breathing difficulties may occur as a result of increased pressure in the abdomen when the gastroschisis is closed. In this case, mechanical ventilation may be necessary.

Other risks of major abdominal surgery include peritonitis and temporary paralysis of the small bowel.

If a large portion of the small bowel is damaged, the infant may develop short bowel syndrome and have problems digesting and absorbing feedings.

Cost:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: $1,500 to $3,000, depending on the size of the defect and how many stages of surgery are required.
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.