Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements

Myron Yaster, Tres L R Scherer, Marshall M. Stone, Lynne G. Maxwell, Charles L. Schleien, Randall C. Wetzel, James R. Buck, David G. Nichols, Paul M. Colombani, David L. Dudgeon, J. Alex Haller

Research output: Contribution to journalArticle

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Abstract

To determine whether intragastric pressure (IGP) and central venous pressure (CVP) would reliably predict successful primary closure of congenital abdominal wall defects (omphalocele/gastroschisis) in newborn infants, we developed the following prospective intraoperative management protocol. Following a temporary trial of fascial closure, infants who had an IGP less than 20 mm Hg or an increase in CVP of less than 4 mm Hg were primarily closed. If IGP was greater than 20 mm Hg or if CVP increased by more than 4 mm Hg, the temporary closure of the abdomen was reopened and a prosthetic silo was placed. Ten infants who were less than 24 hours old and averaged 2.7 kg (range, 1.4 to 4.2 kg) and 37-weeks gestation (range, 32 to 41 weeks) were studied. Eight infants met criteria for primary closure. Their IGP averaged 14±4 mm Hg (±SD) (range, 8 to 19 mm Hg), and their increase in CVP averaged 1±2 mm Hg (range, -2 to 3 mm Hg). In the two infants who required staged repair, IGP averaged 25±1 mm Hg (±SD) (range, 24 to 25 mm Hg), and the increase in CVP averaged 7±1 mm Hg (range, 6 to 8 mm Hg). All patients were anesthetized with fentanyl (12.5 μg/kg) and paralyzed with metocurine (0.3 mg/kg) intraoperatively. There were no postoperative complications in either group of patients related to increased intraabdominal pressure, and all patients were extubated within 48 hours of the initial surgery. We conclude that the intraoperative measurement of changes in IGP and CVP can serve as a guide to the operative management of congenital abdominal wall defects and can reliably predict successful outcome following repair.

Original languageEnglish
Pages (from-to)1217-1220
Number of pages4
JournalJournal of Pediatric Surgery
Volume24
Issue number12
DOIs
StatePublished - 1989
Externally publishedYes

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Abdominal Wall
Central Venous Pressure
Pressure
Gastroschisis
Umbilical Hernia
Fentanyl
Abdomen
Newborn Infant
Pregnancy

Keywords

  • gastroschisis
  • Omphalocele

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Yaster, M., Scherer, T. L. R., Stone, M. M., Maxwell, L. G., Schleien, C. L., Wetzel, R. C., ... Haller, J. A. (1989). Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. Journal of Pediatric Surgery, 24(12), 1217-1220. https://doi.org/10.1016/S0022-3468(89)80554-8

Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. / Yaster, Myron; Scherer, Tres L R; Stone, Marshall M.; Maxwell, Lynne G.; Schleien, Charles L.; Wetzel, Randall C.; Buck, James R.; Nichols, David G.; Colombani, Paul M.; Dudgeon, David L.; Haller, J. Alex.

In: Journal of Pediatric Surgery, Vol. 24, No. 12, 1989, p. 1217-1220.

Research output: Contribution to journalArticle

Yaster, M, Scherer, TLR, Stone, MM, Maxwell, LG, Schleien, CL, Wetzel, RC, Buck, JR, Nichols, DG, Colombani, PM, Dudgeon, DL & Haller, JA 1989, 'Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements', Journal of Pediatric Surgery, vol. 24, no. 12, pp. 1217-1220. https://doi.org/10.1016/S0022-3468(89)80554-8
Yaster, Myron ; Scherer, Tres L R ; Stone, Marshall M. ; Maxwell, Lynne G. ; Schleien, Charles L. ; Wetzel, Randall C. ; Buck, James R. ; Nichols, David G. ; Colombani, Paul M. ; Dudgeon, David L. ; Haller, J. Alex. / Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. In: Journal of Pediatric Surgery. 1989 ; Vol. 24, No. 12. pp. 1217-1220.
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AU - Stone, Marshall M.

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AU - Wetzel, Randall C.

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