3. Clinical And Prognostic Significance Of Intra-Abdominal Pressure In Choosing A Surgical Strategy For Gastroschisis In Newborns

Аңдатпа

Background. Gastroschisis is a congenital defect of the anterior abdominal wall in newborns, characterized by the evisceration of bowel loops without a protective sac. Timely and appropriate abdominal wall closure is essential for favorable outcomes.

Objective: To evaluate the clinical and prognostic significance of intra-abdominal pressure monitoring for determining the optimal surgical strategy in newborns with gastroschisis.

Materials and Methods. A retrospective cohort study was conducted on 32 newborns with gastroschisis treated in two tertiary centers in Kazakhstan and Russia from 2015 to 2025. Patients were allocated into two groups based on intraoperative intra-abdominal pressure values: Group 1 (n=21) underwent primary fascial closure using the Elective Delayed Midgut Reduction technique; Group 2 (n=11) received staged silo-assisted closure. intra-abdominal pressure was measured intravesically, and a threshold of 22–24 cm H₂O was used to guide the surgical decision. Clinical outcomes included duration of mechanical ventilation, total parenteral nutrition, ICU stay, hospital stay, complication rate, and mortality. Statistical analysis was performed using the Mann–Whitney U test (p < 0.05).

Results. Group 1 had significantly better outcomes, including shorter durations of mechanical ventilation (6 vs. 13 days, p = 0.01), ICU stay (12 vs. 20 days, p = 0.01), parenteral nutrition (14 vs. 22 days, p = 0.04), and lower mortality (4.8% vs. 27.3%, p = 0.03). Group 2 showed a higher complication rate, especially adhesive obstruction and sepsis.

Conclusion. Intraoperative intra-abdominal pressure measurement is a valuable tool for guiding surgical strategy in gastroschisis. An individualized approach based on physiological parameters improves safety and outcomes in neonatal surgical care.