Elective delayed midgut reduction[mdash ]No anesthesia for gastroschisis: Selection and conversion criteria

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• 作者：A. Bianchi ; A. P. Dickson ; N. K. Alizai
• 关键词：Tissue engineering ; mesenchymal stem cells ; bone marrow-derived stromal cells ; cartilage ; tracheal malformations ; fetal surgery ; congenital anomalies ; transplantation
• 刊名：Journal of Pediatric Surgery
• 出版年：2002
• 出版时间：September 2002
• 年：2002
• 卷：37
• 期：9
• 页码：1334-1336
• 全文大小：40 K

文摘

Background/Purpose: In 1998 Bianchi and Dickson published their proposal for elective delayed midgut reduction without anaesthesia (EDMR-No GA). The study has been prospectively extended to develop [ldquo ]selection and conversion criteria[rdquo ] to ensure safe application of the technique.

Methods: In a prospective study from 1993 to date, EDMR-No GA was considered as first-line postnatal management in 35 children. The protocol and technique were those described by Bianchi and Dickson in 1998.

Results: EDMR-No GA was completed successfully in 25 children, of whom, 23 are normal with an aesthetic, scarless abdomen. Two children had bowel necrosis and died of short bowel state. A trial EDMR-No GA was converted to a staged silo reduction in 2 children who are both alive and well. EDMR-No GA was considered contraindicated in 8. Five had an elective, staged silo reduction, 2 had EDMR under anesthesia, and one 27-week-gestation baby died of severe hypothermia and acidosis before any procedure.

Conclusions: No single technique is applicable in all circumstances, and [ldquo ]selection and conversion criteria[rdquo ] are relevant to safe EDMR-No GA. These include poor general condition, significant vital organ anomaly, bowel-to-abdomen disproportion and [ldquo ]at risk[rdquo ] bowel circulation. The development of distress and progressive metabolic acidosis during and after EDMR-No GA, are indications for urgent conversion to avoid serious bowel injury. Experience with EDMR-No GA hones the surgeon's sensitivity in assessing abdominal J Pediatr Surg 37:1334-1336.