Mortality, bowel preservation, and surgical strategy in closing and closed gastroschisis: A systematic review and individual participant data meta-analysis

IF 2.3 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2026-12-01 Epub Date: 2026-10-06 DOI:10.1016/j.jpedsurg.2026.163520

Dikshit Chawla, Adin Belet, Tályta Pessoa, Sehajnoor Singh, Leo Yu, Ashwin Pimpalwar

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引用次数: 0

Abstract

Background

Closing and closed gastroschisis represent the most severe end of the gastroschisis spectrum, carrying high mortality and risk for short bowel syndrome (SBS). No individual participant data (IPD) meta-analysis exists, and the choice for opting an optimal surgical strategy, intracorporeal parking versus primary resection, is unresolved.

Methods

We systematically searched PubMed, EMBASE, and the Cochrane Library (inception to June 2026) for studies reporting patient-level data on closing, closed, or vanishing gastroschisis, following the PRISMA-IPD guidelines. Individual data were pooled in one-stage generalized linear mixed models with each study as a random intercept. The primary outcome was survival to discharge.

Results

Ninety-four patients from 36 IPD studies across 17 countries were analyzed; 3 further studies contributed aggregate data. Closing was defined as Perrone Types A-C (n = 67) and closed as Type D (n = 27). Overall mortality was 28.6%. Mortality rose across Perrone types A to D (0%, 3.6%, 27.3%, 59.3%; OR 5.30 per type; 95% CI 2.23–12.6; P = 0.0002). Closing (versus closed) gastroschisis (OR 0.10), residual bowel preservation (OR 0.03), greater residual bowel length, and intracorporeal parking (OR 0.13) were univariably associated with survival; male sex with death (OR 5.58). Intracorporeal parking was associated with lower mortality (10.5% versus 35.9%) and less SBS (31.6% versus 59.4%) than resection.

Conclusions

In this first IPD meta-analysis of closing and closed gastroschisis, the Perrone classification strongly predicted mortality, and bowel-preserving intracorporeal parking was associated with better outcomes. Prospective international registries with standardized outcome definitions are needed.

PROSPERO registration number

CRD420261448853.

Reporting guideline

Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data (PRISMA-IPD, 2015).

查看原文本刊更多论文

闭合性胃裂的死亡率、肠保存和手术策略：系统综述和个体参与者数据荟萃分析。

背景：闭合性和闭合性胃裂是胃裂谱系中最严重的一端，具有高死亡率和短肠综合征（SBS）的风险。没有个体参与者数据（IPD）荟萃分析存在，并且选择最佳手术策略的选择，体内停放还是初次切除，尚未解决。方法：我们系统地检索PubMed、EMBASE和Cochrane图书馆（成立至2026年6月），根据PRISMA-IPD指南报告关于胃裂闭合、闭合或消失的患者水平数据的研究。单个数据汇集在一期广义线性混合模型中，每个研究作为随机截距。主要终点是存活至出院。结果：来自17个国家的36项IPD研究的94名患者进行了分析；进一步的研究提供了汇总数据。闭合定义为Perrone A-C型（n = 67），闭合为D型（n = 27）。总死亡率为28.6%。从A型到D型的死亡率上升（0%,3.6%,27.3%,59.3%;OR 5.30 /型；95% CI 2.23-12.6; P = 0.0002）。闭合（相对于闭合）胃裂（OR 0.10）、残留肠保存（OR 0.03）、较大残留肠长度和体内滞留（OR 0.13）与生存相关；男性与死亡（OR 5.58）。与切除相比，体内停车的死亡率（10.5%比35.9%）和SBS（31.6%比59.4%）更低。结论：在这项关于闭合性和闭合性胃裂的首个IPD荟萃分析中，Perrone分类强有力地预测了死亡率，保留肠道的体内停车与更好的结果相关。需要具有标准化结果定义的前瞻性国际登记处。报告指南：个人参与者数据系统评价和荟萃分析的首选报告项目（PRISMA-IPD, 2015）。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.