Repair of postclosure of incisional hernia was needed in seven patients in group I and in three patients in group II.
Follow-up period ranged from 2 to 6 months in both groups (average: 3.7 months). Two patients came later with adhesive intestinal obstruction that was treated conservatively and another one with inguinal hernia.
During the past 12 years, there was a steady improvement in antenatal care at our region. Prenatal diagnosis of abdominal wall defect increased from 16.7% in group I to 31.8% in group II. All mothers were advised to continue the normal course of pregnancy instead of preterm delivery. The limited incubators equipped with advanced neonatal intensive care facilities dictated this approach.
Owing to increased prenatal diagnosis, more deliveries were performed at hospitals equipped with neonatal care facilities. Earlier presentation and primary closure was noted in group II compared with group I (5 vs. 7 h). This might have contributed to the overall improvement of outcome in the second group. Stringer et al.  reported that prenatal diagnosis and transfer of patient to a specialized center is in favor of more frequent successful primary closure, less postoperative ventilation, and reduced hospital stay, because of earlier surgery and early management of patient with regard to hypothermia and hypovolemia and adequate nasogastric drainage.
More patients underwent primary repair in the first group (60% of cases). For fear of infection and disruption of the silo at the margin of the defect and risk of evisceration, many surgeons still prefer primary closure in many cases of gastroschisis, if at all possible. The use of intraoperative pressure manometry by measuring either intragastric central venous pressure or bladder was recommended as a guide for primary closure of the abdominal defect to avoid potential abdominal compartment syndrome, which may lead to ischemic/necrotic bowel, renal insufficiency, and respiratory distress [22–24].
Operative staged reduction has been predominantly achieved by suturing a synthetic material to the enlarged defect and delayed defect closure. Staged closure carries the risk of loss of fascial strength at the margins of the defect, the infection risk from the lack of a watertight seal, and the risk of evisceration due to disrupt suture line .
A more conservative approach toward overzealous primary closure has been adopted in our practice during the past 5 years. The availability of SLS has encouraged us to limit primary closure to cases in which this can be done safely without the need of postoperative ventilation. The use of a preformed SLS bag in infants with gastroschisis has been shown to be associated with improved facial closure rates, fewer ventilator days, more rapid return of bowel function, and fewer complications. Reduction of gastroschisis bowel has been successfully performed with and without anesthesia [26,27].
Despite the several advantages of SLS, it has potential pitfalls including ischemic complications, dislodgment, bowel twisting, and difficulties with final closure. One of the disadvantages of SLS is the progressively increased abdominal wall defect, which may be explained by the development of lateral distractive forces being applied to the abdominal wall . Another potential complication is bowel ischemia at the inferior portion of the silo during reduction through small openings that can serve as a constriction point of the bowel or mesentery ‘funnel effect’ .
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