Closing gastroschisis: The good, the bad, and the not-so ugly

J Pediatr Surg. 2019 Jan;54(1):60-64. doi: 10.1016/j.jpedsurg.2018.10.033. Epub 2018 Oct 5.


Purpose: The diagnosis of "closing" or "closed gastroschisis" is made when bowel is incarcerated within a closed or nearly closed ring of fascia, usually with associated bowel atresia. It has been described as having a high morbidity and mortality.

Methods: A retrospective review of closing gastroschisis cases (n = 53) at six children's hospitals between 2000 and 2016 was completed after IRB approval.

Results: A new classification system for this disease was developed to represent the spectrum of the disease: Type A (15%): ischemic bowel that is constricted at the ring but without atresia; Type B (51%): intestinal atresia with a mass of ischemic, but viable, external bowel (owing to constriction at the ring); Type C (26%): closing ring with nonviable external bowel +/- atresia; and Type D (8%): completely closed defect with either a nubbin of exposed tissue or no external bowel. Overall, 87% of infants survived, and long-term data are provided for each type.

Conclusions: This new classification system better captures the spectrum of disease and describes the expected long-term results for counseling. Unless the external bowel in a closing gastroschisis is clearly necrotic, it should be reduced and evaluated later. Survival was found to be much better than previously reported.

Type of study: Retrospective case series with no comparison group.

Level of evidence: Level IV.

Keywords: Atresia; Classification; Closed/closing; Gastroschisis; Short gut.

Publication types

  • Multicenter Study

MeSH terms

  • Digestive System Surgical Procedures / methods
  • Follow-Up Studies
  • Gastroschisis / classification*
  • Gastroschisis / mortality
  • Gastroschisis / surgery
  • Humans
  • Infant, Newborn
  • Intestinal Atresia / etiology
  • Intestines / surgery
  • Retrospective Studies
  • Survival Rate