Gastroschisis in Newborns: Surgical Techniques, Postoperative Care, and Prognostic Factors

Abstract

 Gastroschisis is a congenital paraumbilical abdominal wall defect characterized by evisceration of abdominal viscera without a protective sac. Although survival now exceeds 90% in well-resourced neonatal surgical systems, morbidity remains substantial and is driven primarily by the condition of the bowel, the presence of complex gastroschisis, and the pace of postoperative intestinal recovery. This narrative review synthesizes contemporary evidence on surgical closure, postoperative management, and prognostic factors in newborns with gastroschisis. Current guidelines support individualized closure based on bowel condition, abdominal domain, and physiologic tolerance. Primary fascial closure is appropriate when reduction can be achieved without clinically important respiratory or hemodynamic compromise, whereas staged silo reduction remains valuable when immediate reduction would create excessive intra-abdominal pressure. Sutureless closure has emerged as an effective alternative in selected infants and is associated with less general anesthesia exposure, shorter ventilation, and fewer surgical-site infections, but a higher risk of umbilical hernia and later hernia repair. Postoperative care is dominated by intestinal dysmotility, the need for parenteral nutrition, cautious transition to enteral feeding, prevention of central-line infection, and surveillance for cholestasis and other complications of prolonged intestinal failure. Protocolized feeding and avoidance of unnecessarily delayed enteral nutrition are supported predominantly by low- or very-low-certainty evidence, so recommendations should be applied with attention to clinical context. Prognosis is strongly influenced by the distinction between simple and complex gastroschisis; intestinal atresia, perforation, necrosis, or volvulus are associated with longer parenteral nutrition, delayed feeding autonomy, longer hospitalization, and increased risk of intestinal failure and bowel obstruction. Long-term survival is excellent for many patients, but gastrointestinal symptoms, reoperations, and possible neurodevelopmental vulnerabilities justify structured follow-up. The available literature remains heterogeneous, and high-quality multicenter prospective studies are needed to define optimal closure, nutritional strategies, and long-term surveillance