Does gastroschisis reduction require general anesthesia?: A comparative analysis

Abstract Background Outcome after gastroschisis repair without general anesthesia is controversial, and published conclusions are variable with no comparative studies. Aim The aim of this study was to present a comparative study evaluating outcome after gastroschisis repair with and without general anesthesia. Methods An ambispective nonrandomized study of a cohort of 51 neonates born with gastroschisis between July 1998 and December 2003 was performed. Twenty-four neonates (group 1) had conventional reduction under general anesthesia, and 27 (group 2) cotside minimal intervention reductions were without general anesthesia. Results Groups were comparable regarding gestational age, birth weight, and quality of eviscerated bowel. Statistical significance ( P P > .05) was seen with respect to start of feeds (10.4 ± 3.6 vs 10.9 ± 4.1 days), duration of total parenteral nutrition (21.5 ± 7.3 vs 22.4 ± 6.8 days), and total hospital (stay 29 ± 10 vs 30 ± 13 days). Admission to the intensive care unit was required in 92% in group 1 for 1 to 6 days vs 7% in group 2 for 3 to 6 days. There was 1 death in group 1 (4%). Total hospital cost in group 1 was £12,283 ± £2438 vs £6208 ± £2120 in group 2 ( P = .013). Conclusions Neonates with gastroschisis, whose bowel was reduced without general anesthesia, have similar outcomes to those whose bowel was reduced under general anesthesia. Both approaches appear to be safe and effective, but reduction without general anesthesia was cost-effective.