GASTROSCHISIS: SYSTEMATIC REVIEW ON PATHOPHYSIOLOGY, ABDOMINAL WALL CLOSURE STRATEGIES, AND NEONATAL PROGNOSTIC CHALLENGES

Abstract

Objective: The overall objective of this study is to analyze the scientific literature on gastroschisis, identifying the pathophysiological mechanisms, the main associated postoperative complications, and current surgical correction techniques. Methodology: This is a systematic review focused on understanding the essential aspects of gastroschisis, from the fetal period to long-term outcomes. The research was guided by the question: "What are the best surgical approaches and the main systemic complications in the management of newborns with gastroschisis?". Nineteen scientific articles addressing clinical differentiation, closure strategies, and innovations in nutritional support were critically analyzed. Results: The severity of the disease is fundamentally dictated by its classification as simple or complex gastroschisis, the latter being associated with intestinal atresia, necrosis, or volvulus, which drastically increases mortality and length of hospital stay. The central surgical debate revolves around the method of abdominal wall closure: primary closure, staged use of a silo (ideally for less than five days to avoid hernias and infections), and the innovative sutureless ("bedside closure") technique, which eliminates the need for general anesthesia. Profound systemic complications include prolonged dependence on parenteral nutrition and the risk of sepsis, mitigable through the implementation of rigorous early feeding protocols and techniques such as sham feeding to prevent oral aversions. Conclusion: Gastroschisis requires a multidisciplinary and highly individualized approach. Placement in integrated birth centers, optimization of surgical techniques to minimize intra-abdominal pressure, and standardization of nutritional support are fundamental pillars for reducing the high complication rates and improving the quality of life and long-term survival of these newborns.