ABSTRACT: Twenty two patients of gastroschisis were admitted to Pediatric surgical unit of Kalawati Saran Children's Hospital of Lady Hardinge Medical College, Delhi, India between January 1991 and July 1997 who underwent surgical repair of the defect and 9 (40.9 percent) survived. The practice of performing primary fascial closure in small neonates with oedematous, compromised gut lying outside has been associated with unacceptably high rate of complications and is not preferred by all In our study, none of the patients who underwent primary fascial closure survived; whereas a survival rate of 50 percent was achieved for the patients treated with either mesh 'silo' closure or skin flap closure followed by delayed fascial closure. The skin flap method was used for premature, low birth weight babies with small amount of eviscerated contents without associated gut anomalies; whereas indications for 'silo' cover were full blown gastroschisis and associated gut anomalies which would be corrected on 5th to 7th postoperative day during final fascial closure. In view of nonavailbility of T.P.N. and inadequate ventilatory facilities, this approach seems to be reasonable and in combination with positive attitude of the treating physicians, a good outcome can be expected. An early return of peristalsis achieved by above mentioned techniques of closure facilitated institution of enteral nutrition and ventilation was used only when absolutely necessary. An individualized approach based upon clinical findings should be selected for each patient for optimal outcome.

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