Spatulated umbilical cord technique embracing Wharton’s jelly for gastroschisis repair

The purpose was to prospectively analyze outcomes of gastroschisis closure using the Spatulated Umbilical Cord technique (SUCT). In SUCT, the umbilical cord is split open and used to cover the abdominal defect. The procedure involved opening the amnion layer from the base, exposing Wharton’s jelly and ‘spatulating’ using longitudinal incisions and securing it as a patch over the defect. A pilot interventional study was conducted prospectively at 3 centres from 2016 to 2023 with follow-up till 2024. The inclusion criteria included uncomplicated gastroschisis, where primary fascial closure was at risk of developing compartment syndrome (CS). The outcome measures were success rates (no CS), post-operative ventilation, days of parenteral nutrition (PN), time to full enteral feeds and complications. SUCT was successful in 80% (8/10) of the total cases. The median (min/max range) duration of mechanical ventilation required in 8 patients was 3(2–6) days. Two patients did not require mechanical ventilation. The median (min/max range) time-to-start enteral feeds(n = 9) was 8 (2–11) days and time to achieve goal enteral feeding (n = 9) was 20(5–48) days. Partial PN(n = 8) was given for 17(10–46) days. 2/10 patients needed re-laparotomy following CS, one succumbed. Other complications included wound infection (2/10), intestinal obstruction (1/10), persistent umbilical hernia (1/10), and sepsis-associated mortality (1/10). At a median follow-up of 61(36–92) months, 8 survivors were healthy. To conclude, SUCT is safe and feasible. Mesenchymal stromal cells from Wharton’s jelly have wound-healing properties through paracrine signalling and enhanced migration of fibroblasts.