A Controlled Trial of Immediate and Delayed Closure of Spina Bifida Cystica

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Abstract
A controlled trial of immediate operative closure compared with no closure of myelomeningoceles in the napkin area in 40 newborn infants failed to disclose any advantage in conservative management provided that the closure was done within 48 hours of birth. The differences between the operated and the unoperated group were in favour of those treated by immediate operation as to mortality, local sepsis, meningitis and ventriculitis, muscle paralysis or duration of hospital stay. Muscle paralysis, in particular, diminished in many infants operated upon immediately, but increased in many treated conservatively. Although statistical analysis does not allow firm conclusions to be drawn about any single aspect of the analysis, summation of the trends in various aspects was sufficiently conclusive to us to make it ethically unjustifiable to continue the experiment and investigation further. The main conclusion of the trial was that operative closure of a myelomeningocele should be regarded as a surgical emergency.