Abstract
Introduction
Primary suture-less closure of gastroschisis using negative pressure dressing (wound
vacuum) involves the application of an initial preformed Silo with subsequent bedside
suture-less closure of the defect using negative pressure dressing. The advantages
of this gentle approach are the simple bedside closure without intubation, paralysis
or ventilation as well as reduced risk of barotrauma, abdominal compartment syndrome,
acidosis, bowel infarction and necrotizing enterocolitis. This study is a report of
the technique we used for gastroschisis closure at our institute.
Methods
The medical records of 15 newborns who underwent primary suture-less closure of gastroschisis
using a negative pressure dressing (wound vacuum) technique between March 2008 and
February 2010 were retrospectively reviewed. Outcome criteria such as time on ventilation,
time to initiating feeds, time to full feeds, time to discharge from NICU and complications
were recorded.
Results
The median follow-up was 234 days (range: 13–528 days). The time on ventilation was
(n=8: no ventilation; n=3: 1 day; n=2: 2–5 days; n=2:>5 days). The median time to
initiating feeds was 13 days (range: 6–61 days), the median time to full feeds was
20 days (range: 12–91 days) and the median time to discharge was 24 days (range: 21–131
days). 2 patients had a tiny umbilical hernia at last follow-up.
Conclusion
Primary suture-less closure of gastroschisis using a negative pressure dressing (wound
vacuum) technique is easily reversible, does not need intubation/ventilation, avoids
a trip to the operating room (OR), has minimal to no complications and provides good
cosmetic results.
Key words
gastroschisis - wound vacuum - abdominal wall defects - suture-less closure of gastroschisis
- primary closure of gastroschisis
