Preformed Silos versus Traditional Abdominal Wall Closure in Gastroschisis: 163 Infants at a Single Institution
16 May 2013
22 August 2013
25 October 2013 (eFirst)
Introduction The surgical management of gastroschisis (GS) is controversial. The most commonly used strategy for abdominal wall closure is surgery on day 1 of life with the aim of primary closure (PC) or construction of a surgical silo (SS) and secondary closure thereafter. The other widely used technique is application of a preformed silo (PFS) and reduction of contents over a few days before final closure. There is still a paucity of comparative outcome data.
Methods A retrospective case note review of all infants initially treated at a single institution between October 1993 and October 2012. PFS was adopted as the technique of choice in April 2005. Infants with closed or closing GS were excluded. Data are presented as median (range). p < 0.05 were significant.
Results There were 163 infants (156 complete data sets). PFSs were applied in 67 infants and PC/SS were applied in 89 infants of whom 19 infants required a SS. There was no statistical difference between gestational age (p = 0.8), birth weight (p = 0.7), time to first (p = 0.07) and full enteral feeding (p = 0.08), length of hospital stay (p = 0.17), or necrotizing enterocolitis (p = 0.4) and mortality (p = 0.4). Infants treated with PC + SS were closed on day 0 (range, 0–11 days) versus day 6 (range, 2–22 days) of life (p < 0.001). PC + SS were ventilated for day 5 (range, 1–22 days) versus day 3.5 (range, 0–20 days) days (p = 0.01).
Conclusion Infants treated with PFS required less ventilation than those treated by PC + SS. There was no difference in time to full feeds, length of hospital stay mortality or morbidity.
- 1 Penman DG, Fisher RM, Noblett HR, Soothill PW. Increase in incidence of gastroschisis in the south west of England in 1995. Br J Obstet Gynaecol 1998; 105 (3) 328-331
- 2 Kilby MD. The incidence of gastroschisis. BMJ 2006; 332 (7536) 250-251
- 3 Watkins D. Gastroschisis. Va Med Mon 1943; 70: 42
- 4 Di Lorenzo M, Yazbeck S, Ducharme JC. Gastroschisis: a 15-year experience. J Pediatr Surg 1987; 22 (8) 710-712
- 5 Schuster SR. A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet 1967; 125 (4) 837-850
- 6 Bower RJ, Bell MJ, Ternberg JL, Cobb ML. Ventilatory support and primary closure of gastroschisis. Surgery 1982; 91 (1) 52-55
- 7 Charlesworth P, Njere I, Allotey J , et al. Postnatal outcome in gastroschisis: effect of birth weight and gestational age. J Pediatr Surg 2007; 42 (5) 815-818
- 8 Fischer JD, Chun K, Moores DC, Andrews HG. Gastroschisis: a simple technique for staged silo closure. J Pediatr Surg 1995; 30 (8) 1169-1171
- 9 Schlatter M, Norris K, Uitvlugt N, DeCou J, Connors R. Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach. J Pediatr Surg 2003; 38 (3) 459-464, discussion 459–464
- 10 Kidd Jr JN, Jackson RJ, Smith SD, Wagner CW. Evolution of staged versus primary closure of gastroschisis. Ann Surg 2003; 237 (6) 759-764 , discussion 764–765
- 11 Lansdale N, Hill R, Gull-Zamir S , et al. Staged reduction of gastroschisis using preformed silos: practicalities and problems. J Pediatr Surg 2009; 44 (11) 2126-2129
- 12 Allotey J, Davenport M, Njere I , et al. Benefit of preformed silos in the management of gastroschisis. Pediatr Surg Int 2007; 23 (11) 1065-1069
- 13 Zani A, Ruttenstock E, Davenport M, Ade-Ajayi N. Is there unity in Europe? First survey of EUPSA delegates on the management of gastroschisis. Eur J Pediatr Surg 2013; 23 (1) 19-24
- 14 Aldrink JH, Caniano DA, Nwomeh BC. Variability in gastroschisis management: a survey of North American pediatric surgery training programs. J Surg Res 2012; 176 (1) 159-163
- 15 Pastor AC, Phillips JD, Fenton SJ , et al. Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial. J Pediatr Surg 2008; 43 (10) 1807-1812
- 16 Weil BR, Leys CM, Rescorla FJ. The jury is still out: changes in gastroschisis management over the last decade are associated with both benefits and shortcomings. J Pediatr Surg 2012; 47 (1) 119-124
- 17 Bradnock TJ, Marven S, Owen A , et al; BAPS-CASS. Gastroschisis: one year outcomes from national cohort study. BMJ 2011; 343: d6749
- 18 Kunz SN, Tieder JS, Whitlock K, Jackson JC, Avansino JR. Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg 2013; 48 (4) 845-857
- 19 Shalaby A, Davenport M. Closed gastroschisis. Pediatr Surg Int 2011; 27 (3) 335
- 20 Houben C, Davenport M, Ade-Ajayi N, Flack N, Patel S. Closing gastroschisis: diagnosis, management, and outcomes. J Pediatr Surg 2009; 44 (2) 343-347
- 21 Owen A, Marven S, Johnson P , et al; BAPS-CASS. Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 2010; 45 (9) 1808-1816
- 22 Komuro H, Hoshino N, Urita Y , et al. Pathogenic implications of remnant vitelline structures in gastroschisis. J Pediatr Surg 2010; 45 (10) 2025-2029
- 23 Chiu B, Lopoo J, Hoover JD, Almond PS, Arensman R, Madonna MB. Closing arguments for gastroschisis: management with silo reduction. J Perinat Med 2006; 34 (3) 243-245
- 24 Choi WW, McBride CA, Bourke C , et al. Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit. J Pediatr Surg 2012; 47 (8) 1516-1520
- 25 Wu Y, Vogel AM, Sailhamer EA , et al. Primary insertion of a silastic spring-loaded silo for gastroschisis. Am Surg 2003; 69 (12) 1083-1086