Primary Closure versus Bedside Silo and Delayed Closure for Gastroschisis: A Truncated Prospective Randomized Trial

Abstract

Background We report a prospective randomized trial comparing primary closure (PC) to bedside silo and delayed closure (DC) for babies with gastroschisis.

Materials and Methods Patients were randomized to PC versus DC. We excluded those with atresia/necrosis, <34 weeks' gestation, or congenital anomalies. The primary outcome was length of stay (LOS).

Results A total of 38 patients were included from August 2011 to August 2016; 18 patients underwent DC and 20 PC. There were no differences in gestational age or birth weight. Fifty percent of PC patients were successfully closed with the rest closed at a median of 4 days (interquartile range [IQR]: 2–4 days). DC patients were closed at a median of 4 days after silo placement (IQR: 2–5.8 days). None of the patients in this series developed abdominal compartment syndrome after closure. Median LOS, median time to enteral tolerance, and median time on ventilation were not statistically different. Two patients (one DC and one PC) had bowel ischemia and necrosis following silo placement requiring reoperation. Four patients (two DC and two PC) were noted to have small umbilical defects; none have yet required operative correction.

Conclusion There were no differences seen between PC and DC in LOS, time to enteral feeds, or ventilator times.

Keywords

gastroschisis - randomized - silo - primary closure

• References

• 1 Skarsgard ED, Claydon J, Bouchard S. , et al; Canadian Pediatric Surgical Network. Canadian Pediatric Surgical Network: a population-based pediatric surgery network and database for analyzing surgical birth defects. The first 100 cases of gastroschisis. J Pediatr Surg 2008; 43 (01) 30-34
• 2 Baird R, Puligandla P, Skarsgard E, Laberge J-M. ; Canadian Pediatric Surgical Network. Infectious complications in the management of gastroschisis. Pediatr Surg Int 2012; 28 (04) 399-404
• 3 Minkes RK, Langer JC, Mazziotti MV, Skinner MA, Foglia RP. Routine insertion of a silastic spring-loaded silo for infants with gastroschisis. J Pediatr Surg 2000; 35 (06) 843-846
• 4 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 (03) 459-464
• 5 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
• 6 Kidd Jr JN, Jackson RJ, Smith SD, Wagner CW. Evolution of staged versus primary closure of gastroschisis. Ann Surg 2003; 237 (06) 759-764
• 7 Banyard D, Ramones T, Phillips SE, Leys CM, Rauth T, Yang EY. Method to our madness: an 18-year retrospective analysis on gastroschisis closure. J Pediatr Surg 2010; 45 (03) 579-584
• 8 Driver CP, Bowen J, Doig CM, Bianchi A, Dickson AP, Bruce J. The influence of delay in closure of the abdominal wall on outcome in gastroschisis. Pediatr Surg Int 2001; 17 (01) 32-34
• 9 Luck SR, Sherman JO, Raffensperger JG, Goldstein IR. Gastroschisis in 106 consecutive newborn infants. Surgery 1985; 98 (04) 677-683
• 10 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 (04) 845-857
• 11 Tsai M-H, Huang H-R, Chu S-M, Yang P-H, Lien R. Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair. Pediatr Neonatol 2010; 51 (06) 320-325
• 12 Fischer JD, Chun K, Moores DC, Andrews HG. Gastroschisis: a simple technique for staged silo closure. J Pediatr Surg 1995; 30 (08) 1169-1171
• 13 Bruzoni M, Jaramillo JD, Dunlap JL. , et al. Sutureless vs sutured gastroschisis closure: a prospective randomized controlled trial. J Am Coll Surg 2017; 224 (06) 1091-1096
• 14 Sandler A, Lawrence J, Meehan J, Phearman L, Soper R. A “plastic” sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 2004; 39 (05) 738-741
• 15 Dariel A, Poocharoen W, de Silva N, Pleasants H, Gerstle JT. Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation. Eur J Pediatr Surg 2015; 25 (01) 34-40
• 16 Zajac A, Bogusz B, Soltysiak P. , et al. Cosmetic outcomes of sutureless closure in gastroschisis. Eur J Pediatr Surg 2016; 26 (06) 537-541
• 17 Schlueter RK, Azarow KS, Hines AG. , et al. Identifying strategies to decrease infectious complications of gastroschisis repair. J Pediatr Surg 2015; 50 (01) 98-101
• 18 Orion KC, Krein M, Liao J, Shaaban AF, Pitcher GJ, Shilyansky J. Outcomes of plastic closure in gastroschisis. Surgery 2011; 150 (02) 177-185