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Routine insertion of a silastic spring-loaded silo for infants with gastroschisis.
R K Minkes1, J C Langer, M V Mazziotti
1Department of Surgery, St Louis Children's Hospital and Washington University School of Medicine, Missouri 63110, USA.
Journal of Pediatric Surgery
|June 29, 2000
Summary
Routine use of a spring-loaded silo (SLS) for gastroschisis management leads to better outcomes than emergency closure (EC). The SLS approach resulted in shorter hospital stays, reduced ventilator days, and fewer complications.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Innovation
Background:
- Gastroschisis management traditionally involves emergency operating room closure (EC).
- A silo is typically reserved for cases requiring staged repair.
- A new approach using routine spring-loaded silo (SLS) insertion followed by elective closure was adopted.
Purpose of the Study:
- To compare the outcomes of routine spring-loaded silo (SLS) insertion versus emergency closure (EC) for gastroschisis.
- To evaluate the impact of SLS on patient recovery and hospital resource utilization.
Main Methods:
- A cohort of 43 consecutive neonates with gastroschisis was studied.
- Patients were divided into two groups: those undergoing EC and those treated with SLS followed by elective closure.
- Data collected included length of stay, ventilator days, airway pressures, time to full feedings, complications, and hospital charges.
Main Results:
- The SLS group had a significantly shorter median length of stay (25 vs 32 days, P=.05).
- SLS patients required fewer ventilator days (4 vs 6 days, P=.03) and experienced lower peak airway pressures.
- The SLS group also showed fewer complications and lower median hospital charges ($71,498 vs $85,147, P=.05).
Conclusions:
- Routine spring-loaded silo (SLS) insertion facilitates gentle, gradual reduction of viscera in gastroschisis.
- SLS is associated with improved clinical outcomes compared to emergency closure (EC).
- This approach leads to reduced airway pressures, earlier extubation, fewer complications, shorter hospital stays, and decreased costs.