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Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach
Marc Schlatter1, Kristen Norris, Neal Uitvlugt
1DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA.
Insights
Delayed surgical repair using a silo for gastroschisis (a congenital abdominal wall defect) in infants leads to better outcomes. This approach improves fascial closure rates and reduces complications compared to early repair.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a congenital defect requiring surgical intervention.
- Treatment strategies aim to optimize outcomes for affected infants.
- Comparing surgical approaches is crucial for evidence-based practice.
Purpose of the Study:
- To compare clinical outcomes of two surgical methods for gastroschisis.
- Evaluate early repair versus delayed repair with a silo.
Main Methods:
- Retrospective review of 65 infants with gastroschisis (1991-2000).
- Group I: attempted early repair (n=39).
- Group II: delayed repair after silo placement (n=26).
Main Results:
- Group II showed significantly higher fascial closure rates (96% vs 82%).
- Group II experienced fewer ventilator days, faster return of bowel function, and reduced complications (23% vs 56%).
- Hospital stay was shorter by an average of 14 days for Group II.
Conclusions:
- Initial silo placement followed by delayed repair improves outcomes in gastroschisis.
- This method is associated with better fascial closure, reduced morbidity, and shorter hospitalization.
- Delayed repair offers advantages over immediate surgical closure for gastroschisis.
Background/Purpose:
The aim of this study was to critically evaluate the clinical outcomes of two different surgical treatment approaches for infants born with gastroschisis.
Methods:
The medical records of 65 infants with gastroschisis treated at one institution from 1991 to 2000 were available. Infants in group I (prior to December 1998) underwent attempted early repair of the gastroschisis defect on their first day of life. Infants in group II had delayed repair after the initial placement of a preformed silo.
Results:
Group I had 39 patients; group II had 26 patients. The two groups were equal with respect to maternal age, gestational age, and birth weight. Complete reduction and fascial closure were accomplished for 32 patients (82%) in group I and 25 patients (96%) in group II (P <.02). Median time on the ventilator was significantly less for group II (P <.0001). Infants in group II had shorter times until first postoperative feeding (P <.01) and full feedings (P <.006). Group II had fewer complications than group I (23% v 56%; P <.01). There appeared to be less necrotizing enterocolitis in group II. The average length of hospital stay was 14 days less for group II.
Conclusions:
The use of a preformed silo initially followed by delayed fascial closure in infants with gastroschisis is associated with improved fascial closure rates, fewer ventilator days, more rapid return of bowel function, and fewer complications compared with attempts at initial early repair.
