Gastroschisis wringer clamp: a safe, simplified method for delayed primary closure.

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Congenital anomalies

Background:

• Gastroschisis requires abdominal wall closure in newborns.
• Primary closure is not always feasible, necessitating delayed primary closure (DPC).
• Silastic silos are used to protect the eviscerated organs during DPC.

Purpose of the Study:

• To describe the experience with the gastroschisis wringer clamp (GWC) for DPC in gastroschisis.
• To evaluate the safety and efficacy of the GWC in facilitating delayed primary closure.
• To advocate for the GWC as a preferred method for DPC in gastroschisis.

Main Methods:

• The gastroschisis wringer clamp (GWC), an aluminum alloy device with serrated rollers, was used.
• The GWC was applied to a Silastic silo containing the eviscerated intestines.
• Daily adjustments of the GWC were made based on the infant's cardiopulmonary status.

Main Results:

• 30 infants with gastroschisis were treated with a Silastic silo and GWC for DPC.
• Delayed primary closure was performed at an average of 6.7 days post-application.
• Mean mechanical ventilation duration was 3.8 days; three patients had silo-fascia dehiscence, with no deaths.

Conclusions:

• The GWC facilitates delayed primary closure by protecting the intestine and converting the defect.
• The device offers technical advantages and is reversible if the infant's condition deteriorates.
• The GWC is a recommended method for newborns with gastroschisis requiring DPC.