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Closing arguments for gastroschisis: management with silo reduction
Bill Chiu1, John Lopoo, J David Hoover
1Children's Memorial Hospital Chicago, IL 60614, USA.
Insights
Primary closure (PC) for gastroschisis had more complications than silo closure (SC). Silo closure is recommended as the preferred treatment for gastroschisis due to better outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis management involves primary closure (PC) or silo closure (SC).
- A shift in practice from PC to SC has been observed.
- This study aimed to compare the outcomes of these two surgical techniques.
Purpose of the Study:
- To compare the outcomes of primary closure versus silo closure for gastroschisis.
- To evaluate complication rates and patient recovery metrics between the two closure methods.
Main Methods:
- Retrospective review of gastroschisis cases from 1994-2004.
- Data collected included closure type, ventilator days, time to full feeding, hospital stay, complications, and mortality.
- Statistical analysis was performed to compare outcomes between PC and SC groups.
Main Results:
- Primary closure (PC) was performed on 28 infants; silo closure (SC) on 20.
- No significant differences were found in ventilator days, days to full feeds, or hospital days.
- PC group had higher rates of closure-related complications (9 vs. 0), non-closure-related complications (8 vs. 2), necrotizing enterocolitis (4 vs. 0), and ventral hernias (5 vs. 1) compared to SC (P < 0.05 for all).
- No mortality was reported in either group.
Conclusions:
- Primary closure for gastroschisis is associated with a higher incidence of complications, including reclosure, non-closure-related issues, and necrotizing enterocolitis.
- Silo closure demonstrates superior outcomes and is recommended as the preferred treatment for gastroschisis.
Background:
There are two approaches to close gastroschisis. Primary closure (PC) is reduction and fascial closure; silo closure (SC) places viscera in a preformed-silo and reduces the contents over time. We have shifted from PC to SC. This study compared the outcomes of these two techniques.
Methods:
Records of babies with gastroschisis from 1994-2004 were reviewed. Closure type, ventilator days, days to full-feeds, hospital days, complications, and mortality were recorded.
Results:
Twenty-eight patients underwent PC; 20 patients had SC. Differences in ventilator days, days to full-feeds, and hospital days were not statistically significant. Nine PC patients developed closure-related complications vs. none in SC (P < 0.05). Eight PC vs. two SC patients had non-closure-related complications (P < 0.05). Four PC vs. zero SC patients developed necrotizing enterocolitis (P < 0.05). Five PC vs. one SC patients had ventral hernia (P < 0.05). No patient died.
Conclusion:
PC resulted in higher incidence of reclosure, non-closure-related complications, and necrotizing enterocolitis. Consequently, we recommend SC as the preferred treatment.
