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Published on: February 5, 2019
Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled
Aimee C Pastor1, J Duncan Phillips, Stephen J Fenton
1Pediatric General Surgery, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Routine use of preformed silos for infants with gastroschisis showed similar outcomes to primary closure, with a trend toward fewer ventilator days. This approach allows for more elective abdominal wall closure.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Retrospective studies suggest preformed silos improve outcomes in gastroschisis.
- A prospective multicenter randomized controlled trial was conducted to evaluate this hypothesis.
Purpose of the Study:
- To compare the outcomes of routine preformed silo placement versus primary closure in infants with gastroschisis.
Main Methods:
- Infants were randomized to either routine bedside placement of a preformed Silastic spring-loaded silo or primary closure.
- Outcomes assessed included ventilator days, total parenteral nutrition duration, length of stay, and incidence of sepsis and necrotizing enterocolitis.
Main Results:
- No significant differences were observed in age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery between the groups.
- The spring-loaded silo group had fewer ventilator days (3.2 vs. 5.3), though not statistically significant (P = .07).
- Similar rates of total parenteral nutrition, length of stay, sepsis, and necrotizing enterocolitis were found in both groups.
Conclusions:
- Routine preformed silo use in gastroschisis is associated with comparable outcomes to primary closure.
- A trend towards reduced ventilator days was noted with preformed silos.
- Preformed silos facilitate elective abdominal wall closure, offering a potential surgical advantage.
Background:
Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis.
Methods:
Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure.
Results:
There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis.
Conclusion:
Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting.