Primary suture-less closure of gastroschisis using negative pressure dressing (wound vacuum)
S F Hassan, S Hassan1, A Pimpalwar
1Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, United States.
Introduction:
Primary suture-less closure of gastroschisis using negative pressure dressing (wound vacuum) involves the application of an initial preformed Silo with subsequent bedside suture-less closure of the defect using negative pressure dressing. The advantages of this gentle approach are the simple bedside closure without intubation, paralysis or ventilation as well as reduced risk of barotrauma, abdominal compartment syndrome, acidosis, bowel infarction and necrotizing enterocolitis. This study is a report of the technique we used for gastroschisis closure at our institute.
Methods:
The medical records of 15 newborns who underwent primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique between March 2008 and February 2010 were retrospectively reviewed. Outcome criteria such as time on ventilation, time to initiating feeds, time to full feeds, time to discharge from NICU and complications were recorded.
Results:
The median follow-up was 234 days (range: 13-528 days). The time on ventilation was (n = 8: no ventilation; n = 3: 1 day; n = 2: 2-5 days; n = 2: > 5 days). The median time to initiating feeds was 13 days (range: 6-61 days), the median time to full feeds was 20 days (range: 12-91 days) and the median time to discharge was 24 days (range: 21-131 days). 2 patients had a tiny umbilical hernia at last follow-up.
Conclusion:
Primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique is easily reversible, does not need intubation/ventilation, avoids a trip to the operating room (OR), has minimal to no complications and provides good cosmetic results.
