Preformed silos versus traditional abdominal wall closure in gastroschisis: 163 infants at a single institution
Paul Charlesworth1, Ibiyinka Akinnola1, Charlotte Hammerton1
1Department of Paediatric Surgery, Kings College Hospital, London, United Kingdom.
Insights
Preformed silo (PFS) application for gastroschisis (GS) closure in infants resulted in less ventilation time compared to primary closure or surgical silo methods. Outcomes like feeding, hospital stay, and mortality showed no significant differences between techniques.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Gastroschisis (GS) management involves surgical closure, with primary closure (PC) or surgical silo (SS) and preformed silo (PFS) techniques being common.
- Comparative outcome data for these gastroschisis management strategies remain limited.
Purpose of the Study:
- To compare the outcomes of preformed silo (PFS) application versus primary closure (PC) or surgical silo (SS) for gastroschisis (GS) abdominal wall closure.
Main Methods:
- Retrospective review of 163 infants with gastroschisis treated between 1993 and 2012.
- Data collected included gestational age, birth weight, time to enteral feeding, hospital stay, and complications.
- Infants treated with PFS (n=67) were compared to those treated with PC/SS (n=89).
Main Results:
- No significant differences were observed in gestational age, birth weight, time to first or full enteral feeding, hospital stay, necrotizing enterocolitis, or mortality between PFS and PC/SS groups.
- Infants treated with PC + SS required significantly longer ventilation duration (5 days) compared to those treated with PFS (3.5 days).
- Closure occurred significantly later in the PC + SS group (day 6) versus the PFS group (day 0).
Conclusions:
- Preformed silo (PFS) application for gastroschisis is associated with reduced ventilation requirements compared to primary closure (PC) or surgical silo (SS) methods.
- There were no significant differences in major outcomes such as time to full feeds, length of hospital stay, mortality, or morbidity between the two management strategies.
Introduction:
The surgical management of gastroschisis (GS) is controversial. The most commonly used strategy for abdominal wall closure is surgery on day 1 of life with the aim of primary closure (PC) or construction of a surgical silo (SS) and secondary closure thereafter. The other widely used technique is application of a preformed silo (PFS) and reduction of contents over a few days before final closure. There is still a paucity of comparative outcome data.
Methods:
A retrospective case note review of all infants initially treated at a single institution between October 1993 and October 2012. PFS was adopted as the technique of choice in April 2005. Infants with closed or closing GS were excluded. Data are presented as median (range). p < 0.05 were significant.
Results:
There were 163 infants (156 complete data sets). PFSs were applied in 67 infants and PC/SS were applied in 89 infants of whom 19 infants required a SS. There was no statistical difference between gestational age (p = 0.8), birth weight (p = 0.7), time to first (p = 0.07) and full enteral feeding (p = 0.08), length of hospital stay (p = 0.17), or necrotizing enterocolitis (p = 0.4) and mortality (p = 0.4). Infants treated with PC + SS were closed on day 0 (range, 0-11 days) versus day 6 (range, 2-22 days) of life (p < 0.001). PC + SS were ventilated for day 5 (range, 1-22 days) versus day 3.5 (range, 0-20 days) days (p = 0.01).
Conclusion:
Infants treated with PFS required less ventilation than those treated by PC + SS. There was no difference in time to full feeds, length of hospital stay mortality or morbidity.
