Staged gastroschisis closure using Alexis wound retractor: first experiences.

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Surgical Devices

Background:

• Gastroschisis is a congenital abdominal wall defect requiring surgical intervention.
• Primary closure may not be feasible in severe cases, necessitating staged management.
• The Alexis wound retractor (AWR) is a device explored for its utility in such scenarios.

Purpose of the Study:

• To evaluate the effectiveness of the Alexis wound retractor (AWR) for staged gastroschisis closures.
• To analyze the outcomes of infants managed with AWR for gastroschisis.

Main Methods:

• Retrospective analysis of prenatal, post-natal, and operative data.
• The AWR device was used to create a silo for unreduced viscera in gastroschisis cases.
• Gradual reduction of abdominal contents was achieved via traction on the AWR.

Main Results:

• The AWR was utilized in eight cases of gastroschisis requiring staged closure.
• Complete reduction and fascial closure occurred at a median of 3.5 days.
• Patients required ventilatory support for a median of 4 days and full parenteral feeds for 7.5 days.

Conclusions:

• The Alexis wound retractor serves as a safe and effective silo for progressive reduction in severe gastroschisis.
• The AWR facilitates continuous stretching, increasing peritoneal cavity volume.
• This can help equalize viscero-abdominal disproportion, improving surgical outcomes.