Early versus delayed silo closure in gastroschisis: a retrospective study
Pragati Sharma1, Parshotam Gera1, Shripada Rao2,3
1Department of Paediatric Surgery, Perth Children's Hospital, Nedlands, WA, Australia.
Insights
Early abdominal wall closure in gastroschisis infants (≤5 days) improved outcomes, reducing time to full feeds and hospital stay compared to delayed closure (>5 days). This approach enhances recovery for neonates with this congenital condition.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Gastroschisis management typically involves gradual reduction of herniated viscera using preformed silos.
- Delayed abdominal wall closure post-silo reduction may increase infant morbidities.
Purpose of the Study:
- To compare outcomes of gastroschisis infants based on abdominal wall closure timing: ≤5 days versus >5 days after birth.
Main Methods:
- Retrospective cohort study including 109 infants managed with primary silo and staged reduction.
- Infants were categorized into early-closure (≤5 days) and delayed-closure (>5 days) groups.
Main Results:
- Early closure (34 infants) showed significantly shorter median age at full feeds (15 days) and hospital stay (19 days) compared to delayed closure (75 infants) (24.5 days and 32 days, respectively).
- Delayed closure and complex gastroschisis were independently associated with longer time to full feeds and hospital stay.
- Mortality rate was low (2.7%) with no significant difference between groups.
Conclusions:
- Gradual silo reduction is effective for gastroschisis.
- Closing the abdominal wall defect within five days may further improve outcomes for neonates with gastroschisis.
Background:
A well accepted approach to the management of gastroschisis is gradual reduction of the herniated viscera using preformed silos followed by surgical closure of the abdominal wall defect. However, if the abdominal wall closure is delayed for a longer duration than necessary, it may increase morbidities. We sought to compare the outcomes of infants undergoing silo reduction whose abdominal wall defect was closed ≤ 5 days versus > 5 days after birth.
Methods:
Retrospective cohort study (January-2010 to December-2020).
Results:
One-hundred-and-nine infants who were managed using primary silo with staged reduction were included. Median gestation was 36.2 (interquartile range, IQR: 35.2, 37) weeks. Ten infants had complex gastroschisis. Thirty-four infants underwent early-closure of abdominal wall defect and 75 had delayed closure. Mortality rate was 2.7% (3/109; one in early and two in delayed closure). The median age at full feeds was 24.5 days (IQR 17.5, 30) in the delayed-closure group vs 15 (12.5, 22.5) in the early-closure group. The median hospital stay was 32 days (IQR 23, 43) vs 19 (15, 30) days. On multivariable analysis, delayed closure (Exponentiated regression coefficient ERC 1.40, 95% confidence interval CI: 1.05, 1.86, P = 0.020) and complex gastroschisis (ERC 2.03; 95% CI: 1.11, 3.72, P = 0.021) were associated with longer time to reach full feeds. Same factors were associated with longer duration of hospital stay.
Conclusions:
Gradual reduction using silos achieved excellent outcomes in neonates with gastroschisis. Completing the silo reduction and closing the abdominal wall within five days could further improve their outcomes.
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