Closing arguments for gastroschisis: management with silo reduction.
BACKGROUND
There are two approaches to close gastroschisis. Primary closure (PC) is reduction and fascial closure; silo closure (SC) places viscera in a preformed-silo and reduces the contents over time. We have shifted from PC to SC. This study compared the outcomes of these two techniques.


METHODS
Records of babies with gastroschisis from 1994-2004 were reviewed. Closure type, ventilator days, days to full-feeds, hospital days, complications, and mortality were recorded.


RESULTS
Twenty-eight patients underwent PC; 20 patients had SC. Differences in ventilator days, days to full-feeds, and hospital days were not statistically significant. Nine PC patients developed closure-related complications vs. none in SC (P < 0.05). Eight PC vs. two SC patients had non-closure-related complications (P < 0.05). Four PC vs. zero SC patients developed necrotizing enterocolitis (P < 0.05). Five PC vs. one SC patients had ventral hernia (P < 0.05). No patient died.


CONCLUSIONS
PC resulted in higher incidence of reclosure, non-closure-related complications, and necrotizing enterocolitis. Consequently, we recommend SC as the preferred treatment.
Chiu
Bill
B
Children's Memorial Hospital Chicago, IL 60614, USA.
Lopoo
John
J
Hoover
J David
JD
Almond
P Stephen
PS
Arensman
Robert
R
Madonna
Mary Beth
MB
D000009:Abdominal Muscles / Q000002:abnormalities / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000209:etiology; D005205:Fascia / Q000002:abnormalities; D000071938:Fasciotomy; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013536:Suture Techniques