Benefit of preformed silos in the management of gastroschisis.
Gastroschisis is traditionally managed by primary closure (PC) or delayed closure after surgical silo placement. Bedside insertion of preformed silos (PFS) and delayed closure has become more widespread, although its benefits remain unclear. To identify differences in outcome of infants managed with PFS compared with traditional closure (TC) techniques. Single-centre retrospective review of 53 consecutive neonates admitted between February 2000 and January 2006. Data expressed as median (range). Non-parametric statistical analysis used with P < 0.05 regarded as significant. Forty infants underwent TC and 13 had PFS and delayed closure. Median ventilation time in both groups was 4 days (P = 0.19) however this was achieved with higher mean airway pressures (MAPs) (day 0, 10 (5-16) versus 8 (5-10) cmH(2)O; P = 0.02) and inspired oxygen (40 (21-100) versus 30 (21-60)%; P = 0.03) in TC group. Urine output on day-1 of life was significantly higher in PFS group (1.1 (0.16-3.07) versus 0.45 (0-2.8) ml/kg/h; P = 0.02). Inotrope support was required in 17/40 (43%) of TC versus 0/13 (0%) in PFS (P < 0.01). After exclusion of infants with short bowel syndrome and/or intestinal atresia (n = 9), there was a shorter time to full enteral feeds in the TC group (22 (12-36) versus 27 (17-45); P = 0.07), although there was no difference in the period of parenteral nutrition (PN) (P = 0.1) or overall hospital stay (P = 0.34). No deaths or episodes of necrotizing enterocolitis occurred. The use of PFS for gastroschisis closure is associated with a reduction in pulmonary barotrauma, better tissue perfusion and improved early renal function, consistent with a reduction in abdominal compartment syndrome.
Allotey
J
J
Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Davenport
M
M
Njere
I
I
Charlesworth
P
P
Greenough
A
A
Ade-Ajayi
N
N
Patel
S
S
D034861:Abdominal Wall / Q000601:surgery*; D001672:Biocompatible Materials; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D012826:Silicone Elastomers; D016896:Treatment Outcome
D001672:Biocompatible Materials; D012826:Silicone Elastomers
Pediatr Surg Int. 2001 Mar;17(2-3):242-4
11315303
J Pediatr Surg. 1996 Feb;31(2):280-2
8938360
J Pediatr Surg. 2000 Dec;35(12):1719-23
11101722
Am Surg. 1989 Apr;55(4):209-11
2523206
J Perinat Med. 2006;34(3):243-5
16602846
Ann Surg. 2003 Jun;237(6):759-64; discussion 764-5
12796571
Anesthesiology. 1988 Jul;69(1):84-8
2968772
J Pediatr Surg. 2001 Dec;36(12 ):1834-7
11733918
Pediatr Surg Int. 2001;17(1):32-4
11294264
J Pediatr Surg. 2003 Mar;38(3):459-64; discussion 459-64
12632367
Am Surg. 2003 Dec;69(12):1083-6
14700295
J Pediatr Surg. 1995 Aug;30(8):1169-71
7472975
J Pediatr Surg. 2000 Jun;35(6):843-6
10873023
J Pediatr Surg. 2006 Nov;41(11):1830-5
17101353
J Pediatr Surg. 1998 Mar;33(3):497-9
9537565
Pediatr Surg Int. 1997;12(1):34-7
9035207
J Pediatr Surg. 1993 Oct;28(10):1370-4; discussion 1374-5
8263703
Eur J Pediatr Surg. 2006 Apr;16(2):79-83
16685611