title: Salvaging the severe congenital diaphragmatic hernia patient: is a silo the solution?
abstract: BACKGROUND
  Infants with severe congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) have a high morbidity and mortality. We hypothesized that placement of an abdominal wall silo and staged abdominal wall closure may reduce problems associated with decreased abdominal domain in CDH.
  
  
  METHODS
  We performed a retrospective review and identified 7 CDH patients requiring ECMO who had a silastic abdominal wall silo between 2003 and 2006. Variables analyzed included survival, ECMO duration, duration of silo, time to discharge, and long-term outcome.
  
  
  RESULTS
  Predicted mean survival for the entire cohort using the published CDH Study Group equation was 47% (range, 9%-86%). All 7 patients (100%) survived. Extracorporeal membrane oxygenation duration averaged 15 days (range, 5-19 days). Four of the patients (58%) were repaired with a silo on ECMO, and 3 (42%) had their repair after ECMO. The abdominal wall defect was closed at a mean of 21 days (range, 4-41 days). Hospital stay after silo placement averaged 54 days (range, 20-170 days) with no infections or wound complications.
  
  
  CONCLUSIONS
  Abdominal wall silo placement in infants with CDH requiring ECMO appears to be an effective strategy for decreased abdominal domain. Further studies are warranted to determine the efficacy of such a strategy for these high-risk CDH patients.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
authors.forename: Ankur R
authors.initials: AR
authors.lastname: Rana
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Khouri
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.forename: Robert A
authors.initials: RA
authors.lastname: Drongowski
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D001034:Apgar Score; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008170:Lung Compliance; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013536:Suture Techniques