title: Staged reduction of gastroschisis using preformed silos: practicalities and problems.
abstract: OBJECTIVE
  Previous single-center studies have reported favorable outcomes when preformed silos (PFS) are used for the staged reduction of gastroschisis. The aim of this study was to assess the frequency and nature of complications associated with PFS in a large population and provide an insight into the practicalities of their routine use.
  
  
  METHODS
  A retrospective review was carried out of all cases of gastroschisis managed with PFS in 4 UK neonatal surgical units for a 6-year period.
  
  
  RESULTS
  One hundred fifty infants were included, and 139 (92.7%) silos were applied at cot side (no sedation, n = 93). Median silo size was 4 cm, and time of application was 2.5 hours. Enlarging the defect by incision of fascia was required in 17 (11%). Defect closure was performed at a median of 4 days (0-47) with 93 (62%) being at cot side. Methods of closure were adhesive strips/dressings (n = 94), sutures (n = 48), and patch (n = 8). Discoloration of the viscera occurred in 16 (11%), managed successfully by simple methods (change of PFS, aspirating the stomach, or incision of the defect fascia) (n = 8), conversion to operative silo (n = 3), and operative reduction (n = 1). Four required bowel resection. Other complications included missed atresia (n = 5; 3.3%) and nectrotizing enterocolitis (n = 11; 7%). There were 5 deaths in the series (3.3%).
  
  
  CONCLUSIONS
  Staged reduction of gastroschisis with PFS is simple, convenient, and safe. The low rates of associated complications and mortality appear favorable when compared to infants managed with more traditional techniques. We recommend that PFS should be used for the routine management of gastroschisis.
authors: Pediatric Surgical Unit, Sheffield Children's Hospital, Sheffield, United Kingdom.
authors: Nick
authors: N
authors: Lansdale
authors: Richard
authors: R
authors: Hill
authors: Sobbia
authors: S
authors: Gull-Zamir
authors: Melanie
authors: M
authors: Drewett
authors: Emma
authors: E
authors: Parkinson
authors: Mark
authors: M
authors: Davenport
authors: Javaid
authors: J
authors: Sadiq
authors: Kokila
authors: K
authors: Lakhoo
authors: Sean
authors: S
authors: Marven
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D001915:Braces / Q000009:adverse effects; D002675:Child, Preschool; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome