Closing arguments for gastroschisis: management with silo reduction

Chiu, Bill; Lopoo, John B.; Hoover, J.; Almond, P. S.; Arensman, Robert M.; Madonna, Mary Beth

doi:10.1515/jpm.2006.043

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…The average length of ventilation; however, was fairly short (average of 3 days, range 1-8) in the PC group when compared with another study [10] and with the POC and the SSC groups (average of 3.9 and 3.1 days, respectively). Furthermore, there were no observed increased rates of morbidity related to the mechanical ventilation.…”

Section: (25-5) 34 (2-5) Nsmentioning

confidence: 59%

“…Average size of effect 208 (1.5-3.5) by fascial closure was associated with minimal time of mechanic ventilation, faster establishment of feeds and shorter length of stay [9,10]. The concept of PC, initially described by Sandler et al [1], is a technique, whereby a silo is initially placed; after complete reduction of the extruded viscera the fascia is left open and a dressing (usually utilizing the umbilical cord and a non-adherent dressing) is placed on the defect obviating the need for formal operative closure.…”

Section: Discussionmentioning

confidence: 99%

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Non-operative management of gastroschisis: a case-matched study

et al. 2008

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Non-operative management of gastroschisis also known as plastic closure (PC) has been described as an alternative to conventional primary operative closure (POC) or staged silo closure (SSC). The aim of this study was to compare these techniques in neonates with gastroschisis. A retrospective review of neonates with gastroschisis who underwent PC was undertaken. The minimum follow-up was 1 year. Premature neonates (<35 weeks) and those with intestinal atresia or multiple congenital anomalies were excluded. Frequency matching of PC cases with two control groups with either POC or SSC was performed on 1:1 ratio, based on gestational age and birth weight. Statistical analysis using univariate analysis was performed. Three groups were assembled: PC, POC and SSC (n = 33). Median follow-up was 1,198 days. Groups were comparable with regard to: time to first feed, time to full enteral feeding, frequency of vascular access related infections, ventilation time, NICU LOS (length of stay) and hospital LOS. There was no difference observed in surgical complications. Almost all neonates in the PC group developed an umbilical hernia (83.8%). Umbilical hernias were highly associated with PC compared to the other two groups P = 0.001. To date only one patient has had to have an operative repair of the umbilical hernia in the PC group. Plastic closure is safe and comparable to conventional closure techniques. However, PC is associated with the development of more umbilical hernias. The natural history of these hernias remains to be defined.

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Section: (25-5) 34 (2-5) Nsmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Non-operative management of gastroschisis: a case-matched study

et al. 2008

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“…Some authors have found better results by inserting a spring-loaded silo and allowing the gradual reduction of the viscera in patients whenever primary closure is not possible [24][25][26][27][28]. In 2001, our center began to routinely insert a spring-loaded silo in the NICU, whenever primary reduction of the viscera was not readily achievable.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?

et al. 2009

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“…Although these studies have not been randomized, the results between both treatment strategies have been disparate. For example, wide ranges were observed for the length of stay (LOS) (27-40 vs 25-38 days), days on mechanical ventilation (2.5-6 vs 0-8.6), time to full feeds (26-34 vs 19-31), and rate of complications (14-57 vs 3-37) for PR versus RS, respectively [4][5][6][7][8][9]. Further complicating our interpretation of these results is the fact that nearly all studies have combined patients who failed PR and required a silo with those patients who had a silo placed without any attempt at intestinal reduction, an RS.…”

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confidence: 99%