The female condom as a temporary silo: A simple and inexpensive tool in the initial management of the newborn with gastroschisis

We herein describe a case of serial reduction of an extremely large and complex gastroschisis using vacuum-assisted closure (VAC) therapy in a boy born at 35 5/7 weeks' gestation. A spring-loaded silicone silo was placed at birth. By day of life (DOL) 22, minimal visceral contents had been reduced, and the silo was difficult to maintain due to the size of the fascial defect and loss of abdominal domain. A bespoke VAC dressing was constructed, and biweekly dressing changes allowed gradual reduction of the gastroschisis until the viscera were consolidated. By DOL 50, the viscera were completely reduced, and VAC therapy was discontinued. Feeds were commenced on DOL 57 and increased to goal by DOL 86. The baby was discharged home on DOL 115. We conclude that VAC dressings can be used to aid gradual reduction of an extremely large gastroschisis, particularly in medical fragile infants.

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“…13 14 15 In some resource-poor countries, locally sourced female condoms have been used when spring-loaded silicone silos are not available. 16…”

Section: Discussionmentioning

confidence: 99%

Serial Reduction of an Extremely Large Gastroschisis using Vacuum-Assisted Closure

Butler

Fuchs

Bruzoni

2018

European J Pediatr Surg Rep

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“…Once the baby was born, a temporary silo was placed under mild sedation in the NICU until surgery and was kept for an average of 2 days 15. The IVP was measured during the surgical procedure.…”

Section: Methodsmentioning

confidence: 99%

Does staged closure have a worse prognosis in gastroschisis?

Schmidt

Gonçalves

Bustorff‐Silva

et al. 2011

Clinics

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INTRODUCTION:Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established.OBJECTIVE:To compare the outcome of primary and staged closure in newborns with gastroschisis using intravesical pressure (IVP) as the decision criterion.PATIENTS & METHODS:We prospectively analyzed 45 newborns with gastroschisis. An IVP with a threshold of 20 cm H2O was used to indicate primary or staged closure, and the outcomes between the two methods were compared.RESULTS AND DISCUSSION:Newborns in whom primary closure was feasible were born at a lower gestational age. There was no significant difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay. Compared with previous reports, our data showed higher rates of prenatal diagnosis and cesarean delivery, a lower average birth weight, a higher rate of small gestational age babies and a more frequent association with intestinal atresia. Conversely, our data showed a lower rate of postoperative necrotizing enterocolitis and a lower average length of hospital stay.CONCLUSION:No significant difference was observed in the outcome of newborns who underwent primary closure or staged closure of gastroschisis when using an IVP below 20 cm H2O as the criterion for primary closure.

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“…These cases will require either primary or delayed bowel lengthening procedures [62]. Available silo materials [55,59,60].…”

Section: Intra-operative Decision Makingmentioning

confidence: 99%

Management of Gastroschisis

Obeida¹,

Shalaby²

2019

Pediatric Surgery, Flowcharts and Clinical Algorithms

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Gastroschisis (GS) is one of the congenital abdominal wall defects, in which the bowel has prolapsed without a covering through a defect adjacent to (and nearly always to the right of) an otherwise normal umbilicus. Proper management of such cases gives them the opportunity to survive and thrive. In this chapter, simplified flowcharts for the initial management of GS, surgical intra-operative decisions and post-operative active follow-up of such cases will be presented and discussed. The first flowchart will discuss how to deal with a GS case from birth till the operative theatre, while the second flowchart will take the lead to guide the surgeon with the available surgical options and how to choose the suitable one for the case. Finally, the post-operative active follow-up fluid management and possible complications are discussed.

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The female condom as a temporary silo: A simple and inexpensive tool in the initial management of the newborn with gastroschisis

Abstract: The use of a female condom as a silon pouch is a low-cost and simple alternative in the initial management of newborns with gastroschisis in whom primary correction is considered non-feasible.

Cited by 9 publications

References 16 publications

Serial Reduction of an Extremely Large Gastroschisis using Vacuum-Assisted Closure

Serial Reduction of an Extremely Large Gastroschisis using Vacuum-Assisted Closure

Does staged closure have a worse prognosis in gastroschisis?

Management of Gastroschisis

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