Gastroschisis: A Simple Technique for Staged Silo Closure

Abstract

The authors report their initial use of a preformed spring-loaded silicone rubber silo (Silastic®) bag (Figure 28.1) to cover the eviscerated gut in infants with gastroschisis. This was applied by the cot-side on the neonatal unit with the help of a sedative agent (Fentanyl). The eviscerated intestines were then gradually reduced over a number of days before formal surgical fascial closure was performed. Initially, this was undertaken in the operating room; however, later in the series cot-side silo removal and fascial closure under sedation was successful. From October 1992 to April 1994, the authors managed ten infants using this protocol. The results were compared with gastroschisis infants treated conventionally between August 1982 and June 1993. Though there was no actual statistical comparison, outcome measures such as time to full closure (range: two to eight days), time to full enteral nutrition (range: 11-25 days) and time to discharge (range 12-37 days) seemed similar. The procedure was well tolerated in the ten infants and there was no incidence of bowel injury, dehiscence of the closure, sepsis or necrotizing enterocolitis.