No free ride? The hidden costs of delayed operative management using a spring-loaded silo for gastroschisis

Journal of Pediatric Surgery
Jennifer D LoboGeorge B Mychaliska

Abstract

The ideal management of gastroschisis (primary vs staged closure) has not yet been established. Despite the ease of silo placement, anecdotal experience shows that silos do not always offer benefit. The aim of this study was to highlight concerns regarding use of spring loaded silos and compare outcomes to primary closure. Thirty-seven neonates with gastroschisis treated with either primary (n = 10) or staged closure with a spring-loaded silo (n = 27) were reviewed (1998-2007). Variables included ventilator days, daily intravenous fluid, hospital days, and complication rates. SPSS (SPSS Inc, Chicago, Ill) was used to perform t test and chi(2) analyses (significance P < .05). Survival for primary closure was 100% (10/10) compared to 89% (24/27) for staged closure (P = .548). Patients managed with silos required prolonged ventilation (16.1 +/- 4 days vs 3.6 +/- 1 days; P < or = .05) and greater intravenous fluids on days 3, 4, and 5 of life (132 +/- 25 mL/kg per day vs 104 +/- 18 mL/kg per day; P < or = .01). Although there was no difference in the complication rates between the groups, several problems were evident in the silo group: 15% (4/27) required silo replacement, 44% (12/27) required fascial defect enlargement for silo p...Continue Reading

References

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Citations

Feb 15, 2012·Pediatric Surgery International·Arash SafaviSonia Butterworth
Dec 3, 2014·Seminars in Pediatric Surgery·Piergiorgio Gamba, Paola Midrio
Dec 10, 2014·Journal of Pediatric Surgery·Leslie A LuskUNKNOWN University of California Fetal Consortium
Jun 19, 2012·Journal of Pediatric Surgery·Brian T BucherJacqueline M Saito
May 19, 2012·The Surgical Clinics of North America·Daniel J Ledbetter
Jul 9, 2011·The Journal of Surgical Research·Jennifer H AldrinkBenedict C Nwomeh
Dec 3, 2014·Early Human Development·Bhanumathi Lakshminarayanan, Kokila Lakhoo
Apr 16, 2013·Journal of Pediatric Surgery·Sarah N KunzJeffrey R Avansino
Jul 2, 2011·Surgery·Kristine Clodfelter OrionJoel Shilyansky
Apr 15, 2017·Journal of Pediatric Surgery·Lori A GurienSamuel D Smith
May 29, 2018·Pediatric Surgery International·Theerayuth PratheeppanyapatJiraporn Khorana
Sep 2, 2019·Journal of Pediatric Surgery·Russell B HawkinsSaleem Islam

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