Using A Spring-Loaded Silo To Facilitate Immediate Bowel Reduction For Sutureless Closure In Gastroschisis
BACKGROUND: "Sutureless" closure of gastroschisis involves the manual reduction of bowel and covering the defect with umbilical cord. If manual reduction is difficult, we propose using a spring-loaded silo to facilitate immediate bowel reduction.
METHODS: Retrospective data was collected on gastroschisis infants who underwent immediate bowel reduction using a spring-loaded silo and sutureless closure by one surgeon at one institution from May 2015 to September 2018. Bowel is placed into a silo and the base beneath fascia. Bowel is completely reduced, and silo removed. Skin edges are brought together with adhesive strips.
RESULTS: In six infants (four female, two male), median gestational age [SD; range] and median birthweight [SD; range] were 35.4 [0.65; 34.7-36.6] weeks and 2.22 [0.39; 1.82-2.76] kg, respectively. Five had 3.0 cm fascial defects. One had a 4.0 cm defect. Median procedure duration [SD; range] was 30 [6.57; 24-42] minutes. Median times to first and full enteral feeding [SD; range] were 13.5 [4.26; 6-17] and 25 [10.06; 20-47] days, respectively. Five required intubation, one post-delivery, and four after bowel reduction. Median duration of intubation [SD; range] was 2 [1.30; 1-4] days. Median duration of hospital stay [SD; range] was 31 [17.18; 25-72] days. Median duration of follow-up [SD; range] was 15.7 [7.60; 0.9-23.3] months. One infant's fascial defect closed, three had a 3 mm residual defect, and two underwent umbilical herniorrhaphy for larger defects (1.5 cm and 4 cm).
CONCLUSION: A spring-loaded silo is a helpful adjunct for immediate bowel reduction to facilitate sutureless closure for gastroschisis.