Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach

Background/Purpose: The aim of this study was to critically evaluate the clinical outcomes of two different surgical treatment approaches for infants born with gastroschisis. Methods: The medical records of 65 infants with gastroschisis treated at one institution from 1991 to 2000 were available. Infants in group I (prior to December 1998) underwent attempted early repair of the gastroschisis defect on their first day of life. Infants in group 11 had delayed repair after the initial placement of a preformed silo. Results: Group I had 39 patients; group 11 had 26 patients. The two groups were equal with respect to maternal age, gestational age, and birth weight. Complete reduction and fascial closure were accomplished for 32 patients (82%) in group I and 25 patients (96%) in group 11 (P < .02). Median time on the ventilator was significantly less for group 11 (P < .0001). Infants in group 11 had shorter times until first postoperative feeding (P < .01) and full feedings (P < .006). Group 11 had fewer complications than group 1 (23% v 56%; P < .01). There appeared to be less necrotizing enterocolitis in group 11. The average length of hospital stay was 14 days less for group 11. Conclusions:The use of a preformed silo initially followed by delayed fascial closure in infants with gastroschisis is associated with improved fascial closure rates, fewer ventilator days, more rapid return of bowel function, and fewer complications compared with attempts at initial early repair. Copyright 2003, Elsevier Science (USA). All rights reserved.