A. Urevick1, R. C. Hicks1, N. G. Foster2, E. P. Harpstead2, T. Cabbage3, S. D. Bhattacharya1 1University Of Tennessee Health Science Center, Department Of Surgery, Chattanooga, TN, USA 2University Of Tennessee Health Science Center, Medical School, Memphis, TN, USA 3University Of Tennessee Health Science Center, Pediatrics, Chattanooga, TN, USA
Introduction: Neonatal gastroschisis remains a clinical entity with a wide array of methods of repair. The incidence of gastroschisis continues to increase, further stressing a need to evaluate outcomes and motivate innovation in clinical management. In this study we present a single institution’s perspective on repair of gastroschisis over a period of 10 years.
Methods: Within our institution, two methods of immediate reduction of gastroschisis with primary fascial closure are performed in the operating room including manual reduction of eviscerated contents or the use of a spring-loaded silo to organize these contents for reduction and reduce manipulation of bowel. Using a retrospective review of available records for 62 neonatal patients born with gastroschisis over a period of 10 years, silo-assisted immediate reduction (SIR) was performed in 21 patients, 20 patients underwent manual immediate reduction (MIR), and 21 patients had a silo-placed with delayed closure in the NICU. Our inclusion criteria was neonates born with gastroschisis and exclusion criteria was early perinatal mortality within 30 days. We elected for a head-to-head comparison of immediate closure techniques (MIR vs. SIR) and evaluated primary objectives of operative times, time to initial feeding, time to bowel function were measured. Secondary objectives of ventilator days, hospital length of stay, days of TPN requirement were also evaluated for additional measures of perinatal outcome.
Results: There was a statistically significant difference (p=.018) in operative time between the MIR (M = 73 min, SD 55.3) and SIR groups (M = 41 min, SD 12.1), however, no significant difference was shown in time to bowel function, time to initial feeding, ventilator time, nor hospital length of stay. d
Conclusion: With silo-assisted immediate reduction we have demonstrated improved operative time compared with manual reduction with no apparent clinical consequence. The SIR technique has minimal bowel manipulation though does not improve time to bowel function, time to enteral feeds, days on TPN, or days on ventilator. It does not result in increased morbidity such as abdominal compartment syndrome or respiratory embarrassment.
