Early versus delayed silo closure in gastroschisis: a retrospective study.

Abstract

Background: A well accepted approach to the management of gastroschisis is gradual reduction of the herniated viscera using preformed silos followed by surgical closure of the abdominal wall defect. However, if the abdominal wall closure is delayed for a longer duration than necessary, it may increase morbidities. We sought to compare the outcomes of infants undergoing silo reduction whose abdominal wall defect was closed ≤ 5 days versus > 5 days after birth.

Methods: Retrospective cohort study (January-2010 to December-2020).

Results: One-hundred-and-nine infants who were managed using primary silo with staged reduction were included. Median gestation was 36.2 (interquartile range, IQR: 35.2, 37) weeks. Ten infants had complex gastroschisis. Thirty-four infants underwent early-closure of abdominal wall defect and 75 had delayed closure. Mortality rate was 2.7% (3/109; one in early and two in delayed closure). The median age at full feeds was 24.5 days (IQR 17.5, 30) in the delayed-closure group vs 15 (12.5, 22.5) in the early-closure group. The median hospital stay was 32 days (IQR 23, 43) vs 19 (15, 30) days. On multivariable analysis, delayed closure (Exponentiated regression coefficient ERC 1.40, 95% confidence interval CI: 1.05, 1.86, P = 0.020) and complex gastroschisis (ERC 2.03; 95% CI: 1.11, 3.72, P = 0.021) were associated with longer time to reach full feeds. Same factors were associated with longer duration of hospital stay.

Conclusions: Gradual reduction using silos achieved excellent outcomes in neonates with gastroschisis. Completing the silo reduction and closing the abdominal wall within five days could further improve their outcomes.