STAGED SILO REPAIR OF GASTROSCHISIS WITH PRESERVATION OF THE UMBILICAL-CORD

Background: The optimal surgical approach for gastroschisis remains co ntroversial, although primary closure after vigorous stretching of the abdominal wall and decompression of the intestinal contents is curren tly preferred. Methods: Between 1984 and 1997, 24 newborns with gastro schisis were treated at Saitama Children's Medical Center. The average gestational age was 37.3 weeks, and the average birth weight was 2,28 5 g. One patient had the associated anomaly of intestinal atresia and short bowel. Rupture of the intestines during delivery was noted in on e patient. The authors applied their nonaggressive staged repair using a prosthetic silo with preservation of the umbilical cord in 20 of th e 24 cases (83.3%). Primary closure with preservation of the umbilical cord was performed in the remaining four cases (16.7%). In these pati ents, the gastroschisis was mild. Results: In the 20 cases treated by staged repair, the average interval between the first and second opera tion was 9.8 days. Mechanical ventilation was not required in 16 of 20 (80%) patients treated by staged repair, or in two of four (50%) pati ents treated by primary repair. The number of days to the first feedin g averaged 14.6 days in 23 cases, excluding the patient with short bow el syndrome who required continuous total parenteral nutrition (TPN). TPN through a central venous catheter was required in 3 of 23 patients (13.0%). The overall average hospital stay was 55.1 days. Survival wa s 24 of 24 or 100%. Complications included perforation of the intestin es, gastric bleeding, ventral hernia, and wound infection. No infectio ns were associated with the prosthetic silo. All of the patients had a satisfactory cosmetic outcome. Recent advances in neonatal intensive care, including antibiotic therapy, reduced the possibility of infecti on. Conclusions: This staged repair of gastroschisis was simple and sa fe, neither requiring experienced surgical judgment nor complicated po stoperative management, and achieved satisfactory results. Furthermore , preservation of the umbilical cord provided an improved cosmetic app earance. Copyright (C) 1998 by W.B. Saunders Company.