Routine insertion of a Silastic (R) spring-loaded silo for infants with gastroschisis

Background/Purpose: Gastroschisis traditionally is managed by emergency ope rating room closure (EC), with a silo reserved for cases that cannot be clo sed primarily. The authors recently began using routine insertion of a SILA STIC((R)) (Dow Coming, Midland, MI) spring-loaded silo (SLS), followed by e lective closure. Methods: A total of 43 consecutive neonates with gastroschisis were treated between 1993 and 1998. Results: Thirty patients underwent EC, and 13 underwent closure after inser tion of a SLS (10 at bedside, 3 in the operating room). Eight infants treat ed by EC required staged repair. There were no differences with respect to gestational age, birth weight, gender, Apgar score, maternal age, or mode o f delivery. Median length of stay was 32 days for EC and 25 days for SLS (P = .05). The SLS group required fewer days on a ventilator (4 v 6 days, P = .03) and had lower intraoperative (28 v 21, P = .02) and early postoperati ve peak airway pressures. The time to tolerate full feedings was 21 days fo r SLS and 27 days for EC (P = .07). The SLS group had fewer complications a nd a lower median hospital charge ($71,498 v $85,147; P = .05). Conclusion: SLS followed by elective repair permits gentle, gradual reducti on of the viscera. When compared with EC, SLS is associated with significan tly lower airway pressures, earlier extubation, fewer complications, and de creased length of stay and hospital charges. Copyright (C) 2000 by W.B. Sau nders Company.