Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

• Published in: Journal of pediatric surgery 2008-10, Vol.43 (10), p.1807-1812
• Main Authors: Pastor, Aimee C, Phillips, J. Duncan, Fenton, Stephen J, Meyers, Rebecka L, Lamm, Amy W, Raval, Mehul V, Lehman, Elizabeth, Karp, Tracy B, Wales, Paul W, Langer, Jacob C
• Format: Article
• Language: English
• Subjects: Abdominal Wall - surgery; Abdominal wall defects; Adolescent; Adult; Dimethylpolysiloxanes; Elective Surgical Procedures; Enterocolitis, Necrotizing - epidemiology; Enterocolitis, Necrotizing - etiology; Equipment Design; Gastroschisis - epidemiology; Gastroschisis - surgery; Humans; Incidence; Intestinal Atresia - epidemiology; Intestinal Atresia - surgery; Intraabdominal pressure; Length of Stay; Parenteral Nutrition, Total - utilization; Pediatrics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Protective Devices; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Respiration, Artificial - utilization; Sepsis - epidemiology; Sepsis - etiology; Spring-loaded silo; Surgery; Surgical Flaps - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2008.04.003

Abstract Background Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis. Methods Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure. Results There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis. Conclusion Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting.