Immediate versus silo closure for gastroschisis: Results of a large multicenter study

The optimal method to repair gastroschisis defects continues to be debated. The two primary methods are immediate closure (IC) or silo placement (SP). The purpose of this study was to compare outcomes between each approach using a multicenter retrospective analysis. We hypothesized that patients und...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pediatric surgery 2020-07, Vol.55 (7), p.1280-1285
Main Authors: Hawkins, Russell B., Raymond, Steven L., St. Peter, Shawn D., Downard, Cynthia D., Qureshi, Faisal G., Renaud, Elizabeth, Danielson, Paul D., Islam, Saleem
Format: Article
Language:English
Subjects:
Digestive System Surgical Procedures - methods
Female
Follow-Up Studies
Gastroschisis
Gastroschisis - mortality
Gastroschisis - surgery
Humans
Immediate closure
Infant
Infant, Newborn
Male
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Silo
Treatment Outcome
Ventral hernia
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The optimal method to repair gastroschisis defects continues to be debated. The two primary methods are immediate closure (IC) or silo placement (SP). The purpose of this study was to compare outcomes between each approach using a multicenter retrospective analysis. We hypothesized that patients undergoing SP for ≤5 days would have largely equivalent outcomes compared to IC patients. Gastroschisis patient data were collected over a 7-year period. The cohort was separated into IC and SP groups. The SP group was further stratified based on time to closure (≤5 days, 6–10 days, >10 days). Characteristics and outcomes were compared between groups. Multivariate logistic regression was also performed. 566 neonates with gastroschisis were identified including 224 patients in the IC group and 337 patients in the SP group. Among SP patients, 130 were closed within 5 days, 140 in 6–10 days, and 57 in >10 days. There were no significant differences in mortality, sepsis, readmission, or days to full enteral feeds between IC patients and SP patients who had a silo ≤5 days. IC patients had a significantly higher incidence of ventral hernias. Multivariate analysis revealed time to closure as a significant independent predictor of length of stay, ventilator duration, time to full enteral feeds, and TPN duration. Our data show largely equivalent outcomes between patients who undergo immediate closure and those who have silos ≤5 days. We propose that closure within 5 days avoids many of the risks commonly attributed to delay in closure. Level II retrospective study.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2019.08.002