Outcome of management of gastroschisis: comparison of improvised surgical silo and extended right hemicolectomy

Abstract

Background: Gastroschisis is onea of the major abdominal wall defects encountered commonly in pediatric surgery. Whereas complete reduction and abdominal closure is achieved easily sometimes, a daunting situation arises when the eviscerated bowel loops and other viscera cannot be returned immediately into the abdominal cavity. This situation is a major contributor to the outcome of the treatment of gastroschisis in our region. In our efforts to improve our outcome, we have adopted the technique of extended right hemicolectomy for cases where complete reduction and primary abdominal wall closure is otherwise not possible. This study compared the management outcome of gastroschisis using our improvised silo, and performing an extended right hemicolectomy. Results: Thirty-nine cases were analyzed. Simple closure could not be achieved in 28 cases. In the absence of standard silos, improvised ones were constructed from the amniotic membrane (3 cases), urine bag (4 cases), and latex gloves (9 cases) giving a total of 16 cases managed with silos. Extended right hemicolectomy was performed in 12 cases. Conclusions: Given the peculiarities of circumstances in our region regarding human and material resources in the care of gastroschisis patients, an extended right hemicolectomy, to make it possible to close the abdomen primarily in gastroschisis is a more viable option than the use of improvised silo.

Spectrum of Congenital Abdominal Wall Defects in Neonates in a Teaching Hospital in Enugu, Nigeria

“…The immature immune status of the neonate and foreign body (silo) reaction may be responsible for the high infection rate. The high infection rates experienced with silo has been reported by other practitioners [33]. In low income like Nigeria, silo is always improvised using surgical gloves and drainage bags.…”

Challenges and lessons learnt in the management of an HIV-exposed neonate with gastroschisis in a resource-limited setting: case report

“…Gastroschisis treatment mainly involves surgical closure of the defect to return the exposed bowel and organs into the abdominal cavity. Gastroschisis repair can be a primary or delayed closure, with significant differences in the length of stay, time to enteral feeds, or ventilator time 6 , 9 , 10 , 17 . Management should begin in the delivery room by placing the lower part of the neonate into the bowel bag while initiating maintenance fluids, to reduce evaporative fluid loss through the exposed bowel 6 .…”

“…In this case, the diagnosis was only possible at the time of delivery in a peripheral lower-level health facility, followed by two simultaneous referrals to a remote hospital and a tertiary paediatric surgical centre. This caused delays of greater than 72 h for a properly modified silo to be established, which increased the risk of fluid loss, necrosis of the bowel, and mortality 10 , 17 . This neonate underwent secondary repair with delayed reduction, but unfortunately, we lost the neonate to hypovolemic shock on day 5 of life at the hospital.…”

“…Mortality rates among neonates born with gastroschisis are as low as 9% in developed countries and often among babies born with associated congenital heart malformations and prematurity 1 , 18 but are as high as 30–100% in sub-Saharan Africa due to late presentation and intervention, absence of parenteral feeding modalities, non-functional neonatal intensive care units, and paediatric ventilators 17 . Evidence shows that neonates born with gastroschisis suffer few long-term complications, and surgical repair has good outcomes 6 , 9 , 19 ; however, this neonate had a high risk of mortality, such as low birth weight, delays in surgical repair (up to 72 h of life), lack of parenteral nutrition, and non-functional neonatal intensive care unit encountered in the management; however, the neonate died of hypovolemic and septic shock on day 5 of life.…”

Role of Surgery in the Outcome Difference of Gastroschisis between High-income and Lowmiddle- income Countries: A Review

“…Okoro PE et al achieved >67% survival rate in African resourceconstrained centers with primary closure after extended right hemicolectomy. 21 Negash et al 22 described a successful outcome of primary closure aided by ileocecal resection and ileostomy in two patients.…”