Sequential Silo Placement and Relaxing Skin Incision for
Complex Gastroschisis
Tongsin A, MD¹, Poocharoen W, MD¹, Noitumyae J, MD¹
Affiliation : ¹ Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
Background: Complex gastroschisis is an anterior abdominal wall defect associated with gastrointestinal anomalies or liver
herniation. Operative repair of complex gastroschisis can be challenging. The authors described a technique of staged repair to
achieve rapid and gentle reduction of the herniated contents, followed by delayed closure of the abdominal wall defect.
Objective: To describe the experience with the sequential silo placement (SSP) and relaxing skin incision (RSI) in complex gastroschisis patients.
Materials and Methods: A retrospective study of patients with complex gasroschisis treated by SSP and RSI at Queen Sirikit National Institute of Child Health between January 2013 and December 2017 was conducted. SSP included placement of the Alexis wound retractor and protector first and followed by placement of the Steri-drape artificial sac later. RSI included a curvilinear skin incision on lateral abdominal wall to achieved abdominal wall closure. Patients were followed for complications and outcomes.
Results: Six patients with complex gastroschisis, two with ileal atresia, three with colonic atresia, and one with liver herniation were enrolled in the present study. Five patients with intestinal atresia underwent second silo placement and enterostomy, three of these patients achieved abdominal wall closure without RSI, and two achieved abdominal wall closure by RSI. One patient with liver protrusion underwent SSP and achieved abdominal wall closure by bilateral RSI. Synthetic absorbable meshes were used for closure of fascial defect in five patients without post-operative adhesion or fistula formation. There was ventral hernia in one patient, which was repaired two years later without complication.
Conclusion: SSP and RSI are very simple and useful technique to repair complex gastroschisis with large abdominal wall defect and severe viscera abdominal disproportion.
Keywords : Sequential silo placement, Relaxing skin incision, Complex gastroschisis, Staged repair, Gastroschisis
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