Primary Suture-less Closure of Gastroschisis Using Negative Pressure Dressing (Wound Vacuum)

Abstract

Introduction

Primary suture-less closure of gastroschisis using negative pressure dressing (wound vacuum) involves the application of an initial preformed Silo with subsequent bedside suture-less closure of the defect using negative pressure dressing. The advantages of this gentle approach are the simple bedside closure without intubation, paralysis or ventilation as well as reduced risk of barotrauma, abdominal compartment syndrome, acidosis, bowel infarction and necrotizing enterocolitis. This study is a report of the technique we used for gastroschisis closure at our institute.

Methods

The medical records of 15 newborns who underwent primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique between March 2008 and February 2010 were retrospectively reviewed. Outcome criteria such as time on ventilation, time to initiating feeds, time to full feeds, time to discharge from NICU and complications were recorded.

Results

The median follow-up was 234 days (range: 13–528 days). The time on ventilation was (n=8: no ventilation; n=3: 1 day; n=2: 2–5 days; n=2:>5 days). The median time to initiating feeds was 13 days (range: 6–61 days), the median time to full feeds was 20 days (range: 12–91 days) and the median time to discharge was 24 days (range: 21–131 days). 2 patients had a tiny umbilical hernia at last follow-up.

Conclusion

Primary suture-less closure of gastroschisis using a negative pressure dressing (wound vacuum) technique is easily reversible, does not need intubation/ventilation, avoids a trip to the operating room (OR), has minimal to no complications and provides good cosmetic results.

Key words

gastroschisis - wound vacuum - abdominal wall defects - suture-less closure of gastroschisis - primary closure of gastroschisis

• References

• 1 Singh SJ, Fraser A, Leditschke JF et al. Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int 2003; 19 (04) 260-265
• 2 Tawil KA, Gillam GL. Gastroschisis: 13 years’ experience at RCH Melbourne. J Paediatr Child Health 1995; 31 (06) 553-556
• 3 Bianchi A, Dickson AP. Elective delayed reduction and no anesthesia: ‘minimal intervention management’ for gastrochisis. J Pediatr Surg 1998; 33 (09) 1338-1340
• 4 Hubbard BA, Pimpalwar A. Sutureless delayed primary gastroschisis repair with negative pressure dressing. Eur J Pediatr Surg 2009; 19 (02) 132-133
• 5 Sandler A, Lawrence J, Meehan J et al. A "plastic" sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 2004; 39 (05) 738-741
• 6 Riboh J, Abrajano CT, Garber K et al. Outcomes of sutureless gastroschisis closure. J Pediatr Surg 2009; 44 (10) 1947-1951
• 7 Kimble RM, Singh SJ, Bourke C et al. Gastroschisis reduction under analgesia in the neonatal unit. J Pediatr Surg 2001; 36 (11) 1672-1674
• 8 Ogasawara Y, Okazaki T, Kato Y et al. Spontaneous sutureless closure of the abdominal wall defect in gastroschisis using a commercial wound retractor system. Pediatr Surg Int 2009; 25 (11) 973-976
• 9 Owen A, Marven S, Jackson L et al. Experience of bedside preformed Silo staged reduction and closure for gastroschisis. J Pediatr Surg 2006; 41 (11) 1830-1835
• 10 Weinsheimer RL, Yanchar NL, Bouchard SB et al. Gastroschisis closure – does method really matter?. J Pediatr Surg 2008; 43 (05) 874-878
• 11 Kidd Jr JN, Jackson RJ, Smith SD et al. Evolution of staged versus primary closure of gastroschisis. Ann Surg 2003; 237 (06) 759-764 discussion 764–765