Serial Reduction of an Extremely Large Gastroschisis using Vacuum-Assisted Closure

Abstract

We herein describe a case of serial reduction of an extremely large and complex gastroschisis using vacuum-assisted closure (VAC) therapy in a boy born at 35^5/7 weeks' gestation. A spring-loaded silicone silo was placed at birth. By day of life (DOL) 22, minimal visceral contents had been reduced, and the silo was difficult to maintain due to the size of the fascial defect and loss of abdominal domain. A bespoke VAC dressing was constructed, and biweekly dressing changes allowed gradual reduction of the gastroschisis until the viscera were consolidated. By DOL 50, the viscera were completely reduced, and VAC therapy was discontinued. Feeds were commenced on DOL 57 and increased to goal by DOL 86. The baby was discharged home on DOL 115. We conclude that VAC dressings can be used to aid gradual reduction of an extremely large gastroschisis, particularly in medical fragile infants.

Keywords

gastroschisis - omphalocele - vacuum-assisted closure - VAC - negative-pressure wound therapy

• References

• 1 Laje P, Fraga MV, Peranteau WH. , et al. Complex gastroschisis: clinical spectrum and neonatal outcomes at a referral center. J Pediatr Surg 2018; 53 (10) 1904-1907
• 2 Stoffan AP, Ricca R, Lien C, Quigley S, Linden BC. Use of negative pressure wound therapy for abdominal wounds in neonates and infants. J Pediatr Surg 2012; 47 (08) 1555-1559
• 3 Lopez G, Clifton-Koeppel R, Emil S. Vacuum-assisted closure for complicated neonatal abdominal wounds. J Pediatr Surg 2008; 43 (12) 2202-2207
• 4 McBride CA, Stockton K, Storey K, Kimble RM. Negative pressure wound therapy facilitates closure of large congenital abdominal wall defects. Pediatr Surg Int 2014; 30 (11) 1163-1168
• 5 Choi WW, McBride CA, Kimble RM. Negative pressure wound therapy in the management of neonates with complex gastroschisis. Pediatr Surg Int 2011; 27 (08) 907-911
• 6 Yaster M, Buck JR, Dudgeon DL. , et al. Hemodynamic effects of primary closure of omphalocele/gastroschisis in human newborns. Anesthesiology 1988; 69 (01) 84-88
• 7 Cordero L, Touloukian RJ, Pickett LK. Staged repair of gastroschisis with Silastic Sheeting. Surgery 1969; 65 (04) 676-682
• 8 Schuster SR. A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet 1967; 125 (04) 837-850
• 9 Gilbert MG, Mencia LF, Puranik SR, Litt RE, Altman DH. Management of gastroschisis and short bowel: report of 17 cases. J Pediatr Surg 1972; 7 (05) 598-607
• 10 Kidd Jr JN, Jackson RJ, Smith SD, Wagner CW. Evolution of staged versus primary closure of gastroschisis. Ann Surg 2003; 237 (06) 759-764 , discussion 764–765
• 11 Sawin R, Glick P, Schaller R, Hatch E, Hall D, Hicks L. Gastroschisis wringer clamp: a safe, simplified method for delayed primary closure. J Pediatr Surg 1992; 27 (10) 1346-1348
• 12 Othersen Jr HB, Smith CD. Pneumatic reduction bag for treatment of gastroschisis and omphalocele. A 10-year experience. Ann Surg 1986; 203 (05) 512-516
• 13 Bianchi A, Dickson AP. Elective delayed reduction and no anesthesia: ‘minimal intervention management’ for gastrochisis. J Pediatr Surg 1998; 33 (09) 1338-1340
• 14 Lansdale N, Hill R, Gull-Zamir S. , et al. Staged reduction of gastroschisis using preformed silos: practicalities and problems. J Pediatr Surg 2009; 44 (11) 2126-2129
• 15 Fischer JD, Chun K, Moores DC, Andrews HG. Gastroschisis: a simple technique for staged silo closure. J Pediatr Surg 1995; 30 (08) 1169-1171
• 16 Bustorff-Silva JM, Schmidt AF, Gonçalves A, Marba S, Sbragia L. The female condom as a temporary silo: a simple and inexpensive tool in the initial management of the newborn with gastroschisis. J Matern Fetal Neonatal Med 2008; 21 (09) 648-651
• 17 Fonkalsrud EW, Smith MD, Shaw KS, Borick JM, Shaw A. Selective management of gastroschisis according to the degree of visceroabdominal disproportion. Ann Surg 1993; 218 (06) 742-747
• 18 Aoyama K. A new operation for repair of large ventral hernias following giant omphalocele and gastroschisis. J Pediatr Surg 1979; 14 (02) 172-176
• 19 Anderl H, Menardi G, Hager J. Closure of gastroschisis by mesh skin grafts in problem cases. J Pediatr Surg 1986; 21 (10) 870-872
• 20 Stringel G. Large gastroschisis: primary repair with Gore-Tex patch. J Pediatr Surg 1993; 28 (05) 653-655
• 21 Beres A, Christison-Lagay ER, Romao RL, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012; 47 (05) 917-919
• 22 Gharib M, Ure BM, Klose M. Use of amniotic grafts in the repair of gastroschisis. Pediatr Surg Int 1996; 11 (2-3): 96-99
• 23 van Tuil C, Saxena AK, Willital GH. Experience with management of anterior abdominal wall defects using bovine pericard. Hernia 2006; 10 (01) 41-47
• 24 T Adikibi B, O'Toole S. Reverse tissue expansion in gastroschisis: what to do if the defect is too large to close after silo removal?. J Neonatal Surg 2014; 3 (04) 47
• 25 Zivković SM. Repair of gastroschisis using umbilical cord as a patch. J Pediatr Surg 1991; 26 (10) 1179-1180
• 26 Sandler A, Lawrence J, Meehan J, Phearman L, Soper R. A “plastic” sutureless abdominal wall closure in gastroschisis. J Pediatr Surg 2004; 39 (05) 738-741