Objectives: To introduce the clinical practice and experience of using a modified silo technique to treat neonates with severe gastroschisis in three referral medical centers in Shanghai, China.
Study design: Seventeen neonates with severe gastroschisis, whose viscera could not be reduced primarily, were admitted to three referral hospitals in Shanghai in the period of April 2004-July 2008. We placed a spring-loaded silo bag to hold the viscera as a bedside procedure and without anesthesia. Five to eight days later, after the bowel had been reduced to the abdominal cavity, we explored the intestines and closed the abdominal wall defect secondarily. Three of the cases had been diagnosed prenatally. Immediately after these 3 infants had been born and while still in the delivery room, the pediatric surgeons placed the silo bag.
Results: In 16 of the 17 cases, we performed a secondary surgery to explore the abdominal cavity and to close the defective abdominal wall 5-8 days after the silo bag had been inserted. When closing the abdominal wall, omphaloplasty was performed in 12 cases and transverse skin closure was done in 4 cases. All 16 cases recovered well. The follow-up periods ranged from 1 to 51 months, during which 15 babies developed well. One baby, however, incurred an intestinal obstruction 1 month after discharge and died, because his parents failed to send him to the hospital immediately. Due to an improper placement of the silo bag, one patient's bowel became incarcerated, ischemic and necrotic locally, causing the death of the patient.
Conclusions: Placing a spring-loaded silo bag as a bedside procedure without anesthesia on newborns with severe gastroschisis whose viscera cannot be reduced primarily has increased the survival rate (94.1%, 16/17, 2004-2008) of infants with severe gastroschisis in comparison to our previous experience (60.9%, 14/23, 1996-2003, p=0.026, Chi-square test) in Shanghai, China. This modified procedure deviates from the classic silo procedure, which is carried out under anesthesia..