Sutureless Delayed Primary Gastroschisis Repair with Negative Pressure Dressing

Introduction

Gastroschisis is a congenital abnormality of the anterior abdominal wall through which the uncovered abdominal viscera herniates. Several repair techniques have been described, employing primary, if possible, or delayed operative closure. Traditionally, reduction of the viscera with primary surgical repair was the method of choice. This regimen, although usually obtaining similar long-term outcomes, commonly requires intubation, paralysis, and mechanical ventilation with elevated peak pressures. The risk of barotrauma, acidosis, pedal edema, and other short-term complications have been described [3]. Although occurring less frequently, significant morbidity can occur from elevated abdominal pressures, including compartment syndrome and necrotizing enterocolitis.

The delayed approach is used out of necessity in cases where the viscera cannot be internalized due to abdominal wall compliance, visceral edema, or both. In this scenario, preformed SILASTIC® (Dow Corning, Midland, MI, USA) silos with spring-loaded rings or similar devices are used to gradually reduce the abdominal contents. Once domain has been restored, surgical methods of abdominal defect closure are employed. Results with this treatment were excellent and elective delayed closure has been adopted by many institutions. Elective delayed closure has been associated with improved defect closure rates, fewer ventilator days, a more rapid return of bowel function, and fewer complications [3]. Operative treatment is still required with general anesthesia and paralysis. The risk of long-term ventilation and complications previously described still exists, due to the definitive surgical fascial abdominal closure. We have been using the method of gastroschisis repair without suture as our procedure of choice which we call delayed primary sutureless repair of gastroschisis [1], [2]. This method employs steri-strips to strap the edges of the defect together. Not only is it less traumatic, it has the added benefit of simple reversibility, if necessary. The problem we have faced is a delay in closure due to premature separation of the steri-strips because of peritoneal fluid seepage under the strips. We present two cases where this problem was overcome by the addition of a Vacuum Assisted Closure® device (Kinetic Concepts Inc., San Antonio, TX, USA).

References

• 1 Owen A, Marven S. et al . Experience of bedside preformed silo staged reduction and closure of gastroschisis.  J Pediatr Surg. 2006;  41 1830-1835
• 2 Sandler A, Lawrence J. et al . A “plastic” sutureless abdominal wall closure in gastroschisis repair.  J Pediatr Surg. 2004;  39 738-741
• 3 Schlatter M, Norris K. et al . Improved outcomes in the treatment of gastroschisis using a preformed silo and delayed repair approach.  J Pediatr Surg. 2003;  38 459-464