Closure of Gastroschisis

Muhammad Amin

Introduction

• Gastroschisis is a congenital condition, characterised by a full-thickness defect in the anterior abdominal wall, with intestinal herniation.

• Managed by primary closure or staged closure.

Gastroschisis

Staged Closure

Pre-formed Silo

Surgical Silo

Primary Closure

Primary Closure

• Firstly reported in 1878 fatal outcome.

• Watkins, 1943: Reported the first successful primary closure of gastroschisis.

• Moor and Stokes, 1953: Reported the use of skin flap technique to close the abdomen two of the patients died because of acute respiratory insufficiency and ACS.

• Izan et al, 1966: Manual stretching of the abdominal wall Complicated by lateral abdominal wall hernia.

Staged Closure: Surgical Silo

• Also known as: Bogota Bag, Modified Bogota Bag, Hand-sewn Silo.

• Bogota Bag is a sterile plastic bag used for closure of an abdominal wound. Its use was first described in 1984 by Oswaldo Borráez in Bogotá, Colombia.

• Schuster, 1967: Used sheets of Teflon as a temporary covering for the herniated bowel.

• Allen and Wrenn modified Schuster’s technique by using silastic instead of Teflon.

• Shermata and Haller, 1975: Used a preformed transparent silo sutured to the abdominal wall.

Bogota Bag dr. Oswaldo Borráez

Surgical silo

Staged Closure: Pre-formed Silo

• Also known as: Silastic Silo, Spring-loaded Silo, Gastroschisis Bag.

• Starting from 1997, surgeons began inserting a silastic silo or a spring-loaded silo.

Pre-formed Silo

The Differences

Surgical Silo Pre-formed Silo Should be placed at operating room

Could be placed at bedside

Need for suturing to the abdominal wall

No need for suturing

Performed under general anesthesia

Could be performed using anelgesia alone

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