The two most common methods of surgical repair are primary closure or staged silo closure. In a primary closure, the intestines will be reduced back into the abdomen shortly after birth and surgically sutured. When this is not possible, the intestines may be placed in a plastic silo and slowly reduced into the abdomen over the course of a few days, then surgically sutured. Sometimes, this is a matter of surgeon’s preference. Studies conflict on which method is “best”, although primary closure is often preferred.30 However, a recent analysis demonstrated that staged silo closure may have better clinical outcomes.31 Other studies show little difference in the post-operative outcomes but remind us that the length of time taken to close a baby’s abdomen is correlated to a delay in intestinal function and an increased NICU stay.32
A third, less common option is a sutureless closure. In this method, the surgeon reduces the intestines back into the body, then uses the infants own umbilical cord to cover the opening and a small piece of clear film is placed over this.34
NOTE: there are currently two clinical trials involving closure methods which are recruiting for patients to enroll in their studies. One is located at Standford University and is studying sutureless vs. sutured closure35, while the other is located at Children’s Mercy Hospital and is studying silo vs. primary closure.36Participation in clinical trials is entirely voluntary, and those electing to join the studies are encouraged to thoroughly read all informed consents to be sure they understand any inherit risks or benefits to themselves or others.
30. http://www.medscape.com/viewarticle/458475_10
31. http://www.ncbi.nlm.nih.gov/pubmed/23583145
32. http://www.ncbi.nlm.nih.gov/pubmed/18485957
33. http://ohiofetalmedicine.org/services-gastroschisis.cfm
34. http://www.ncbi.nlm.nih.gov/pubmed/15137009
35. http://clinicaltrials.gov/ct2/show/NCT01094587?term=gastroschisis&rank=3
36. http://clinicaltrials.gov/ct2/show/NCT01506531?term=gastroschisis&rank=1