[size=20px]While having a discussion with a woman who is carrying a fetus with gastroschisis, she asks about silo and delayed repair versus immediate closure. You explain that compared to immediate repair, a standard three to five day silo closure is associated with

 

A increased use of parenteral nutrition.

 

B increased duration of ventilator use.

 

C increased incidence of abdominal infections.

 

D similar length of neonatal intensive care unit stay.

 

E increased risk of bowel damage.​[/size]

D

D

D

[size=20px]While having a discussion with a woman who is carrying a fetus with gastroschisis, she asks about silo and delayed repair versus immediate closure. You explain that compared to immediate repair, a standard three to five day silo closure is associated with

 

A increased use of parenteral nutrition.

 

B increased duration of ventilator use.

 

C increased incidence of abdominal infections.

 

D similar length of neonatal intensive care unit stay.

 

E increased risk of bowel damage.​[/size]

 

C

C

D

B

correct answer

D similar length of neonatal intensive care unit stay.

 

Silo versus immediate closure of patients with gastroschisis is an area of much debate among pediatric surgeons. There has been one attempt at a prospective randomized controlled trial which did not complete its accrual. They were able to show that there was no difference in bowel damage, time to feeds, time of parenteral nutrrition, infection risk or length of stay. They showed a trend to reduced need for ventilator use. In an unpublished abstract presented at the American Academy of Pediatrics in 2014, there was no advantage to immediate versus silo repair when the silo group was stratified into closure before or after five days. Those who took longer to close would not have been candidates for immediate closure and were likely a higher risk group. Overall, there is no difference in the length of stay for the two groups.

 

​

B