1/4. Silo reduction of giant omphalocele and gastroschisis utilizing continucous controlled pressure.A method is described utilizing continuous controlled pressure to achieve smooth, rapid, and safe silo reduction of an anterior abdominal-wall defect. A metal tube with larger wheels at each end is suspended by runners and counterweights to slowly roll the silo and squeeze the contents into the abdominal cavity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/4. gastroschisis: etiology, diagnosis, delivery options, and care.gastroschisis, one of the more common congenital abdominal wall defects, results in herniation of fetal abdominal viscera into the amniotic cavity. This article discusses theories about gastroschisis etiology, in utero diagnostic tools, delivery options, and postdelivery care. Included are detailed considerations regarding immediate interventions after delivery to support the infant's thermal and fluid management needs and to protect the exposed bowel. Surgical options and postoperative care issues and complications are reviewed, as are respiratory distress and vena cava compression from increased abdominal pressure, nutritional support, and interventions related to the prevention of infection. Giving birth to an infant with gastroschisis is an upsetting experience for parents. Evidence suggests, however, that with today's advances in neonatal care and nutrition and with meticulous attention, the survival rate for infants born with gastroschisis can be excellent.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
3/4. gastroschisis management: an experience in Angau Memorial Hospital.This paper is the report of a 2 kg baby girl born with a large gastroschisis at the Angau Memorial Hospital. She is the first long-term survivor in papua new guinea with this major ventral abdominal wall defect as far as we are aware. In the report important steps in the management of this major congenital defect are highlighted from both the surgical and anaesthetic perspectives. It is imperative that a large gastroschisis be managed by a reduction carried out over two or more stages to prevent catastrophic abdominal compartment syndrome. Postoperative ventilation via an endotracheal tube was required due to respiratory compromise from the raised intra-abdominal pressure. Deflation of the dilated small bowel was shown to be an important step to allow full return of the small bowel into the abdominal cavity. A percutaneous jejunostomy feeding tube was inserted for feeding postoperatively as total parenteral nutrition was not available, and this was crucial for the nutritional management and ultimate survival of the baby. gastroschisis is a very significant congenital defect with major challenges in its management in a developing country, but if important principles of management are followed, the prognosis can be remarkably improved.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
4/4. Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy.INTRODUCTION: In almost all cases of gastroschisis, fascial closure may be achieved primarily or after silo reduction. Rarely, fascial and skin closure are impossible. We report our experience with visceral coverage in complicated cases of gastroschisis with porcine small intestinal submucosa (SIS) augmented by negative pressure wound therapy (NPWT). methods: Over a 3-year period, 55 infants with gastroschisis were managed. In 3 of these cases, fascia and skin could not be approximated safely after complete reduction of abdominal viscera with a spring-loaded silo. Visceral coverage in each case was achieved with 0.42-mm-thickness Surgisis ES (Cook Surgical, Bloomington, Ind) that was sewn to the fascial edges. Negative pressure wound therapy was then initiated at 75 mm Hg over the exposed SIS using vacuum-assisted closure. RESULTS: In each case, granulation tissue developed quickly and was followed by complete epithelialization. Two patients subsequently developed umbilical hernias. CONCLUSION: We have successfully used SIS augmented by NPWT in the management of 3 infants with complicated gastroschisis. In the rare situation in which fascial closure cannot be achieved, the combination of SIS and NPWT can provide a safe and effective means of abdominal wall closure.- - - - - - - - - - ranking = 1.2keywords = pressure (Clic here for more details about this article) |