A critical look at delayed intestinal motility in gastroschisis.

: The motility of the gastrointestinal tract after the accepted management of gastroschisis by using a Silon pouch and gradually reducing the herniated intestine is compared with the intestinal motility after primary reduction and closure of the defect. Since 1970, 46 children with gastroschisis have been treated at the Hospital for Sick Children, Toronto. Twenty-seven were treated with a Silon pouch. Eleven died after an average postoperative survival of 17 weeks; not one had bowel motility that allowed oral feeding. Among the 16 survivors an average of 10 weeks elapsed between operation and the institution of full oral feeding. Seventeen children were treated by forceful stretching of the abdominal cavity, primary replacement of the eviscerated intestines and closure of the defect. Two died in the early postoperative period of conditions unrelated to the gastroschisis or to the procedure. The average period between operation and full oral intake of food was only 4 weeks. In addition, two neonates were admitted after primary closure was done at the referring hospital. Roentgenograms obtained postoperatively in 24 of the patients showed the "typical" dilated loops with air fluid levels in patients treated with a Silon pouch. The authors' findings indicate that primary reduction and closure of the defect has a distinct advantage over use of a Silon pouch in the treatment of gastroschisis.