Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial Aimee C. Pastor a , J. Duncan Phillips b , Stephen J. Fenton c , Rebecka L. Meyers c , Amy W. Lamm b , Mehul V. Raval b , Elizabeth Lehman c , Tracy B. Karp c , Paul W. Wales a , Jacob C. Langer a, ⁎ a Pediatric General Surgery, Hospital for Sick Children, Toronto, ON Canada M5G1X8 b Pediatric Surgery, University of North Carolina, Chapel Hill, NC 27599, USA c Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT 84113, USA Received 12 December 2007; revised 2 April 2008; accepted 2 April 2008 Key words: Abdominal wall defects; Spring-loaded silo; Intraabdominal pressure Abstract Background: Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis. Methods: Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure. Results: There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis. Conclusion: Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting. © 2008 Elsevier Inc. All rights reserved. Gastroschisis is a congenital abdominal wall defect initially described by Calder [1] in 1733, which is typically located to the right of the umbilicus and associated with herniation of the midgut. The incidence of gastroschisis is approximately 1 to 4 per 10,000 live births and has recently ⁎ Corresponding author. Tel.: +1 416 813 7340; fax: +1 416 813 7477. E-mail address: jacob.langer@sickkids.ca (J.C. Langer). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2008.04.003 Journal of Pediatric Surgery (2008) 43, 1807–1812