Document Detail

Salvaging the severe congenital diaphragmatic hernia patient: is a silo the solution?
MedLine Citation:
PMID:  18485939     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Infants with severe congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) have a high morbidity and mortality. We hypothesized that placement of an abdominal wall silo and staged abdominal wall closure may reduce problems associated with decreased abdominal domain in CDH. METHODS: We performed a retrospective review and identified 7 CDH patients requiring ECMO who had a silastic abdominal wall silo between 2003 and 2006. Variables analyzed included survival, ECMO duration, duration of silo, time to discharge, and long-term outcome. RESULTS: Predicted mean survival for the entire cohort using the published CDH Study Group equation was 47% (range, 9%-86%). All 7 patients (100%) survived. Extracorporeal membrane oxygenation duration averaged 15 days (range, 5-19 days). Four of the patients (58%) were repaired with a silo on ECMO, and 3 (42%) had their repair after ECMO. The abdominal wall defect was closed at a mean of 21 days (range, 4-41 days). Hospital stay after silo placement averaged 54 days (range, 20-170 days) with no infections or wound complications. CONCLUSIONS: Abdominal wall silo placement in infants with CDH requiring ECMO appears to be an effective strategy for decreased abdominal domain. Further studies are warranted to determine the efficacy of such a strategy for these high-risk CDH patients.
Ankur R Rana; Joseph S Khouri; Daniel H Teitelbaum; Robert A Drongowski; Ronald B Hirschl; George B Mychaliska
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  43     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-19     Completed Date:  2008-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  788-91     Citation Subset:  IM    
Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
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MeSH Terms
Abdominal Wall / surgery*
Apgar Score
Extracorporeal Membrane Oxygenation
Hernia, Diaphragmatic / congenital*,  surgery*
Infant, Newborn
Length of Stay
Lung Compliance
Prostheses and Implants*
Retrospective Studies
Salvage Therapy / methods*
Survival Analysis
Suture Techniques

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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