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Low Cost Gastroschisis Silo for Sub-Saharan Africa: Testing in a Porcine Model

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Abstract

Background

Gastroschisis mortality in sub-Saharan Africa (SSA) remains high at 59–100%. Silo inaccessibility contributes to this disparity. Standard of care (SOC) silos cost $240, while median monthly incomes in SSA are < $200. Our multidisciplinary American and Ugandan team designed and bench-tested a low-cost (LC) silo that costs < $2 and is constructed from locally available materials. Here we describe in vivo LC silo testing.

Methods

A piglet gastroschisis model was achieved by eviscerating intestines through a midline incision. Eight piglets were randomized to LC or SOC silos. Bowel was placed into the LC or SOC silo, maintained for 1-h, and reduced. Procedure times for placement, intestinal reduction, and silo removal were recorded. Tissue injury of the abdominal wall and intestine was assessed. Bacterial and fungal growth on silos was also compared.

Results

There were no gross injuries to abdominal wall or intestine in either group or difference in minor bleeding. Times for silo application, bowel reduction, and silo removal between groups were not statistically or clinically different, indicating similar ease of use. Microbiologic analysis revealed growth on all samples, but density was below the standard peritoneal inoculum of 105 CFU/g for both silos. There was no significant difference in bacterial or fungal growth between LC and SOC silos.

Conclusion

LC silos designed for manufacturing and clinical use in SSA demonstrated similar ease of use, absence of tissue injury, and acceptable microbiology profile, similar to SOC silos. The findings will allow our team to proceed with a pilot study in Uganda.

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Abbreviations

LC:

Low cost

SOC:

Standard of care

LMICs:

Low- and middle-income countries

SSA:

Sub-Saharan Africa

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Acknowledgements

None.

Funding

Dr. Leraas’ work is supported by a T32 training grant in Surgical Oncology. BME-IDEA International Students Grants Program, VentureWell Grants; “Saving Intestines at Birth: Gastroschisis Silos for Sub-Saharan Africa (#20538-20).

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Authors and Affiliations

  1. Department of Surgery, Duke University School of Medicine, DUMC, Box 3815, Durham, NC, 27710, USA

    Harold J. Leraas, Anthony Eze, Siddesh Zadey & Tamara N. Fitzgerald

  2. Pratt School of Engineering, Duke University, Durham, NC, USA

    Arushi Biswas, Patrick Wilson, Caroline Salzman & Ann Saterbak

  3. Duke Global Health Institute, Durham, NC, USA

    Siddesh Zadey & Tamara N. Fitzgerald

  4. Department of Pediatrics, Duke University, Durham, NC, USA

    Barbara S. Theriot & Neeraj K. Surana

  5. Makerere University, Kampala, Uganda

    Robert Ssekitoleko & Julius Mugaga

  6. Department of Pathology, Duke University, Durham, NC, USA

    Allison Hall

  7. Mulago Hospital, Kampala, Uganda

    Anne Wesonga

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  1. Harold J. Leraas
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  2. Arushi Biswas
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Correspondence to Harold J. Leraas.

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Leraas, H.J., Biswas, A., Eze, A. et al. Low Cost Gastroschisis Silo for Sub-Saharan Africa: Testing in a Porcine Model. World J Surg 47, 545–551 (2023). https://doi.org/10.1007/s00268-022-06797-2

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