Gastroschisis reduction using “Applied Alexis”, a wound protector and retractor

Abstract

We used an Applied Alexis (APPLIED MEDICAL RESOURCES CORP, USA) wound protector and retractor (WPAR) instead of a “spring loaded silo” (SLS) for gastroschisis reduction because SLS is currently unavailable in Japan. Our patient was a 1,707 g female diagnosed prenatally with gastroschisis born at 35 weeks gestation by spontaneous vaginal delivery. Attempted primary closure failed and a WPAR was used as a silo. A piece of the bottom ring of the WPAR was cut out and a smaller ring was made from it, so it would fit into the patient’s abdomen. Eviscerated organs were inserted into the retractor through the bottom ring, and the bottom ring was placed into the abdominal cavity through the gastroschisis defect without suturing to complete the silo. Operating time was 20 minutes. Three days later, all eviscerated organs had been reduced into the peritoneal cavity, the silo was removed, and the gastroschisis defect closed without difficulty. Postoperative recovery was uneventful and the WPAR was an excellent alternative for making a silo.