8. Post-operative care

The staged reduction process should take between 1 day and 2 weeks and is dependent on the degree of VPD. Enteral feeds are started once the gastro-intestinal system shows signs of resumed function: decreased nasogastric aspirates <20 ml/kg and bowel motions. Ideally expressed maternal breast milk is used [63–65], but formula feeds are acceptable. Elemental feeds may help protect against necrotizing enterocolitis. GS infants fed at around 7 days post closure seem to have the best outcome [66]. If the bowels do not open within 10–14 days a water-soluble contrast

lend themselves to resection and primary anastomosis (either at the time of reduction, or delayed). Necrotic gut will require resection (Figures 10 and 11) and vanished gut will indicate an ultra-short intra-abdominal segment. These cases will

require either primary or delayed bowel lengthening procedures [62].

Pre-formed silos http://bentecmed.com/bentec-medical-products/ventral-wall-defect-silo-bags/.

Figure 8.

Box 1.

Figure 9.

124

Available silo materials [55, 59, 60].

(a–c) Staged silo reduction.

• Prolene mesh

Pediatric Surgery, Flowcharts and Clinical Algorithms

• Silicone sheet

• Goretex mesh

• IV fluid bag

• Female condom

• Alexis wound protector

• Sterile adhesive drapes +/ prolene mesh

• Biomaterials (Alloderm, Permacol)

enema should be done to rule out a bowel atresia. An atresia detected at the time of initial closure of by subsequent imaging may be safely repaired after 3–6 weeks. Albeit uncommon in GS, cases with any associated malformations will require further investigations and management according to the findings.
