For the first time, we present the use of a non-operative bespoke hydrocolloid silo (BHS) to relocate the viscera into the abdominal cavity without general anaesthetic.
In 2010, Dr Abello, a paediatric surgeon in Columbia, posted a video showing a hydrocolloid silo to treat giant exomphalos. We have modified Dr Abello’s technique and present the use of a BHS without intubation or paralysis.
Patients were given IV paracetamol and then oral sucrose during the silo placement. The abdominal skin and exomphalos sac is cleaned and a barrier film applied to the skin to prevent adhesive trauma and friction. A T-shaped piece of adhesive hydrocolloid dressing is applied on either side of the abdomen and wrapped around the exomphalos (Figure 1). The silo is rolled, compressed daily and replaced twice a week until the viscera is reduced. Once viscera are relocated into the abdomen, a single sheet of hydrocolloid was applied to maintain compression and then a Melolite ™ with circumferential compression bandage maintains the reduced viscera.
3 giant exomphalos patients have undergone BHS since April 2014. The first patient did not have compression bandages and viscera re-herniated. He underwent a modified component separation at 10 months old with good results.
Our subsequent patients had BHS as described above and progressed to compression bandage on day25 and day31. Both of these patients are at home awaiting component separation to treat their ventral hernias.
Figure 1: a) pre-proceedure, b) BHS in place, c) compression on the BHS to reduce abdominal contents, d) after removal of silo showing ventral hernia, therefore a compression bandage is reapplied.
We debut the use of a BHS to relocated the herniated viscera in the abdominal cavity, allowing the organs to grow intra-abdominally without the need for an anaesthetic.