The SimpleSilo: An Effective and Affordable Solution for Gastroschisis Management in Low-resource Settings

Background: Survival rates for infants born with gastroschisis are extremely poor in low and middle income countries. While reasons for mortality are multifactorial, commercial silo bags have been shown to improve outcomes; however, high cost limits access to these bags. We aimed to develop a low-cost silo bag alternative using locally available materials to meet this need. Methods: To make the SimpleSilo, a flexible ring is tailored to the size of the fascial defect by forming a loop of oxygen tubing. This tubing is folded into a silicone bag and sealed using a commercially available heat sealer. The edge of the bag is then sealed to narrow the diameter of the bag and to create the cylindrical shape required to successfully reduce the intestines into the abdominal cavity. Results: In the laboratory, leakage rate of fluid from the bag was found to be approximately 0.02 mL/h, comparable to commercial silo bags. The bag can be disinfected in Cidex OPA at least five times without significantly increasing leakage rate. The SimpleSilo was tested in a gastroschisis model consisting of cow intestines and produced 50 % intestinal reduction in three days, similar to commercial bags. Pediatric surgeons in Kenya were able to replicate bag production using assembly directions and had positive feedback after clinical use. Conclusions: The SimpleSilo design shows the potential for significant cost reduction by using materials available in low-resource hospitals. Additionally, it can be assembled in a hospital setting, which increases availability. This innovative idea could pave the way for increased survival for babies born with gastroschisis in low-resource settings.