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Use of plastic material from a urine drainage bag in the staged closure of gastroschisis

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Abstract

During the period 1996-98, 5 neonates underwent operative repair of gastroschisis at the Department of Pediatric Surgery, Christian Medical College Hospital, Vellore. While one patient was closed primarily, the other 4 patients underwent silo creation using plastic material cut from a urine drainage bag. Two of these had a successful result and have been followed up for more than 6 months. The other two died of causes unrelated to the repair technique. We conclude that this plastic material from urine drainage bag is a freely available, cheap and effective alternative to other materials in the staged closure of gastroschisis.
... 8 The Bogota bag was a plastic bag first used by Borraez Goana of Bogota. 9 Colombia and it has been used successfully for indications such as situations where early reoperation is necessary, to prevent abdominal compartment syndrome, for the treatment of gastroschisis in neonates, 10 for the treatment of secondary or tertiary peritonitis and for the treatment of missing portions of the abdominal wall. In this case, it was decided to wait for some time to see whether more viable bowel could be salvaged. ...
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We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.
... Drs Vijay and Ann have published several articles on interventions that are as safe and effective or nearly as safe and effective as much more expensive alternatives commonly used today during their postgraduate studies. 14,15,16 Makunda Hospital's "revised gold standard" approach has enabled it to lower the cost of providing health care services so it can in turn lower prices, which drives greater volume. ...
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Background: Mission hospitals in low-resource regions of the world face significant challenges in providing high-quality, accessible care to patients. External funding is limited and can fluctuate significantly from year to year. Additionally, attracting and retaining well-qualified healthcare professionals for more than short stints can seem almost impossible. Located in a remote region in Northeast India, the Makunda Christian Leprosy & General Hospital has developed a model over the past 25 years that has enabled it to sustainably expand access to high-quality care for the region's poor, which we evaluate in this paper. Methods: We combine an external assessment by a research team at the Wharton School of Business with internal insights from two leaders at Makunda Hospital to evaluate the Makunda Model. The external assessment included 31 in-depth, on-site interviews of patients, employees, and competitor hospital administrators; physical observation of Makunda's facilities and operational practices; and an analysis of years of financial documents and hospital statistics. Results: We studied the impact of the Makunda Model on volumes, efficiency, quality, and community impact. In 2018-19, Makunda Hospital provided 109,549 outpatient visits, 14,731 hospital admissions, 6,588 surgeries (2550 major), and 5,871 baby deliveries in a 162-bed facility with a bed occupancy rate of 88%. The hospital operates with an annual budget of $2.7M ($1 = INR 75.70) and receives only 2.5% of its operating revenue from external sources. The hospital has developed a strong reputation in the community and beyond for providing excellent maternal care and catering to the poor. Discussion: The hospital's business model revolves around two key business strategies: (a) poor-centric strategies and (b) thoughtful cost management. Innovative poor-centric strategies include "ability-to-pay"-based pricing, equal services for all (in contrast to a freemium model), hyper-tailored charity (using the "shared meals" and "vital assets" tests), and community engagement. Thoughtful cost management is accomplished by "revised gold standard" treatment protocols and recruitment and retention of an efficient workforce.
... Dacron-reinforced silastic sheet is the preferred material to create such silos, which is very expensive and not easily available in a developing country. The use of plastic material from a urine drainage bag in the staged closure of gastroschisis was reported by Anand et al [8]. This material is made out of polyvinyl chloride with additives to add color and alter hardness. ...
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The aim of this study was to develop a method of management of large omphalocele, with easily available inexpensive materials. The efficacy of using the plastic of urine collection bag and paper stapler, in creating the "silo" for the management of 3 newborns with such defects, were assessed. All operations were done within 36 hours of birth. A silo was created with the plastic of a sterile urine collection bag, which was stapled with a paper stapler at its free margin. The omphalocele was gradually reduced every 24 to 48 hours, using the stapler, until the contents were reduced, when the abdominal wall was repaired. The mean time taken to close the abdominal defect was 34 days. All patients could be breast-fed from 48 hours after the first stage is done. Rooming in was done by day 7. None of the babies required assisted ventilation. This method is simple and cost-effective, using minimally expensive, easily available materials.
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Background Gastroschisis silos are often unavailable in sub-Saharan Africa (SSA), contributing to high mortality. We describe a collaboration between engineers and surgeons in the United States and Uganda to develop a silo from locally available materials. Methods Design criteria included the following: < $5 cost, 5 ± 0.25 cm opening diameter, deformability of the opening construct, ≥ 500 mL volume, ≥ 30 N tensile strength, no statistical difference in the leakage rate between the low-cost silo and preformed silo, ease of manufacturing, and reusability. Pugh scoring matrices were used to assess designs. Materials considered included the following: urine collection bags, intravenous bags, or zipper storage bags for the silo and female condom rings or O-rings for the silo opening construct. Silos were assembled with clothing irons and sewn with thread. Colleagues in Uganda, Malawi, Tanzania, and Kenya investigated material cost and availability. Results Urine collection bags and female condom rings were chosen as the most accessible materials. Silos were estimated to cost < $1 in SSA. Silos yielded a diameter of 5.01 ± 0.11 cm and a volume of 675 ± 7 mL. The iron + sewn seal, sewn seal, and ironed seal on the silos yielded tensile strengths of 31.1 ± 5.3 N, 30.1 ± 2.9 N, and 14.7 ± 2.4 N, respectively, compared with the seal of the current standard-of-care silo of 41.8 ± 6.1 N. The low-cost silos had comparable leakage rates along the opening and along the seal with the spring-loaded preformed silo. The silos were easily constructed by biomedical engineering students within 15 min. All silos were able to be sterilized by submersion. Conclusions A low-cost gastroschisis silo was constructed from materials locally available in SSA. Further in vivo and clinical studies are needed to determine if mortality can be improved with this design.
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