Experience with treatment of gastroschisis and omphalocele

From 1982 to 1990, 31 neonates with omphalocele and 54 with gastroschisis were treated at Mackay Memorial Hospital. The overall survival rate for omphalocele was 71%, while it was 85% for gastroschisis. The rate of primary fascial closure for omphalocele (85%) and gastroschisis (87%) was similar. The mortality from omphalocele was almost exclusively due to the presence of serious associated congenital anomalies. Two cases of Cantrell's pentalogy and two of cloacal exstrophy were found. The incidence of major malformation with gastroschisis was 6%. Sepsis, inadequate perioperative resuscitation and prolonged gastrointestinal dysfunction were the major causes of death in gastroschisis. Among survivors, the hospital stay was significantly longer in the silon pouch group than in the primary fascial closure group (71.5 vs 31.3 days for gastroschisis, 41 vs 14 days for omphalocele). Advances in surgical technique, neonatal intensive care and ventilatory support have made primary fascial closure a superior approach without jeopardizing the babies' chance for survival. An improved survival rate and increased primary closure rate are the main features in the treatment of abdominal wall defects in the last decade.