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Gastroschisis and omphalocele
Insights
This study compares gastroschisis and omphalocele in 100 infants. Primary closure of abdominal wall defects and improved supportive care significantly reduced mortality rates for both conditions.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis and omphalocele are congenital abdominal wall defects with distinct clinical presentations.
- Gastroschisis typically presents homogeneously, while omphalocele exhibits greater heterogeneity.
- Defect closure is a primary challenge in both conditions, with additional concerns in gastroschisis (intestinal length, sepsis) and omphalocele (associated anomalies).
Purpose of the Study:
- To analyze outcomes in a series of 100 patients with gastroschisis and omphalocele.
- To evaluate the impact of improved management strategies on mortality rates.
- To highlight the importance of primary abdominal wall closure and supportive care.
Main Methods:
- Retrospective review of 100 patients with gastroschisis and omphalocele.
- Comparison of outcomes between two nine-year periods.
- Analysis of factors including defect closure, hypothermia prevention, respiratory support, and parenteral nutrition.
Main Results:
- Mortality rate for omphalocele decreased from 60% to 37% over the study period.
- Recent outcomes show a 2-death rate in the last 12 omphalocele patients treated with primary closure.
- Gastroschisis survival rate improved to 69% overall and 74% with primary complete closure, compared to historical rates of 36-43%.
Conclusions:
- Primary closure of abdominal wall defects is crucial for improving survival in both gastroschisis and omphalocele.
- Enhanced supportive care, including respiratory support and parenteral nutrition, significantly contributes to better outcomes.
- Minimizing hypothermia during transport and surgery is vital for patient management.
Abstract:
A series of 100 patients with gastroschisis and omphalocele is presented. It is emphasized that gastroschisis generally has a strikingly homogeneous clinical presentation, while the omphalocele has a more heterogeneous clinical presentation, varying from the smallest to the largest, nearly incorrectable type. The main problem in the two groups is the problem of the closure of the defect. In gastroschisis there are, in addition, two problems related to the length of the intestinal tract and the tendency to peritonitis and septicaemia. In omphalocele, however, the major problem is the associated anomalies. The experience from the present material indicates that greater efforts must be used in the future in trying to avoid hypothermia, both during transportation and during operation. Furthermore, greater efforts must be made in closing the abdominal wall defect primarily in both groups of patients. More liberal use of respirator and total parenteral nutrition, mainly by peripheral veins, has obviously contributed to the improvement in our results from 1 60% mortality rate in the first nine-year period to a 37% mortality rate in the last nine-year period in the omphalocele group. Our best results have been obtained during the last 3 years with 2 deaths in the last 12 patients who all were treated by primary closure. In the gastroschisis group a survival rate of 69% in the whole series and of 74% in those who were primarily completely closed must be looked upon as progress in the light of earlier reports of survival rates of 36% to 43%.
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