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[Clinical analysis of congenital abdominal wall defects--omphalocele and gastroschisis]
Milanka Tatić1, Radoica Jokić, Svetlana Bukarica
1Klinika za decju hirurgiju, Institut za zdravstvenu zastitu dece i omladine Novi Sad. taticma@Eunet.yu
Insights
This study analyzed congenital abdominal wall defects (omphalocele and gastroschisis), finding high mortality rates. Optimizing antenatal and neonatal care is crucial for improving survival in these complex cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Context:
- Retrospective analysis of 13 pediatric cases (1999-2003).
- Evaluated therapeutic approaches and outcomes for omphalocele and gastroschisis.
- Included prenatal ultrasound data and coexisting anomalies.
Purpose:
- Identify factors influencing prognosis in congenital abdominal wall defects.
- Analyze treatment outcomes for omphalocele and gastroschisis.
- Recommend a management protocol based on findings.
Summary:
- Omphalocele detected prenatally in 42.8%, gastroschisis in 16.7%.
- Coexisting anomalies were more frequent in omphalocele (57.1%).
- Mortality rates were 52% for omphalocele and 66.7% for gastroschisis.
Impact:
- Highlights the need for optimized antenatal and neonatal strategies.
- Aims to improve survival rates for infants with abdominal wall defects.
- Provides insights into surgical and conservative management outcomes.
Introduction:
This is a retrospective analysis of therapeutic approaches and treatment outcomes of congenital abdominal wall defects (omphalocele and gastroschisis) in a five year period. The aim of this study was to identify factors which can affect the prognosis of future therapeutic procedures.
Material And Methods:
We evaluated 13 children, 7 with omphalocele (2 female/5 male; mean birth weight of 2862 g; mean gestational age of 37 weeks), and 6 patients with gastroschisis (2 female/4 male; mean birth weight of 2640 g; mean gestational age of 36/2 weeks). All patients were treated at the Clinic of Pediatric Surgery from 1999 to 2003.
Results:
In this study, thirteen cases of congenital abdominal wall defects (omphalocele and gastroschisis) were retrospectively investigated. All patients underwent prenatal ultrasound. Omphalocele was prenatally detected in 42.8% of fetuses, and gastroschisis in 16.7%. Coexisting anomalies were present in 57.1% of patients with omphalocele and in 16.7% of newborns with gastroschisis. Three patients with omphalocele were treated operatively, and four only conservatively. The abdominal wall of patients with gastroschisis was primarily closed in three patients. Two patients required a staged abdominal wall closure. One patient with gastroschisis and intestinal atresia underwent primary closure after partial intestinal resection and enterostomy. Based on these responses, a management protocol (algorithm) was recommended. The most common postoperative complication, in 7 cases of omphalocele, was mechanical ileus (n = 1), whereas among patients with gastroschisis the commonest were mechanical ileus (n = 1) and intestinal perforation (n = 1). The mortality of patients with omphalocele was 52% and with gastroschisis 66.7%.
Conclusion:
A strategy designed to optimize antenatal and neonatal factors is expected to increase the survival rate of patients with abdominal wall defects.
