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Gastroschisis and omphalocele: treatments and long-term outcomes
Katharina Henrich1, Hans P Huemmer, Bertram Reingruber
1Department of Pediatric Surgery, Erlangen University Hospital, Erlangen, Germany.
Insights
This study on gastroschisis and omphalocele found that while omphalocele cases had more associated abnormalities, both conditions showed good long-term outcomes with appropriate treatment and prenatal diagnosis. Developmental delays and gastrointestinal issues were largely resolved within two years.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Developmental Pediatrics
Background:
- Gastroschisis and omphalocele are congenital abdominal wall defects with varying associated anomalies and management challenges.
- Prenatal diagnosis rates have increased, influencing management strategies and outcomes.
- Long-term follow-up is crucial to assess developmental, functional, and cosmetic results.
Purpose of the Study:
- To evaluate and compare the short-term and long-term outcomes of gastroschisis and omphalocele treatment in children.
- To analyze factors influencing outcomes, including prenatal diagnosis, delivery method, and surgical approach.
- To assess developmental progress, gastrointestinal function, physical growth, and quality of life in a cohort of treated children.
Main Methods:
- Retrospective analysis of 40 gastroschisis and 26 omphalocele cases treated between 1994 and 2004.
- Recording of pregnancy, delivery, surgical, and post-operative data.
- Follow-up examinations of 37 children assessing abdominal musculature, development, cosmetic results, and quality of life over a median of 6.3 years.
Main Results:
- Prenatal diagnosis was common (88% gastroschisis, 69% omphalocele).
- Omphalocele cases had a higher incidence of further congenital abnormalities (81%) compared to gastroschisis (28%).
- Mortality was nil for gastroschisis and 8% for omphalocele; outcomes were better with primary closure and improved with advances in prenatal diagnosis and perinatal care.
Conclusions:
- Gastroschisis and omphalocele, despite differences in associated anomalies, demonstrate favorable long-term outcomes with modern management.
- Initial gastrointestinal problems and developmental delays are typically resolved within the first two years post-treatment.
- Advances in prenatal diagnosis and perinatal care have significantly improved short-term results, allowing for more optimistic prenatal counseling.
Abstract:
Between February 1994 and April 2004, we treated 40 children with gastroschisis and 26 children with omphalocele. We recorded the course of pregnancy, pre- and post-natal complications, delivery, operation, post-operative therapy, and long-term outcomes. Additionally, we conducted follow-up examinations of 37 of these 66 children (56%). We analysed their abdominal musculature, development, cosmetic result and quality of life. The median duration of follow-up was 6.3 years (range 1-10). In 35/40 children (88%) with gastroschisis and in 18/26 children (69%) with omphalocele, there had been prenatal diagnosis. The average maternal age of 23.9 years in the gastroschisis group was lower than in the omphalocele group (29.9 years). Delivery was by caesarean section in 93% of the gastroschisis group and 65% of the omphalocele group. Outcomes following vaginal delivery were no worse than those after caesarean section. Further, congenital abnormalities were shown in 28% of gastroschisis cases, and were limited to the gastrointestinal tract. Of the omphalocele cases 81% showed further abnormalities. Direct closure of the abdominal wall defect was possible in 31/40 (78%) of the gastroschisis cases and 15/26 (58%) of the omphalocele cases. Mortality in gastroschisis was nil; two children with omphalocele died (8%). Outcomes were better after primary closure than in stepwise reconstruction. Follow-up showed good results in all categories. Developmental delays were rapidly made up after treatment, and 75% of the children had no gastrointestinal problems, or suffered from these rarely. Almost all the children were of normal weight and height, and physical and intellectual development were delayed in only one third of the children. The surgical scar was rated as good or very good in about 80% of the cases. Except for those with severe defects, the children had good ratings for quality of life. Improvements in short-term results of gastroschisis and omphalocele treatment can be attributed to recent developments in prenatal diagnosis and the advancements of centralised perinatal care. Our long-term results clearly demonstrate that initial gastrointestinal problems and developmental delays were made up during the first two years of life. Prenatal counselling can now be more optimistic.
