Review of the evidence on the closure of abdominal wall defects
Vincent E Mortellaro1, Shawn D St Peter, Frankie B Fike
1Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
Insights
Surgical repair of congenital abdominal wall defects like gastroschisis and omphalocele presents challenges. Current evidence suggests no survival difference between immediate or delayed gastroschisis repair, but optimal omphalocele management remains unclear.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Congenital abdominal wall defects, including gastroschisis and omphalocele, require complex surgical management in infants.
- Current treatment strategies vary, necessitating a review of existing literature to guide clinical practice.
Purpose of the Study:
- To review current treatment modalities for gastroschisis and omphalocele in infants.
- To define the application of these treatment strategies in clinical practice.
- To identify areas where further research is needed for optimal management.
Main Methods:
- Literature review of studies on the surgical management of gastroschisis and omphalocele.
- Analysis of data quality (grades C, D, and E) to assess the strength of evidence for different repair techniques.
- Synthesis of findings to compare outcomes of various surgical approaches.
Main Results:
- For gastroschisis, evidence (Grade C) indicates no significant difference in survival between immediate and delayed operative repair.
- Management of omphalocele involves varied techniques (immediate, staged, or delayed closure), with limited evidence (Grades D and E) to guide optimal selection.
- The optimal management strategy for larger omphalocele defects remains undetermined.
Conclusions:
- While gastroschisis repair strategies show comparable survival rates, omphalocele management requires further investigation.
- A dedicated registry for omphalocele patients with larger defects could provide crucial data to determine optimal treatment.
- Standardizing management protocols for these challenging congenital defects is essential.
Abstract:
Infants with congenital abdominal wall defects pose an interesting and challenging management issue for surgeons. We attempt to review the literature to define the current treatment modalities and their application in practice. In gastroschisis, the overall strategies for repair include immediate closure or delayed operative repair. The best level of data for gastroschisis is grade C and appears to support that there is no major difference in survival between immediate closure or delayed repair. In patients with omphalocele, the management techniques are more varied consisting of immediate closure, staged closure or delayed closure after epithelialization. The literature is less clear on when to use one technique over the other, consisting of mostly grade D and E data. In patients with omphalocele, a registry to collect information on patients with larger defects may help determine which of the management strategies is optimal.
