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[Gastroschisis and omphalocele. Treatment and results]
C P Hovendal1, L Rasmussen, S A Pedersen
1Kirurgisk afdeling K, Odense Sygehus.
Insights
Neonatal abdominal wall defects like gastroschisis and omphalocele require specialized care. Survival is more dependent on the absence of other congenital defects than on birth weight.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Context:
- Gastroschisis and omphalocele are significant congenital anomalies affecting newborns.
- Management strategies have evolved, including primary closure and prosthetic use.
- Early studies highlight critical factors influencing patient outcomes.
Purpose:
- To review treatment outcomes for neonates with gastroschisis and omphalocele.
- To identify key factors affecting mortality in these conditions.
- To emphasize essential perioperative management protocols.
Summary:
- A retrospective analysis of 52 neonates treated for gastroschisis (28) and omphalocele (44) between 1976-1988.
- Primary closure was common (44 patients), with prostheses used in 23.
- Mortality (8%) was linked to bowel infarction and respiratory distress syndrome, particularly in low birth weight infants (<1800g).
Impact:
- Presence of serious congenital defects, not birth weight, is the primary determinant of mortality.
- Mandatory ventilatory support with paralysis is crucial perioperatively.
- Minimizing bowel stretch and proper fluid management are vital for reducing complications and improving survival rates.
Abstract:
Between 1976 and 1988, 28 neonates with gastroschisis and 44 with omphalocele were treated. In 44 patients primary closure was achieved, while silastic prostheses were used in 23 patients, and dura implant in three patients. Two patients were not treated. The mortality rate was 8% (4/52) among the patients without serious congenital defects and birth weights over 1,800 g. This mortality was mainly caused by bowel infarction and, in infants with birth weights below 1,800 g, by the respiratory distress syndrome. Our experience suggests that ventilatory assistance with total paralysis is mandatory per- and postoperatively. The handling of these abdominal wall defects demands transport in an incubator with a nasogastric tube in place, a sterile bowel bag and replacement of fluid loss. Bowel stretch at the edge of the defect should be minimized in order to reduce the risk of bowel infarction. The favorable results of treatment of these malformations depend less on birth weight than on the presence of other serious congenital defects which are decisive for the mortality.