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Treatment of congenital abdominal wall defects -a 25-year review of 132 patients
A Clausner1, A Lukowitz, K Rump
1Department of Pediatric Surgery, Johannes-Gutenberg-University, Langenbeckstrasse 1, D-55101, Mainz, Germany.
Insights
Outcomes for abdominal wall defects (AWDs) show gastroschisis (GS) has more complex recovery than omphalocele (OC). However, survival rates have improved, with long-term quality of life generally unaffected by isolated AWDs.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Background:
- Abdominal wall defects (AWDs) are congenital conditions requiring surgical intervention.
- Prenatal diagnosis influences patient selection and management strategies.
- Gastroschisis (GS) and omphalocele (OC) are the primary types of AWDs with distinct clinical courses.
Purpose of the Study:
- To review the outcomes of patients with abdominal wall defects treated over 25 years.
- To compare the surgical outcomes and mortality rates of gastroschisis and omphalocele.
- To evaluate the impact of primary versus delayed closure on patient recovery.
Main Methods:
- Retrospective review of 132 patients treated for AWDs.
- Analysis of data including diagnosis, surgical approach, postoperative course, and mortality.
- Comparison of outcomes between gastroschisis and omphalocele cohorts.
Main Results:
- Primary abdominal wall closure is more successful in gastroschisis than omphalocele.
- Gastroschisis cases exhibit more complicated and prolonged postoperative courses.
- Delayed or secondary closure did not negatively impact outcomes but extended hospitalization.
- Early mortality rates were 15/55 for omphalocele and 21/77 for gastroschisis, with recent significant reductions.
- Mortality is now primarily associated with additional congenital malformations.
Conclusions:
- Despite challenges, surgical management of AWDs has improved, with reduced mortality.
- Survival of isolated AWDs generally leads to good long-term development and quality of life.
- Potential for parenchymal organ malpositioning post-closure requires consideration during prenatal and surgical management.
Abstract:
The outcome data of 132 patients treated at the Department of Pediatric Surgery in Mainz during the last 25 years were reviewed. Prenatal diagnosis of abdominal wall defects (AWDs) and associated malformations led to increasing selection of the patient population. The aim of primary closure of the abdominal wall can be achieved more frequently in gastroschisis (GS) than omphalocele (OC), while the postoperative course is more complicated and of longer duration in GS. Delayed or secondary closure extended the hospitalization period but had no negative effects on the outcome. Reoperations or planned secondary operations were performed in 23 patients with GS and 14 with OC. Early mortality was 15/55 for OC and 21/77 for GS over the period of 25 years. In recent years, a drastic reduction in mortality has occurred, and mortality is now mainly due to additional malformations. Further development and quality of life are not significantly reduced after survival of an isolated AWD. Malpositioning of parenchymatous organs after closure of AWDs has to be considered during pregnancy and abdominal operations.
