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[193 cases of gastroschisis and omphalocele--postoperative results]
F Schier1, C Schier, M P Stute
1Klinik für Kinderchirurgie, Westfälischen, Wilhelms-Universität Münster.
Insights
This study on omphalocele and gastroschisis treatments found high mortality rates, particularly after complex repairs. Conservative or primary closure methods showed similar risks to more invasive techniques.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
Context:
- This study analyzes 20 years of treatment data for 97 omphalocele and 96 gastroschisis cases at the Dortmund Department of Pediatric Surgery.
- Follow-up assessments were conducted on 56 patients approximately ten years post-surgery, including clinical examinations and questionnaires.
Purpose:
- To evaluate the long-term outcomes and survival rates of different treatment modalities for omphalocele and gastroschisis.
- To compare the risks associated with primary closure, staged closures (dura implantation, silastic pouches), and conservative management.
Summary:
- Overall mortality was 37%, with receptive operations showing 40-50% mortality, irrespective of the primary approach.
- Primary closure and conservative treatment (for closed omphalocele) presented similar risks.
- The highest rates of relaparotomy were observed following dura implantation and silastic pouch use.
Impact:
- Findings highlight the significant mortality associated with complex abdominal wall defect treatments.
- The study suggests that while invasive techniques may increase relaparotomy rates, overall mortality is high across various approaches.
- Results provide valuable data for surgical decision-making and patient counseling in pediatric abdominal wall defects.
Abstract:
Treatment was applied to 97 cases of omphalocele and 96 cases of gastroschisis at the Dortmund Department of Paediatric Surgery over the past 20 years. The survival rate was 122. Follow-up checks were recently applied to 56 of those former patients, after nearly ten years had elapsed from surgery. Thirty-eight of these patients were clinically examined, while questionnaires were completed for the rest. Primary closures had been performed on 50 per cent of the cases, while the defects in the other children were closed in two stages, using dura implantation or silastic pouches, or were conservatively treated. Accompanying malformations were recorded from 21 per cent of the gastroschisis cases and from 28 per cent of those with omphalocele. Overall mortality accounted for 37 per cent, with mortality in the wake of receptive operations being as high as 40 to 50 per cent, the latter rate not depending on the primary approach. One and the same risk was found to exist for conservative treatment (applicable only to closed omphalocele) and primary surgical closure, as may be seen from statistical evaluation. The highest rate of relaparotomy occurred in the wake of dura implantation and use of silastic pouches.