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Gastroschisis: A State-of-the-Art Review
Vishwanath Bhat1, Matthew Moront2, Vineet Bhandari1
1Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ 08103, USA.
Insights
Gastroschisis, a common birth defect, is increasing in prevalence, particularly among young mothers. While outcomes are generally excellent, complex cases and short bowel syndrome present ongoing management challenges.
Area of Science:
- Pediatric Surgery
- Maternal-Fetal Medicine
- Neonatology
Background:
- Gastroschisis is the most common abdominal wall defect, with rising incidence.
- Associated with young maternal age and potential environmental factors; genetic contribution is unclear.
- Prenatal diagnosis via ultrasound aids in identifying associated bowel atresia.
Purpose of the Study:
- To review the epidemiology, diagnosis, management, and outcomes of gastroschisis.
- To highlight challenges in complex cases, particularly short bowel syndrome.
- To suggest future research directions.
Main Methods:
- Literature review and synthesis of current knowledge on gastroschisis.
- Analysis of diagnostic modalities, including prenatal ultrasound.
- Discussion of surgical management options and prognostic factors.
Main Results:
- Gastroschisis prevalence is increasing, often linked to young mothers.
- Prenatal ultrasound is valuable for early diagnosis and predicting complications.
- Surgical outcomes are generally excellent, but short bowel syndrome poses challenges.
Conclusions:
- Gastroschisis management has evolved, with excellent overall prognosis.
- Further research is needed on epidemiological factors and managing short bowel syndrome.
- Optimizing fetal and obstetric interventions may minimize intestinal damage.
Abstract:
Gastroschisis, the most common type of abdominal wall defect, has seen a steady increase in its prevalence over the past several decades. It is identified, both prenatally and postnatally, by the location of the defect, most often to the right of a normally-inserted umbilical cord. It disproportionately affects young mothers, and appears to be associated with environmental factors. However, the contribution of genetic factors to the overall risk remains unknown. While approximately 10% of infants with gastroschisis have intestinal atresia, extraintestinal anomalies are rare. Prenatal ultrasound scans are useful for early diagnosis and identification of features that predict a high likelihood of associated bowel atresia. The timing and mode of delivery for mothers with fetuses with gastroschisis have been somewhat controversial, but there is no convincing evidence to support routine preterm delivery or elective cesarean section in the absence of obstetric indications. Postnatal surgical management is dictated by the condition of the bowel and the abdominal domain. The surgical options include either primary reduction and closure or staged reduction with placement of a silo followed by delayed closure. The overall prognosis for infants with gastroschisis, in terms of both survival as well as long-term outcomes, is excellent. However, the management and outcomes of a subset of infants with complex gastroschisis, especially those who develop short bowel syndrome (SBS), remains challenging. Future research should be directed towards identification of epidemiological factors contributing to its rising incidence, improvement in the management of SBS, and obstetric/fetal interventions to minimize intestinal damage.
