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Omphalocele and gastroschisis. Trends in survival across two decades
Insights
This study compared outcomes for omphalocele and gastroschisis patients treated between 1970-1980. Omphalocele survival remained stable, while gastroschisis survival significantly improved, with no major differences in closure methods impacting outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Omphalocele and gastroschisis are congenital abdominal wall defects requiring surgical intervention.
- Treatment outcomes for these conditions have evolved over time, necessitating updated analyses.
- Understanding factors influencing survival is crucial for improving patient care.
Purpose of the Study:
- To evaluate and compare the treatment outcomes and survival rates for patients with omphalocele and gastroschisis.
- To identify factors affecting mortality and survival in these patient populations.
- To assess the impact of surgical closure techniques on outcomes.
Main Methods:
- Retrospective analysis of 57 omphalocele and 64 gastroschisis patients treated from July 1970 to June 1980.
- Comparison of mortality rates based on defect size, birth weight, liver involvement, and closure method for omphalocele.
- Evaluation of survival rates for gastroschisis patients, comparing primary versus staged closure.
Main Results:
- Omphalocele mortality (19%) showed no significant difference based on defect size, birth weight, liver herniation, or closure technique.
- Omphalocele survival was adversely affected by major chromosomal anomalies.
- Gastroschisis survival markedly increased (91% in 1975-1980), with no statistically significant difference between primary and staged closure methods.
Conclusions:
- Omphalocele survival rates remained consistent, with associated anomalies being key determinants of outcome.
- Significant improvements in gastroschisis survival were observed, independent of the chosen surgical closure method.
- Prematurity, bowel issues, and Candida septicemia were identified as contributors to mortality in gastroschisis patients.
Abstract:
During the decade from July 1970 through June 1980, 57 patients with omphalocele and 64 with gastroschisis were treated at the Childrens Hospital of Los Angeles. Among the patients with omphalocele, the mortality was not significantly different between those with an abdominal wall defect smaller than 4 cm (5 of 24 patients) and those with a larger defect (6 of 33 patients); between those with a birth weight of less than 2,500 g (3 of 13 patients) and those with a higher birth weight (8 of 44 patients); between patients who had part of their liver in the omphalocele sac (6 of 29 patients) and those who did not (5 of 28 patients); and between patients who had primary fascial closure of the abdominal wall defect (3 of 24 patients) and those who had staged closure (4 of 25 patients). The overall mortality of 19 percent (11 of 57 patients) is not significantly different from that seen in patients treated during the preceding decade, 1960 through 1970 (23 percent, 5 of 22 patients), in our institution. Major chromosomal and other associated anomalies adversely affected the survival rate in these patients. In contrast, the overall survival rate of gastroschisis patients has markedly increased over the past two decades (91 percent in 1975 to 1980). In these patients, the difference in survival between those who had primary fascial closure (73 percent) and those who had staged closure by skin flaps or silon chimney (81 percent) was not statistically significant. Prematurity, bowel complications, and candida septicemia associated with the use of total parenteral nutrition contributed to the mortality.