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Abdominal wall defects in infants. Survival and implications for adult life
W P Tunell1, N K Puffinbarger, D W Tuggle
1Department of Surgery, University of Oklahoma College of Medicine/Children's Hospital of Oklahoma, Oklahoma City, USA.
Insights
Survival for infants with abdominal wall defects like omphalocele and gastroschisis is favorable, especially without other major congenital anomalies. Most survivors report a good quality of life, with reoperations mainly for hernias.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Omphalocele and gastroschisis are significant congenital abdominal wall defects requiring surgical intervention.
- Long-term outcomes regarding survival, morbidity, and quality of life are crucial for patient management.
Purpose of the Study:
- To evaluate the survival rates, morbidity, and long-term quality of life in patients treated for omphalocele and gastroschisis.
- To identify factors influencing outcomes in this patient population.
Main Methods:
- A clinical follow-up study of 94 patients diagnosed with omphalocele or gastroschisis.
- Data collected over a 10- to 20-year period post-birth, including survival, reoperations, and quality of life assessments.
Main Results:
- Eighty-three patients (88%) survived initial treatment, with 61 undergoing long-term follow-up (mean 14.2 years).
- Favorable survival was observed in patients without lethal or major co-existing congenital anomalies.
- Nineteen patients required 31 reoperations, primarily for abdominal wall hernias and sequelae of intestinal atresia; 80% reported a favorable quality of life.
Conclusions:
- High survival rates are achievable for abdominal wall defects, with mortality predominantly linked to lethal congenital anomalies.
- Reoperations are mainly indicated for post-closure abdominal wall hernias and congenital bowel atresia, typically not required after school age.
- Patient-reported quality of life among survivors is generally satisfactory.
Objective:
The authors study reviewed patients who underwent operations for omphalocele and gastroschisis to determine survival, morbidity, and long-term quality of life.
Method:
Clinical follow-up of 94 patients cared for with omphalocele and gastroschisis during a 10- to 20-year period after birth.
Result:
Eighty-three patients survived initial treatment. Sixty-one had long-term follow-up. Mean follow-up in the group was 14.2 years. Survival was favorable in the absence of lethal or co-existing major congenital anomalies. Nineteen patients required 31 reoperations, most for abdominal wall hernias and the sequelae of intestinal atresia. Current quality of life was described as favorable (good) in 80% of patients.
Conclusions:
Survival rate in patients with abdominal wall defects is favorable and deaths occur substantially in patients with co-existing lethal, or multiple, congenital anomalies. Reoperative surgery is necessary principally in those patients who have postclosure abdominal wall hernias, and in those with bowel atresia at birth. Reoperations are not likely to be necessary after school age. Quality of life in survivors is patient-perceived as entirely satisfactory.