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[Current status of management of omphalocele and gastroschisis]
1Department of Pediatric Surgery, Central Hospital, Aichi Prefectural Colony, Kasugai, Japan.
Insights
Survival rates for gastroschisis have improved, but omphalocele outcomes remain lower due to defect size and anomalies. Nonoperative management with epithelialization is most reliable for omphalocele treatment.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Context:
- Gastroschisis and omphalocele are common congenital abdominal wall defects.
- Outcomes for gastroschisis have improved significantly over two decades.
- Omphalocele survival rates lag behind gastroschisis, influenced by defect size and associated anomalies.
Purpose:
- To compare outcomes and management strategies for gastroschisis and omphalocele.
- To identify prognostic factors affecting omphalocele survival.
- To evaluate the efficacy of different therapeutic approaches for omphalocele.
Summary:
- A review of 45 gastroschisis and 85 omphalocele cases was conducted.
- Gastroschisis management primarily involved primary fascial closure, with silo use in select cases.
- Omphalocele management included primary closure (34 cases), silo chimney (17 cases), and nonoperative management with epithelialization (45 cases).
- Nonoperative management, specifically painting, emerged as the most reliable therapeutic strategy for omphalocele.
Impact:
- Improved understanding of prognostic factors for omphalocele.
- Highlights the effectiveness of nonoperative management for omphalocele.
- Informs clinical decision-making for treating neonates with abdominal wall defects.
Abstract:
Forty-five cases of gastroschisis and 85 of omphalocele were reviewed. The survival of gastroschisis has dramatically improved over the past 20 years, however, that of omphalocele still remained in the lower value, because the size of the defect and the presence of associated anomalies are prognostic factors. The primary fascial closure was first employed for the patients with gastroschisis and a silo chimney was used for limited cases. On the other hand, for the patients with omphalocele, primary closure was possible in 34 cases, silo chimney was used in 17, and 45 cases had nonoperative management with epithelialization. Among them, nonoperative management using painting was the most reliable therapeutic for omphalocele.