A Retrospective Study of 91 Cases with Gastroschisis or Omphalocele 1956-1985

Abstract

The experiences of treatment of 91 infants with abdominal wall defects during thirty years are presented. The occurrence of gastroschisis increased during the last ten years. The results of treatment have improved markedly during the period of study but there is still a high mortality rate in children with omphalocele and multiple concomitant malformations and in children with gastroschisis and coexisting intestinal atresia. In cases with large omphalocele defects, if primary closure is not possible, an implant is recommended instead of silastic silo, skin flap closure or mercurochrome application. The clinical course in thirty-six patients during the last ten years is reported.

Definitive surgical management of antenatally diagnosed exomphalos

“…The incidence of other congenital anomalies has ranged from 45% to 77% in previous series [2][3][4]7,8]. The incidence, apart from overt chromosomal abnormalities, in the current series is comparable (~70%), although we have also counted minor anomalies such as undescended testes, and so on, probably ignored in past studies.…”

“…Table 4 [3,4,[6][7][8]12,17,18] illustrates that some centers have an aggressive policy of surgical closure [4,12] whereas others advocate a much more liberal use of the conservative option [6,8] even occasionally for the minor exomphalos [8]. The quoted survival rates vary but there has been a definite improvement over time irrespective of technique.…”

“…It is noteworthy that no chromosomal anomalies were identified in any infant in this series. Previous unselected series report an antenatal incidence of chromosomal anomalies of 22% to 54% [1,2,16] in fetuses and 0% to 12% [3,7,8] of live births. This series clearly demonstrates the beffectivenessQ of antenatal screening in our unit during the late 1990s in that no infant was born with an untreatable malformation.…”

“…Such nonoperative treatment has involved painting the sac with a variety of substances (eg, mercurochrome [7,8,11], povidone-iodine [17], silver sulfadiazine [5,12], and neomycin/bacitracin powder [8]). Of course, there are specific complications related to the nature of the agent including mercury [7] and iodine poisoning so care has to be taken in infants so treated. The morbidity associated with conservatively treated infants can also be difficult to establish.…”

“…The size of defect and the nature of its contents are variable ranging from a small defect with a knuckle of intestine to absence of the anterior abdominal wall with protrusion of all the viscera. Some studies have divided this into bminorQ or bmajorQ (or alternatively bgiantQ) exomphalos depending on the diameter of the abdominal wall defect (for instance, N5 or b5 cm) [4][5][6] or based on nature of contents (eg, liver) [7], whereas others have not discriminated [8].…”