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Anesthesiology pp 395-402 | Cite as

Omphalocele and Gastroschisis

  • Wendy Nguyen
  • Kumar Belani
Chapter

Abstract

Omphaloceles and gastroschises are the most common congenital abdominal wall defects. The incidence of omphaloceles is 1:3000–4000 births in western countries (Wilson and Johnson, Fetal Diagn Ther 19:385–398, 2004). The incidence of gastroschises is between 1.10/10,000 and 5.1/10,000 (Zaccara et al., J Pediatr Surg 38:478–481, 2003). There is a rising incidence of both gastroschisis and omphalocele (Fig. 41.1). For gastroschisis, it is secondary to improved antenatal monitoring (Fig. 41.2) and increased interaction with environmental factors (Jones et al., Clin Genet 74:322–325, 2009). It appears to affect babies born to young, first-time mothers with low socioeconomic status and poor maternal diet (Goldbaum et al., Teratology 42:397–403, 1990; Siega-Riz et al., Paediatr Perinat Epidemiol 23:51–57, 2009). Omphalocele is seen more commonly in mothers at the two ends of the reproductive age and babies born with assisted conception (Kong et al., J Pediatr Surg 51:1644–1649, 2016). The complexity of omphaloceles and gastroschises can vary greatly, affecting perioperative care. Strategies for repair have evolved. Both require significant attention and stabilization before surgical intervention.

Keywords

Omphalocele Gastroschisis Abdominal wall defects Staged closure Pre-operative work up for co-existing anomalies Abdominal compartment syndrome and anesthetic management 

References

  1. 1.
    Wilson RD, Johnson MP. Congenital abdominal wall defects: an update. Fetal Diagn Ther. 2004;19(5):385–98.CrossRefPubMedGoogle Scholar
  2. 2.
    Zaccara A, Iacobelli B, Calzolari A, Turchetta A, Orazi C, Schingo P, et al. Cardiopulmonary perfomances in young children and adolescents born with large abdominal wall defects. J Pediatr Surg. 2003;38(3):478–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Jones KL, Benirschke K, Chambers CD. Gastroschisis: etiology and developmental pathogenesis. Clin Genet. 2009;74(4):322–5.Google Scholar
  4. 4.
    Goldbaum G, Daling J, Milham S. Risk factors for gastroschisis. Teratology. 1990;42(4):397–403.CrossRefPubMedGoogle Scholar
  5. 5.
    Siega-Riz AM, Herring AH, Olshan AF, Smith J, Moore C. The joint effects of maternal prepregnancy body mass index and age on the risk of gastroschisis. Paediatr Perinat Epidemiol. 2009;23(1):51–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Kong JK, Yeo KT, Abdel-Latif ME, Bajuk B, Holland AJA, Adams S, et al. Outcomes of infants with abdominal wall defects over 18 years. J Pediatr Surg. 2016;51(10):1644–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Bauman B, Stephens D, Gershone H, Bongiorno C, Osterholm AB, et al. Management of giant omphaloceles: a systemic review of methods of staged surgical vs. nonoperative delayed closure. J Pediatr Surg. 2015;51:1725–30.CrossRefGoogle Scholar
  8. 8.
    Gibbin C, Touch S, Broth RE, Berghella V. Abdominal wall defects and congenital heart disease. Ultrasound Obstet Gynecol. 2003;21(4):334–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Corey KM, Hornik CP, Laughon MM, McHutchison K, Clark RH, Smith PB. Frequency of anomalies and hospital outcomes in infants with gastroschisis and omphalocele. Early Hum Dev. 2014;90(80):421–4.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Benjamin B, Wilson GN. Anomalies associated with gastroschisis and omphalocele: analysis of 2825 cases from the Texas Birth Defects Registry. J Pediatr Surg. 2014;49(4):514–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Christison-Lagay ER, Kelleher CM, Langer JC. Neonatal abdominal wall defects. Semin Fetal Neonatal Med. 2011;16:164–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg. 2014;23:283–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Robinson JN, Abuhamad AZ. Abdominal wall and umbilical abnormalities. Clin Perinatol. 2000;4:947–78.CrossRefGoogle Scholar
  14. 14.
    Weber TR, Au-Fliegner M, Downard CD, Fishman SJ. Abdominal wall defects. Curr Opin Pediatr. 2002;14(4):491–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Mann S, Blinman TA, Wilson RD. Prenatal and postnatal management of omphalocele. Prenat Diagn. 2008;28:626–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Anteby EY, Yagel S. Route of delivery of fetuses with structural anomalies. Eur J Obstet Gynecol Reprod Biol. 2003;106(1):5–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Island S. Advances in surgery for abdominal wall defects. Gastroschisis and omphalocele. Clin Perinatol. 2012;39:375–86.CrossRefGoogle Scholar
  18. 18.
    Fratelli N, Papageoghiou AT, Bhide A, Sharma A, Okoye B, Thilaganathan B. Outcome of antenatally diagnosed abdominal wall defects. Ultrasound Obstet Gynecol. 2007;30:266–70.CrossRefPubMedGoogle Scholar
  19. 19.
    Cohen-Overbeek TE, Tong WH, Hatzmann TR, Wilms JF, Govaerts LCP, Galjaard RJH, et al. Omphalocele: comparison of outcome following prenatal or postnatal diagnosis. Ultrasound Obstet Gynecol. 2010;36(6):687–92.CrossRefPubMedGoogle Scholar
  20. 20.
    Towne BH, Peters G, Chang JH. The problem of “giant” omphalocele. J Pediatr Surg. 1980;15:543–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Schuster SR. A new method for staged repair of large omphaloceles. Surg Gynecol Obstet. 1967;125(4):837–50.PubMedGoogle Scholar
  22. 22.
    Varghese AS, Vause S, Kamupira SR, Emmerson AJB. Congenital abdominal wall defects. Arch Dis Child Educ Pract Ed. 2017;102(1):19.CrossRefPubMedGoogle Scholar
  23. 23.
    Yaster M, Buck JR, Dudgeon DL, Manolio TA, Simmons RS, Zeller P, et al. Hemodynamic effects of primary closure of Omphalocele/gastroschisis in human newborns. Anesthesiology. 1988;69:84–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenthal RJ, Friedman RL, Chidambaram A, Khan AK, Martz J, Shi Q, et al. Effects of hyperventilation and hypoventilation on PaCO2 and intracranial pressure during acute elevations of intraabdominal pressure with CO2 pneumoperitoneum: large animal observations. J Am Coll Surg. 1998;187:32–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Nakayama DK, Mutich R, Motoyama EK. Pulmonary dysfunction after primary closure of an abdominal wall defect and its improvement with bronchodilators. Pediatr Pulmonol. 1992;12:174–80.CrossRefPubMedGoogle Scholar
  26. 26.
    Tobias JD, Rasmussen GE, Holcomb GW III, Brock JW, Morgan WM. Continuous caudal anesthesia with chloroprocaine as an adjunct to general anaesthesia in neonates. Can J Anaesth. 1996;43:69–72.CrossRefPubMedGoogle Scholar
  27. 27.
    Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR III, Engum SA. Gastroschisis: a plea for categorization. J Pediatr Surg. 2001;36:51–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Henrich K, Huemmer HP, Reingruber B, Weber PG. Gastroschisis and omphalocele: treatments and long-term outcomes. Pediatr Surg Int. 2008;24:167–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Tsakayannis DE, Zurakowski D, Lillehei CW. Respiratory insufficiency at birth: a predictor of mortality for infants with omphalocele. J Pediatr Surg. 1996;31(8):1088–90.CrossRefPubMedGoogle Scholar
  30. 30.
    Biard JM, Wilson RD, Johnson MP, Hedrick HL, Schwarz U, Flake AW. Prenatally diagnosed giant omphaloceles: short- and long-term outcomes. Prenat Diagn. 2004;24(6):434–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E, et al. Is early delivery beneficial in gastroschisis? J Pediatr Surg. 2014;49:928–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Lausman AY, Langer JC, Tai M, Seaward PGR, Windrim RC, Kelly EN. Gastroschisis: what is the average gestational age of spontaneous delivery? J Pediatr Surg. 2007;42:1816–21.CrossRefPubMedGoogle Scholar
  33. 33.
    Werler MM, Sheehan JE, Mitchell AA. Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol. 2002;155:26–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Baerg J, Kaban G, Tonita J, Pahwa P, Reid D. Gastroschisis: a sixteen-year review. J Pediatr Surg. 2003;38:771–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Stevenson RE, Rogers RC, Chandler JC, Gauderer MWL, Hunger AGW. Escape of the yolk sac: a hypothesis to explain the embryogenesis of gastroschisis. Clin Genet. 2009;75:326–33.CrossRefPubMedGoogle Scholar
  36. 36.
    Mastroiacovo P, Lisi A, Castilla EE, Martinez-Frias M, Bermejo E, Marengo L. Gastroschisis and associated defects: an international study. Am J Med Genet. 2007;143A:660–71.CrossRefPubMedGoogle Scholar
  37. 37.
    Ghionzoli M, James CP, David AL, Dimple S, Tan AWC, Iskaros J, et al. Gastroschisis with intestinal atresia -predictive value of antenatal diagnosis and outcome of postnatal treatment. J Pediatr Surg. 2012;47:322–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Bergholz R, et al. Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality—a systematic review and meta-analysis. J Pediatr Surg. 2014;49(10):1527–32.CrossRefPubMedGoogle Scholar
  39. 39.
    Kunz LH, Gilbert WM, Tower DR. Increased incidence of cardiac anomalies in pregnancies complicated by gastroschisis. Am J Obstet Gynecol. 2005;193:1248–52.CrossRefPubMedGoogle Scholar
  40. 40.
    Cauchi J, Parikh DH, Samuel M, Gornall P. Does gastroschisis reduction require general anesthesia? A comparative analysis. J Pediatr Surg. 2006;41:1294–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Singh SJ, Fraser A, Leditschke JF, Spence K, Kimble R, Dalby-Payne J, et al. Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int. 2003;19(4):260–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Bianchi A, Dickson AP, Alizai NK. Elective delayed midgut reduction -no anaesthesia for gastroschisis: selection and conversion criteria. J Pediatr Surg. 2002;37:1334–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Vane DW, Abajian JC, Hong AR. Spinal anesthesia for primary repair of gastroschisis: a new and safe technique for selected patients. J Pediatr Surg. 1994;29(9):1234–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Raghavan M, Montgomerie J. Anesthetic management of gastrochisis—a review of our practice over the past 5 years. Pediatr Anesth. 2008;18:1055–9.CrossRefGoogle Scholar
  45. 45.
    Long AM, Court J, Morabito A, Gillham JC. Antenatal diagnosis of bowel dilatation in gastroschisis is predictive of poor postnatal outcome. J Pediatr Surg. 2011;46:1070–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Arnold MA, Chang DC, Nabaweesi R, Colombani PM, Fischer AC, Lau HT. Development and validation of a risk stratification index to predict death in gastroschisis. J Pediatr Surg. 2007;42:950–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Minnesota School of MedicineMinneapolisUSA
  2. 2.University of Minnesota, Masonic Children’s HospitalMinneapolisUSA

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