Gastroschisis and Omphalocele
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Gastroschisis and omphalocele are the most common congenital abdominal wall defects. Very commonly encountered associated chromosomal abnormalities and structural malformations significantly modify treatment strategies in the patients with omphalocele, while congenital cardiac defects are currently observed more frequently in gastroschisis than previously recognized. The incidence of gastroschisis is continuously increasing in the Western world. Despite recent developments of novel abdominal closure methods, including sutureless-staged closure with preformed silo in gastroschisis, and primary skin graft followed by expansion of the abdominal cavity and delayed abdominal wall closure with compartment separation in omphalocele, both conditions are still associated with significant morbidity. Dysmotile intestine in gastroschisis, especially when complicated by intestinal atresia, perforation, or necrosis, predisposes to prolonged dependence of parenteral nutrition and complications of intestinal failure. Mortality in omphalocele is mainly caused by associated congenital malformations and lung hypoplasia occasionally observed with a giant defect. With carefully planned, individualized multidisciplinary management, well over 90% of gastroschisis patients currently survive, while mortality in omphalocele remains higher mainly due to associated disorders.
KeywordsGastroschisis Omphalocele Abdominal wall defect
Mikko Pakarinen was supported with research grants by the Finnish Pediatric Research Foundation and the Sigrid Juselius Foundation.
- 2.Dicken BJ, Sergi C, Rescorla FJ, Breckler F, Sigalet D. Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia. J Pediatr Surg. 2011;46:1618–30. https://doi.org/10.1016/j.jpedsurg.2011.04.002.CrossRefPubMedGoogle Scholar
- 8.Bauman B, Stephens D, Gershone H, Bongiorno C, Osterholm E, Acton R, et al. Management of giant omphaloceles: a systematic review of methods of staged surgical vs. nonoperative delayed closure. J Pediatr Surg. 2016;51:1725–30. https://doi.org/10.1016/j.jpedsurg.2016.07.006.CrossRefPubMedGoogle Scholar
- 10.Folkerth RD, Habbe DM, Boyd TK, McMillan K, Gromer J, Sens MA, et al. Gastroschisis, destructive brain lesions, and placental infarction in the second trimester suggest a vascular pathogenesis. Pediatr Dev Pathol. 2013;16(5):391–6. https://doi.org/10.2350/13-03-1316-CR.1.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.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;90:421–4 Google Scholar
- 33.Danzer E, Gerdes M, D’Agostino JA, Bernbaum J, Hoffman C, Rintoul NE, et al. Patient characteristics are important determinants of neurodevelopmental outcome during infancy in giant omphalocele. Early Hum Dev. 2015;91:187–93. https://doi.org/10.1016/j.earlhumdev.2014.12.009.