Exomphalos and gastroschisis: A 10-year review

Abstract

Ninety-six cases of exomphalos or gastroschisis managed at The children's Hospital, Sheffield, during the period 1964-74 are analysed. There were 306 cases with minor lesions, 30 with major lesions, 27 with a ruptured exomphalos and only 3 with gastroschisis. The overall mortality rate was 46-9 percent. Survival could be closely correlated with the birth weight, the nature of the primary lesion, the presence or absence of liver within the sac and the presence and severity of associated congenital anomalies. A "scoring system" based on these criteria is proposed to predict the prognosis of an infant with an exomphalos.

Definitive surgical management of antenatally diagnosed exomphalos

“…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.…”

“…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.…”

Staged repair of giant omphalocele in the neonatal period

“…A more popular technique is represented by the initial nonoperative management with application of a variety of topical agents to promote epithelialization of the sac [2][3][4][5][6]. However, Venugopal et al [22] reported that epithelialization of the sac is completed only after an average of 10 weeks (range, 6-19 weeks). These techniques require an operation later in life to close the resulting large ventral hernia.…”

Current outcome of antenatally diagnosed exomphalos: an 11 year review

“…In the era before prenatal diagnosis, the condition was an unpredictable finding at delivery, and the outcome for these babies was poor with greater than 30% mortality [3,4]. However, in the last 3 decades, advances in obstetric ultrasound have allowed diagnosis and characterization of this condition prenatally, and most cases are now detected in the midtrimester, although detection rates still vary considerably among centers [5].…”