Gastroschisis and omphalocele: treatments and long-term outcomes

Abstract

Between February 1994 and April 2004, we treated 40 children with gastroschisis and 26 children with omphalocele. We recorded the course of pregnancy, pre- and post-natal complications, delivery, operation, post-operative therapy, and long-term outcomes. Additionally, we conducted follow-up examinations of 37 of these 66 children (56%). We analysed their abdominal musculature, development, cosmetic result and quality of life. The median duration of follow-up was 6.3 years (range 1-10). In 35/40 children (88%) with gastroschisis and in 18/26 children (69%) with omphalocele, there had been prenatal diagnosis. The average maternal age of 23.9 years in the gastroschisis group was lower than in the omphalocele group (29.9 years). Delivery was by caesarean section in 93% of the gastroschisis group and 65% of the omphalocele group. Outcomes following vaginal delivery were no worse than those after caesarean section. Further, congenital abnormalities were shown in 28% of gastroschisis cases, and were limited to the gastrointestinal tract. Of the omphalocele cases 81% showed further abnormalities. Direct closure of the abdominal wall defect was possible in 31/40 (78%) of the gastroschisis cases and 15/26 (58%) of the omphalocele cases. Mortality in gastroschisis was nil; two children with omphalocele died (8%). Outcomes were better after primary closure than in stepwise reconstruction. Follow-up showed good results in all categories. Developmental delays were rapidly made up after treatment, and 75% of the children had no gastrointestinal problems, or suffered from these rarely. Almost all the children were of normal weight and height, and physical and intellectual development were delayed in only one third of the children. The surgical scar was rated as good or very good in about 80% of the cases. Except for those with severe defects, the children had good ratings for quality of life. Improvements in short-term results of gastroschisis and omphalocele treatment can be attributed to recent developments in prenatal diagnosis and the advancements of centralised perinatal care. Our long-term results clearly demonstrate that initial gastrointestinal problems and developmental delays were made up during the first two years of life. Prenatal counselling can now be more optimistic.

Quality of life in patients with gastroschisis is comparable with the general population: A questionnaire survey

“…Henrich et al describe in their study that 75% of the children had no gastrointestinal problems, almost all the children from their study were of normal weight and height, and physical and intellectual development were delayed in only one third of the children; the surgical scar was rated as good or very good in about 80% of the cases 14 . Our study population had no gastrointestinal problems in 87% and the scar is rated as very good in 92% of the cases.…”

Hospital readmission among infants with gastroschisis

“…10,11 These conclusions are based on individual physician experience, small numbers of patients and studies with methodological limitations. The present study does not support that consensus.…”

Predictive factors at birth of the severity of gastroschisis

“…Severity of gastroschisis at birth well known but difficult to predict. Many studies have demonstrated that the presence of a compromised bowel is associated with a significant increase in the number of surgical procedures, a longer period of full enteral feeding and a prolonged hospitalization [15,19] . Prolonged TPN, with its risk of sepsis, is directly related to intestinal recuperation, and the morbidity of GS is closely related to intestinal damage [20] .…”

“…Prolonged TPN, with its risk of sepsis, is directly related to intestinal recuperation, and the morbidity of GS is closely related to intestinal damage [20] . While gastrointestinal complications such as matting between the loops, malrotation, volvulus, perforations and atresia increase the complexity of early management [19,21] , later management may be complicated by the presence of problems of absorption, intestinal dysmotility, obstruction, NEC, infarction and stenosis [1,3,9] . The pathogenesis of secondary bowel lesions is not fully understood, but both chemical and mechanical origins are concerned [2] .…”