Omphalocele und Gastroschisis Ergebnisse – Komplikationen – Verlauf – Lebensqualität

Abstract

From 1970 to 1998, 35 children with omphalocele (OC) and 31 with gastroschisis (GS) were treated at the Department of Paediatric Surgery at Lübeck Medical University. Forty of 43 survivors were examined in 1990, the data of 30 patients were renewed in 1999 and 12 new cases added. Total follow-up was 1-28 years. Primary closure was possible in 25 OCs and 20 GSs. Eighteen children with OC and 8 with GS suffered from additional abnormalities, which were treated simultaneously. Twenty percent of the babies with OC died mostly because of severe congenital anomalies and 12.9% of GS because of infectious complications in combination with other diseases. There were no more deaths in the last decade. Accordingly, there was a reduction in consecutive operations. Improvements were due to better operative and perioperative treatment as well as abortions following improved ultrasound examinations. The results of the literature and our own experience show the benefit of primary closure. A two-stage approach with dura/amnion or a silo procedure prevents high intra-abdominal pressure, therefore, indirect measurements of intra-abdominal pressure can be used exceptionally. Umbilical preservation offers better cosmetic results. Long-term follow-up reveals normal growth and development of the children except for those with severe congenital anomalies. All the others are participating without problems in normal activities and education without reduction in their quality of life. Today an isolated OC or GS is not an indication for abortion. If prenatal OC or GS is diagnosed, paediatric surgeons should be involved in the consultations.

Gastroschisis and omphalocele: treatments and long-term outcomes

“…It lies to the side of the umbilical cord, usually on the right [2][3][4][5][6]. There is almost always intestinal prolapse, but prolapse can also involve the liver, stomach, urinary bladder, spleen or genital organs [4,7]. The exact aetiology and time of occurrence remain controversial.…”

“…The reported rate of caesarean delivery in cases of prenatal gastroschisis diagnosis varies from 28 to 96.6% depending on which report you read [1,3,14,15]. Gastroschisis should be corrected as soon as possible after delivery [7]. Most reports describe primary closure of the abdominal wall as the treatment of choice [7,16], but care must be taken to avoid intra-abdominal pressures higher than 20 cm H 2 O [17].…”

“…Gastroschisis should be corrected as soon as possible after delivery [7]. Most reports describe primary closure of the abdominal wall as the treatment of choice [7,16], but care must be taken to avoid intra-abdominal pressures higher than 20 cm H 2 O [17]. Primary closure can be achieved in 67% of cases [4,8,11,16,18].…”

“…The umbilicus inserts into the sac [2,24,26]. There is almost always intestinal involvement, but other organs can also prolapse [7,8,26]. There are no known specific risk factors.…”

“…There are no known specific risk factors. Omphalocele is frequently seen in the context of congenital syndromes, with multiple associated anomalies, such as Beckwith-Wiedemann syndrome, cloacal exstrophy, OEIS complex (omphalocele, exstrophy, imperforate anus, spinal), Cantrell's pentalogy and trisomies [7][8][9]. Cardiac anomalies are described in 13% [1,8,10,12,16].…”