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Two hundred and fifty-six cases of congenital abdominal wall defects (omphalocele and gastroschisis) were retrospectivly investigated. One hundred and fifteen patients with omphalocele (64 male /51 female, mean birth weight 2731 + 634g; mean gestational age 37 + 2,5 weeks) and 141 patients with gastroschisis ( 65 male/ 76 female; mean birth weight 2430 + 354g; mean gestational age 37 + 1,4 weeks) were analysed. In 59% patients with omphalocele presented coexisiting anomalies. In the group with associated malformations 32% had cardiovascular, 30% had gastrointestinal and 38% had other malformations such as diaphragmatic hernia, chromosomal anomalies or the EMG- syndrome. Twenty-nine per cent of the newborns with gastroschisis suffered from coexisting anomalies, which could be divided in 72% gastrointestinal and 28% other malformations (urinary tract, central nervous system). Omphalocele was treated with primary closure (42%), staged closure (43%), twisting (9%), or only conservative procedures (2%). Four per cent of patients with omphalocele died before correction.The patients who underwent a staged abdominal wall closure were treated by a Schuster plasty (32%), primarily only skin closure (24%) or a patch plasty (44%) using absorbable (Vicryl, Dura) or non-absorbable (Gore) materials. The abdominal wall of patients with gastroschisis was primarily closed in 48%. Fifty-two percent of patients requiered a staged abdominal wall closure, which was performed using Schuster plasty in 14%, primarily only skin closure in 30% and patch implantation in 56%.
Significant postoperative complications in the 115 cases of omphalocele were cardiorespiratory insufficiency (n=27), pneumonia (n=17), impaired wound healing (n=12), intracranial haemorrhage (n=9), vena cava inferior compression syndrome (n=7), sepsis (n=7), mechanical ileus (n=6) and volvulus (n=1). Multivariant regression analyses revealed that cardiorespiratory insufficiency was significantly associated to increased mortality. Postoperative complications among patients with gastroschisis were mechanical ileus (n=31), sepsis (n=27), impaired wound healing (n=19), pneumonia (n=18), intracranial haemorrhage (n =11), abdominal compression (n = 10), volvulus (n=8) and cardiorespiratory insufficiency (n=5). Statistically sepsis was significantly associated to increased mortality.
In the last 30 years mortality of the patients with omphalocele decreased from 60% to 32% for patients with cardiac malformations and to 5% for patients without cardiac malformations. The mortality of children with gastroschisis decreased from 90% to 7%. Investigations performed several years after correction of the defect showed very satisfactory results, supporting the thesis that pregnancies involving fetuses with abdominal wall defects should not be terminated.
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