Considerable improvement have been made in the management of infants born with the abdominal wall defects, gastroschisis and omphalocele, and mortality decreases with these improvements. A clinical analysis was carried on thirty nine
infants(gastroschisis 18 cases, omphalocele 21 cases) who had been admitted to the Department of Surgery, Kyungpook National University hospital between Jan. lst, 1978 and Dec. 31th, 1991. The male to female ratio was 10:8 in gastroschisis and
15:6
in
omphalcele. The prematurity, determined by birth weight and gestational age, was more commonly associated with gastroschisis(44.4% Vs 14.2%).
The gastroschisis had normal umbilical cord location and defect in right side of umbilical cord in all cases. Seventeen patients(94%) with gastroschisis had defects smaller than 5cm in diameter, while 15 patients(71%) with omphalocele had defects
smaller than 5cm in diameter.
In large omphalocele the nonintestinal protruding viscera tended to be liver, whereas in gastroschisis urinary bladder, uterus and fallopian tube tended to protrude through the defects. Incidence of additional malformations in patients with
omphalocele
was 61.9% of patients, opposed to gastroschisis(38.8%). The nature of the associated anomalies was cardiac defects being the most common in omphalocele patients(72%) whereas 66% in gastroschisis patients.
The selection of procedures was determined by the time elapsed after delivery, the degree of contamination of the eviscerated viscera, the size of defect, the associated anomalies, the prematurity and the birth weight. Five patients(27%) among 18
gastroschisis patients were closed primarily, with one death(20%). Nine omphalocele patients(42.8%) among 21 patient were closed primarily, with 2 deaths(22.2%). The remaining thirteen gastroschisis patients(72%) were managed by staged reduction
using a
silastic sac with 4 deaths(31%), and the remaining 10 omphalocele patients(475) were treated by staged reduction using a silastic sac with 6 deaths(60%). One patients closed with skin flap only and one treated with Grob technique with no
mortality.
Overall mortality for primary closure of gastroschisis patients and omphalocele patients was 20%, 22% respectively. Overall mortality for staged siloclosure of gastroschisis patients and omphalocele patient was 31%, 60% Overall mortality of
gastroschisis patients was 27.8% and that of omphalocele patients, 38.1%.
Common postoperative complications in patients with the abdominal well defects were sepsis, respiratory distress and wound infection. The prematurity, low birth weight and the associated anomalies especially cardiac anomalies adversely affected
the
survival rate in these patients. The overall survival for the 37 patients with the abdominal wall defects was 66.6%. As a result, the survival rate yet to be remained discouraging, the chance of survival of the patients with abdominal wall
defects
will
be increasing steadily with the better preoperative, postoperative care and judicious selection of operative managements in the near future.
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