Operative Results and Treatment Outcomes for Abdominal Wall Defects: A 30-Year Single-Institution Experience

Abstract

Purpose: The treatment of patients with abdominal wall defects, such as gastroschisis and omphalocele, has improved. The aim of this study was to clarify the operative results and outcomes for abdominal wall defects in our institution over the past 30 years.

Methods: From 1985 to 2015, 35 patients (omphalocele, n = 21; gastroschisis, n = 14) were treated. The patient background, operative procedure, operative outcome, and prognosis were retrospectively reviewed using medical records.

Results: A prenatal diagnosis confirmed 8 patients with omphalocele (38.1%) and 10 with gastroschisis (71.4%). Associated anomalies were recognized in 18 patients (85.7%) with omphalocele and in 5 (35.7%) with gastroschisis. Chromosomal anomalies were recognized in 3 patients (14.3%) with omphalocele. The operative procedures for omphalocele were as follows: primary closure, n = 14 (66.7%), secondary closure n = 6 (28.6%), and silo formation, n = 1 (4.8%); those for gastroschisis were as follows: primary closure n = 3 (21.4%) and secondary closure, n = 11 (78.6%). An abdominal incisional hernia was recognized in two patients with omphalocele and in one with gastroschisis. Umbilical cosmetic problems were recognized in 14.3% of omphalocele patients and 35.7% of gastroschisis patients. The survival rates of patients with omphalocele and gastroschisis were 81.0% and 92.9%, respectively. Four omphalocele patients died owing to severe associated anomalies, and one gastroschisis patient died because of progressive acidosis after surgery.

Conclusions: Associated anomalies are the most important factors that affect the prognosis of patients with abdominal wall defects. Long-term problems, such as umbilical cosmetic problems and abdominal incisional hernia, should be resolved in addition to improving the prognosis.