From 1982 to 1990, 31 neonates with
omphalocele and 54 with
gastroschisis were treated at Mackay Memorial Hospital. The overall survival rate for
omphalocele was 71%, while it was 85% for
gastroschisis. The rate of primary fascial closure for
omphalocele (85%) and
gastroschisis (87%) was similar. The mortality from
omphalocele was almost exclusively due to the presence of serious associated congenital anomalies. Two cases of
Cantrell's pentalogy and two of cloacal exstrophy were found. The incidence of major malformation with
gastroschisis was 6%.
Sepsis, inadequate perioperative
resuscitation and prolonged gastrointestinal dysfunction were the major causes of death in
gastroschisis. Among survivors, the
hospital stay was significantly longer in the
silon pouch group than in the primary fascial closure group (71.5 vs 31.3 days for
gastroschisis, 41 vs 14 days for
omphalocele). Advances in surgical technique,
neonatal intensive care and ventilatory support have made primary fascial closure a superior approach without jeopardizing the babies' chance for survival. An improved survival rate and increased primary closure rate are the main features in the treatment of abdominal wall defects in the last decade.