What is the best treatment approach for omphalocele and gastroschisis?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Primary closure of fascia and skin is the best approach for omphalocele and gastroschisis. However, increased intra-abdominal pressure from immediate reduction can compromise ventilation and lead to abdominal compartment syndrome with inferior vena caval compression, intestinal and renal hypoperfusion, and lower-extremity edema.

Enlargement of the abdominal cavity by stretching the abdominal wall, decompression of the stomach and irrigation of the intestine and colon to remove meconium, and postoperative use of ventilators and muscle relaxants frequently can facilitate successful primary closure. The sac is removed at the fascial edge. Umbilical artery or vein catheters can be transposed to an extraumbilical location for postoperative monitoring and fluid delivery. Vigorous attempts to decompress can cause intestinal tears and should be avoided.


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