Gastroschisis

Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. In gastrochisis, loops of intestine, stomach, and occasionally gonads herniate out of the abdominal cavity and are exposed to amniotic fluid. The intestine often develops an inflammatory covering with a matted appearance at birth. The etiology is not known, but the incidence is increasing worldwide. A vast majority of these defects are detected by prenatal ultrasound and delivered at a center with pediatric surgical expertise. Controversy exists over the timing and route of delivery. Some centers prefer preterm cesarean deliveries but most recommend term vaginal delivery. Postnatal management consists of closure of the defect either immediately or in a delayed fashion with the use of a silo. Mortality has dramatically declined over the past four decades with survival rates greater than 96 % for simple gastroschisis. Complex gastroschisis includes those with an associated atresia, limited intestinal length, bowel ischemia, or perforation and is associated with a longer hospital stay and poorer outcomes.