Short and Medium-term Outcomes of Omphalocele and Gastroschisis: A Survey from a Tertiary Center / Resultados a curto e médio prazo do onfalocelo e gastrosquisis: uma investigação de um centro terciário

Abstract Objective To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center. Methods This is a retrospective clinical record review of all patients with gastroschisis and omphalocele admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019. Results There were 38 patients, 13 of whom had omphalocele, and 25 of whom had gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) patients with gastroschisis. Compared with patients with omphalocele, those with gastroschisis had younger mothers (24.7 versus 29.6 years; p=0.033), were born earlier (36 versus 37 weeks, p=0.006), had lower birth weight (2365±430.4 versus 2944.2±571.9 g; p=0.001), and had a longer hospital stay (24 versus 9 days, p=0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months; 13 patients with gastroschisis (59.1%) and 8 patients with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%), or additional surgical interventions (27.3% vs 33.3%). Conclusion Despite the high proportion of prematurity, low birth weight, and protracted recovery, gastroschisis and omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in the medium term.

Resumo Objetivo Caracterizar e comparar os desfechos do onfalocelo e gastrosquisis desde o nascimento até aos 2 anos de seguimento numa coorte recente de um centro terciário. Métodos Este é um estudo retrospectivo em que foi feita uma revisão dos registos clínicos de todos os pacientes com gastrosquisis e onfalocelo que foram internados na unidade de cuidados intensivos neonatais, entre janeiro de 2009 e dezembro de 2019. Resultados Identificamos 38 pacientes, 13 dos quais tinham onfalocelo e 25 dos quais tinham gastrosquisis. Anomalias associadas estavam presentes em 6 pacientes (46.2%) com onfalocelo e 10 (41.7%) com gastrosquisis. Comparativamente com os pacientes com onfalocelo, os pacientes com gastrosquisis tinham mães mais jovens (24.7 versus 29.6 anos; p=0.033), nasceram mais precocemente (36 versus 37 semanas, p=0.006), com menor peso ao nascimento (2,365±430.4 versus 2,944.2±571.9 g; p=0.001), e o internamento teve uma duração mais longa (24 versus 9 dias, p=0.001). A taxa de sobrevivência neonatal foi de 92.3% para o onfalocelo e 91.7% para a gastrosquisis. Trinta e quatro pacientes foram seguidos durante umtempo mediano de seguimento de 24meses: 13 com gastrosquisis (59.1%) e 8 com onfalocelo (66.7%) apresentaram pelo menos um evento adverso, sobretudo hérnia umbilical (27.3% vs 41.7%), obstrução intestinal (31.8% vs 8.3%) ou intervenções cirúrgicas adicionais (27.3% vs 33.3%). Conclusão Apesar da alta proporção de prematuridade, de baixo peso e de recuperação lenta, os gastrosquisis, assim como os onfalocelos (sem anomalias cromossómicas), podem ter uma taxa de sobrevivência muito alta; por outro lado, nos primeiros anos de vida, podem surgir complicações não desprezíveis. Assim, aos futuros pais pode ser transmitida uma perspectiva muito positiva em termos de sobrevivência, embora eles também devam ser informados de que pode ocorrermorbidade substancial no médio prazo.

Gastrosquisis en Hospital IESS "Manuel Ygnacio Monteros". Presentación de caso clínico y revisión bibliográfica / Gastroschisis in Hospital del IESS "Manuel Ygnacio Ygnacio". Case Report and Literature Reviview.

INTRODUCCIÓN: La gastrosquisis es una anomalía que expone los órganos abdominales hacia el exterior. La prevalencia media global es de 1.36 por cada 10 000 nacidos vivos. En el Ecuador, según el Instituto Nacional de Estadísticas y Censos (INEC), se evidencia un aumento en el número de casos de egreso hospitalario alcanzando los 52 pacientes en el año 2010, los 85 en el 2012 y los 112 pacientes en el 2015. El objetivo del presente caso es realizar una descripción de esta patología y dar a conocer la importancia que tiene su diagnóstico prenatal con el fin de planificar su resolución quirúrgica para la atención inmediata al recién nacido luego del nacimiento. CASO CLÍNICO: recién nacido de madre primigesta de 16 años, sin más antecedentes prenatales, se realizó cuatro ultrasonidos durante el embarazo en casa de salud particular, los cuales no reportaron alteraciones. A las 37.4 semanas nace por parto eutócico, evidenciándose gastrosquisis. Se realizó laparotomía más peritoneostomía a las 24 horas de vida, y se programó cierre diferido. EVOLUCIÓN: recibió manejo integral en cuidados intensivos neonatales. Se realizó cierre definitivo a los 8 días. Permaneció hospitalizado por 22 días, recibió nutrición parenteral y se inició alimentación trófica a los 15 días de vida; se inició antibioticoterapia de primera línea, sin embargo por evolución tórpida, requirió rotación a antibiótico de amplio espectro. CONCLUSIÓN: la gastrosquisis se puede ser detectada por ecografía desde la semana doce de gestación con el objetivo de minimizar las complicaciones y planificar su resolución quirúrgica inmediatamente luego de su nacimiento.(au)

BACKGROUND: Gastroschisis is an anomaly in which abdominal organs are exposed outside the abdominal wall. The global average prevalence is 1.36 for each 10 000 newborns. In Ecuador, according to the National Institute of Statistics and Censuses (INEC), there is evidence of an increase in the number of hospital discharges with this diagnosis, reaching 52 in 2010, 85 in 2012, and 112 patients in 2015. The aim of this publication is to describe this pathology and expose the importance of prenatal diagnosis to plan prompt surgical intervention for the newborn after birth. CASE REPORT: newborn from a 16-year-old primigravid mother, with no other prenatal history, four ultrasounds were performed during pregnancy in a private health facility, which reported no alterations. At 37.4 weeks of pregnancy, the newborn was delivered by eutocic birth, showing gastroschisis. The patient underwent laparotomy and peritoneostomy at 24 hours of age, delayed closure was scheduled. EVOLUTION: the newborn received comprehensive care in the neonatal intensive care unit. Delayed closure was performed eight days later. He remained hospitalized for 22 days, he received parenteral nutrition and started trophic feeding at 15 days of age; first-line antibiotic therapy was initiated, however due to torpid evolution, he required a change to a broad-spectrum antibiotic. CONCLUSION: gastroschisis can be detected in ultrasound from the twelve week of pregnancy to minimize complications and program the surgical procedure immediately after birth.(au)

Incomplete pentalogy of Cantrell: a case report

Pentalogy of Cantrell (PC) is a rare congenital anomaly characterized by a defect in the lower sternum, anterior diaphragm, and anterior abdominal wall; ectopia cordis; and congenital heart disease. Authors report a case of male foetus terminated at 20 weeks of gestation with an Incomplete (class 3) pentalogy of Cantrell presenting with gastroschisis, ectopia cordis and absence of lower sterna. Prognosis of pentalogy of Cantrell depends on severity of intra and extra cardiac defects, pulmonary hypoplasia, extent of abdominal wall defect, cerebral anomalies and diaphragmatic herniation. Full pentalogy of Cantrell is a severe and rare syndrome, but incomplete forms with combination of two or three defects are reported frequently similar to present case report.  Early diagnosis through obstetric ultrasound would help in improved informed clinical decision making on the part of the obstetrician and family.

Basic principles and repair material selection of abdominal wall defect after breast reconstruction for breast cancer surgery / 中国实用外科杂志

Autologous breast reconstruction after radical resection of breast cancer has been widely used in clinic.Some surgical methods of autologous breast reconstruction may cause abdominal wall defect to a certain extent.The abdominal wall defect leads to the loss of normal function,which leads to a series of serious pathophysiological changes.At present,transverse rectus abdominis myocutaneous flap(TRAM) and deep inferior epigastric artery perforator flap(DIEP) are commonly used for breast reconstruction.According to the different types of abdominal wall defect after breast autoreconstruction for breast cancer surgery,the corresponding surgical repair scheme should be formulated on the basis of strictly following the basic principles of abdominal wall repair.At the same time,appropriate materials for repairing abdominal wall defect are selected according to the different extent of abdominal wall defect.The posterior sheath and peritoneum of rectus abdominis are usually intact after breast reconstruction,and the anterior sheath of rectus abdominis may be retained.The different layers of abdominal wall can be repaired by surgical methods,and the application of repair materials is emphasized.

Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection / 中国修复重建外科杂志

Objective: To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection. Methods: Between September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly. Results: All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites. Conclusion: Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.

Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction / 中国修复重建外科杂志

Objective: To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods: Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results: All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion: Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.

Estado actual de la gastrosquisis en recién nacidos en el Hospital Nacional Daniel A. Carrión: Serie de casos de 5 años / Gastroschisis in newborns at Hospital Nacional Daniel A. Carrión: Case series in 5 years

La gastrosquisis es un defecto congénito de la pared abdominal que permite la exteriorización del contenido abdominal, cuyo pronóstico dependerá de las complicaciones intestinales asociadas. Es importante la detección prenatal de aquellos casos con riesgo de gastrosquisis compleja. Objetivo. Describir las características epidemiológicas de los recién nacidos con gastrosquisis atendidos en un hospital nacional. Diseño. Serie de casos. Institución. Hospital Nacional Daniel A. Carrión (HNDAC), Lima, Perú. Pacientes. Recién nacidos vivos. Metodología. Estudio de todos los recién nacidos vivos con el diagnóstico de gastrosquisis, en un periodo de 5 años. Se excluyó aquellos con nacimiento extrainstitucional o con datos insuficientes. Principales medidas de resultados. Características y manejo de los recién nacidos con gastrosquisis. Resultados. Se reportaron 17 casos. La incidencia fue 9,7/1 000 nacidos vivos y la mortalidad perinatal 14%; 64,3% nacieron de madres adolescentes, 78% primigestas. El nacimiento ocurrió principalmente por cesárea (71,4%). Existió un pobre registro de predictores ecográficos de complicaciones intestinales. Se realizó cierre primario en 28,6% de los casos. El primer caso de mortalidad ocurrió luego de manejo quirúrgico con silo, falleciendo por sepsis. El segundo caso presentó atresia intestinal requiriendo múltiples cirugías y falleció por atelectasia masiva. Conclusiones. Es necesario estandarizar la valoración y registro de los diversos marcadores pronósticos en gastrosquisis fetal. Es necesario establecer series más largas y mejor documentadas.

Gastroschisis is a congenital defect of the abdominal wall that allows externalization of the abdominal contents; prognosis depends on the associated intestinal complications. Prenatal detection of cases with risk of complex gastroschisis is important. Objective: To describe the epidemiological characteristics of newborns with gastroschisis occurring at a national hospital. Design: Case series. Institution: Hospital Nacional Daniel A. Carrion (HNDAC), Lima, Peru. Patients: Newborns with gastroschisis. Methodology: All live newborns with the diagnosis of gastroschisis in a period of 5 years were studied. Cases born in other institutions or with insufficient data were excluded. Main outcome measures: Characteristics of newborns with gastroschisis and their management. Results: 17 cases were reported with an incidence of 9.7/1 000 live newborns and with a perinatal mortality of 14%; 64.3% were born to an adolescent mother, of which 78% carried their first pregnancy. The main delivery mode was cesarean section (71.4%). There were poor records of ultrasonographic predictors of intestinal complications. Primary closure was performed in 28.6% of cases. The first case of death occurred after surgery with silo and died from sepsis. The second case had intestinal atresia requiring multiple surgeries and died due to massive atelectasis. Conclusions: It is necessary to standardize the assessment and registration of various prognostic markers in fetal gastroschisis. More and better documented series are necessary.

Clinical value of human acellular dermal matrix in reconstruction of giant complex abdominal wall defects after open abdomen / 中华消化外科杂志

Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen.Methods The retrospective crosssectional study was conducted.The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected.After open abdomen,fascia of the abdominal wall was fully freed using the component separation,and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture.Observation indicators:(1) intra-and post-operative situations:operation time,volume of intraoperative blood loss,removal time of postoperative drainage-tube,postoperative complications,duration of hospital stay and hospital expenses;(2) follow-up situations:recurrence of abdominal wall hernia at postoperative year 2.Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016.Measurement data with normal distribution were represented as ~±s.Results (1) Intra-and post-operative situations:6 patients underwent successful surgery.Operation time,volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes,(225±57)mL and (8±3)days.Two patients with postoperative seroma were cured by conservative treatment.One patient with postoperative anastomotic leakage received continuously irrigation and drainage,and leakage was stopped using the biomedical fibrin glue.There was no abdominal bulge of the 6 patients in hospital.Duration of hospital stay and hospital expenses were respectively (10±3) days and (12±7) × 104 yuan.(2) Follow-up situations:6 patients were followed up for 14-28 months,with a median time of 23 months.Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years,without bulge of HADM in the rectus abdominis anterior sheath layer.There were no occurrence of abdominal wall hernia,chronic pain,paraesthesia,swelling in the local area and other adverse reaction.Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture is safe and feasible for GCAWR,with good short-term outcomes.

Surgery Requiring Detailed Preoperative Simulation and Scar De-epithelialization to Repair Severe Postoperative Scarring from Gastroschisis

We present the case of a patient with severe postoperative scarring from surgical treatment for gastroschisis, with the intestine located immediately under the dermal scar. Although many patients are unsatisfied with the results of scar repair treatment, few reports exist regarding severe or difficult cases involving the surgical repair of postoperative scar contracture. We achieved an excellent result via simulation involving graph paper drawings that were generated using computed tomography images as a reference, followed by dermal scar de-epithelialization. The strategy described here may be useful for other cases of severe postoperative scar contracture after primary surgery for gastroschisis.

Repair of traumatic abdominal wall defect / 中华消化外科杂志

Repair for traumatic abdominal wall defect (TAWD) is a complex subject to be investigated.No consensus in the management of the subject has currently been reached,and the individualized treatment is performed based on TAWD.There are four kinds of type in repair of TAWD according to characteristics of the defect:(1) repair of traumatic full abdominal wall defect,(2) immediate repair of traumatic abdominal wall myofascial defect,(3) delayed repair of TAWD,(4) management of abdominal open following traumatic abdominal compartment syndrome.The concept and practice of treatment for TAWD will be gradually improved and perfect with development of new techniques and materials.

An Obturation Technique for Closure of Body Wall Defects.

Aims: In the vast majority of instances, closure of abdominal wall defects relies on the tensile strength of transposed native tissue and/or prosthetic material. The purpose of this report is to alert clinicians to a different strategy for closure that we have used successfully on several occasions. Presentation of Case: A 72 year old man had a bulky inguinal nodal metastasis from cutaneous squamous cell carcinoma. He had an extended radical groin dissection including full thickness abdominal wall resection, with primary closure, followed by external beam radiotherapy. After 30 months, he developed an abdominal wall hernia and enterocutaneous fistula at the surgical site. Direct closure and local vascularized flaps were not feasible. Obturation of the defect by omentum was employed, taking advantage of its relative incompressibility rather than its minimal tensile strength. The wound was subsequently covered by a skin graft. The patient survived 10 years with an intact hernia repair and died of unrelated causes. Discussion: The technique has yielded good results. Conclusions: This surgical option is valuable for situations in which the abdominal wall defect to be closed is fibrotic, has been radiated, is infected, or is otherwise not suitable for conventional techniques.

Strategies for functional repair of complex abdominal wall defects / 中华消化外科杂志

It is still a challenge for surgeons to deal with the complex abdominal wall defect.The purpose of surgical treatment is not only to restore the integrity of the abdominal wall, but also to maintain the function of the abdominal wall.Accurate classification and partition of the abdominal wall defects before operation are the base of surgical procedure for complex abdominal wall defects.Reinforcement of the abdominal wall defects with mesh, component separation technique and tissue flap technique are important methods to achieve functional repair of the abdominal wall defects.

Clinical study of open versus endoscopic component separation with biological mesh reinforcement in treatment of patients with abdominal wall defects / 国际外科学杂志

Objective To compare the operation effect of endoscopic versus open component separation on abdominal wall reconstruction.Methods From January 2012 to December 2013,19 patients (ECST 8 and CST 11) with abdominal wall defects were repaired with biomaterials mesh.This study analyzed retrospectively the clinical information between two groups.Results No hernia recurrences were occurred during a mean follow-up of (14.96± 8.89) months.There was no significant difference in EBL,operation time,length of stay.The rate of recurrence wound complications in CST group is higher than the ECST group,but is not significant difference.Conclusions Endoscopic or open component separation with biomaterials mesh could effectively repair the abdominal wall defect and ECST definitely showed the advantage in reducing the incisional complication.But the large sample,long-term clinical follow-up should be confirmed.

Pentalogía de Cantrell: presentación de un caso clínico / Pentalogy of Cantrell: clinical case

La pentalogía de Cantrell es una enfermedad poco frecuente que resulta de alteraciones embriológicas del mesodermo, caracterizada por defecto en la porción baja esternal, defecto de la pared abdominal supraumbilical, defecto diafragmático anterior, defecto del pericardio diafragmático y anomalía cardiaca. Caso clínico: Se presenta el caso de un neonato de sexo masculino con diagnóstico prenatal de defecto de la pared abdominal, en quien posteriormente se realizó el diagnóstico de Pentalogía de Cantrell. Al presentar este caso se destaca la posibilidad diagnóstica en la vida fetal, y el pobre pronóstico de estos pacientes cuando su presentación clínica se asocia a hipoplasia pulmonar severa.

Pentalogy of Cantrell is a rare disease that results from alterations in embryo development. It is characterized by defects of the lower sternum, midline supraumbilical abdominal wall defect, deficiency of the anterior diaphragm, defects in the diaphragmatic pericardium and cardiac anomaly. Case Report: The case of a male neonate with a prenatal diagnosis of abdominal wall defect is presented, who was subsequently diagnosed with Pentalogy of Cantrell. This study emphasizes the prenatal diagnosis possibilities and the poor prognosis for these patients when their clinical presentation is associated with severe lung hypoplasia.

Comparative Study for Compatibility of Acellular Dermis (SureDerm(TM)) and Synthetic Material(PROCEED(R)) on Abdominal Wall Defect in Rabbit Models

PURPOSE: Deficiencies of the abdominal wall can be the a result of infection, surgery, trauma, or primary herniation. For abdominal wall reconstruction, synthetic materials have been shown to provide a better long-term success rate than primary fascial repair. But, synthetic materials cannot elicit angiogenesis or produce growth factor and are therefore plagued by an inability to clear infection. As a result of the inherent drawbacks of synthetic, significant effort has been spent on the identification of new bioprosthetic materials. The aim of our study is to evaluate the effectiveness of a synthetic material(PROCEED(R)) and an ADM(SureDerm(TM)) to repair abdominal wall defects in a rabbit models. METHODS: We measured the tensile strength of the SureDerm(TM) and PROCEED(R) by a Tension meter(Instron 4482). 16 Rabbit models were assigned to this study for abdominal wall reconstruction. Abdominal defect of 8 rabbits were reconstructed by PROCEED(R) and the rest were reconstructed by SureDerm(TM). We assessed gross and histologic examinations for the reconstructed abdominal wall. RESULTS: The tensile strenth of SureDerm(TM) and Gore Tex(R) is 14.64+/-0.51 Mpa, 8.54+/-0.45 Mpa. PROCEED(R) was estimated above the limits of measurement. Inflammatory reaction of PROCEED(R) persisted for 32weeks, but SureDerm(TM) decreased after 16weeks. Vascular ingrowth into the SureDerm(TM) was seen after 32 weeks. The basement membrane of SureDerm(TM) changed into a form of pseudoperitoneum. In PROCEED(R), it seemed like pseudoepithelial lining was made from the fibrosis around the mesh. CONCLUSION: In our study, the SureDerm(TM) not only have less inflammatory reaction and presented more angiogenesis than the PROCEED(R), but also have pseudoperitoneum formation. It is expected that SureDerm(TM) is useful for abdominal wall reconstruction. However, a long-term study of its usage consequences are thought to be needed.

Prenatally Diagnosed Anterior Abdominal Wall Defects / 대한산부인과학회잡지

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.

6 Cases of Expanded PTFE Graft after Abdominal Wall Wide Excision

PURPOSE: Extensive involvement of the abdominal wall or the diaphragm by benign or malignant tumor usually has precluded wide excision. The major reason has been the lack of a satisfactory replacement for the abdominal wall or the diaphragm. When skin and subcutaneous tissues can be preserved, it is possible to restore the abdominal wall or diaphragm by using expanded polytetrafluoroethylene (GORE-TEX soft tissue patch). METHODS: From August 1993 to November 1999, we performed 6 reconstructions of the large abdominal wall or diaphragmatic defects using ePTFE following wide en bloc resection of the abdominal wall or diaphragm. RESULTS: The patients included 4 cases requiring a reconstruction of the abdominal wall. These consisted of one transverse colon cancer invading into the upper abdominal wall, a multiple teratoma recurring in the lower part of the abdominal wall, a recurrent cervix cancer inn the median line of the lower part of the abdominal wall, and an enormous desmoid tumor appearing in the right lower part of the abdominal wall. They were 22, 22, 8 and 4 months respectively after the surgical treatment. Diseases requiring extensive resection of the diaphragm included a case of hepatoma encroaching into the diaphragm and another case of a huge adrenal pheochromocytoma appearing in the right part of the diaphragm. They passed 8 and 4 months respectively following surgical treatment. There were no cases of wound infection or abdominal wall hernia, although seroma occurred in 2 cases (50%). CONCLUSION: In all 6 cases, a good result was achieved by restoring excised tissue using ePTFE graft after wide excision of tumors involving the abdominal wall or the diaphragm. Therefore, it may be possible to use this technique in cases of active excision of tumors that involve an extensive part of the abdominal wall or the diaphragm.

A Case of Reconstruction of Abdominal Wall Defect using Tensor Fascia Lata Myocutaneous Flap: The Defect Caused by a Wide Resection of Squamous Cell Carcinoma of Bladder Invading Abdominal Wall / 대한비뇨기과학회지

Squamous cell carcinoma of bladder is best treated with a radical cystectomy. Squamous cell carcinoma of bladder invading the abdominal wall is not commonly reported and hard to manage surgically. Abdominal wall defect caused by a wide resection of squamous cell carcinoma invading abdominal wall can be reconstructed using various muscle flaps. We performed a salvage cystectomy for a patient with squamous cell carcinoma of bladder invading abdominal wall up to skin, and the abdominal wall defect was successfully reconstructed using a unilateral tensor fascia lata myocutaneous flap.