[Gastroschisis prenatally and postnatally]. / Wrodzone wytrzewienie prenatalnie i postnatalnie.

OBJECTIVE: The aims of the study were: 1) evaluation of progress in surgical treatment of gastroschisis between 1990 and 2004 including the impact of prenatal diagnosis; 2) evaluation of mortality and coexisting congenital abnormalities in fetuses and newborns with gastroschisis. MATERIAL AND METHODS: Between 1990 and 2004 in Polish Mother's Health Institute gastroschisis was diagnosed in 108 cases. Basing on information from the Department of Pathology, Department of Pediatric Surgery and Department of Fetal Therapy, the patients were divided into 2 groups: 1) miscarried fetuses, still born neonates and non-operated live newborns who died within several hours after delivery (31 cases); 2) live born operated on newborns (77 cases). RESULTS: Until 1999 gastroschisis was diagnosed prenatally only in 30% of patients, while after 1999 the defect was diagnosed in 70% of cases. From the year 2000, due to close cooperation with obstetricians, newborns with gastroschisis have been operated on directly after delivery at the same theatre. In this period there were only 2 deaths due to prematurity (both twin deliveries)--5,4%. Main causes of deaths were: in group I--congenital defects of the cardiovascular and respiratory tracts and multiple defects; in group II--peritonitis, ileus due to adhesions and multiorgan failure. CONCLUSIONS: 1. Prenatal diagnostics and close cooperation between gyneacologists, obstetricians, neonatologists and pediatric surgeons significantly decreased mortality of newborns operated for gastroschisis in our Institute from 30% in 1990-1999 to 5,4 % in 2000-2004. 2. If miscarried or premature deliveries and deaths prior to operation are included, the mortality is 41%. 3. Deaths in the group of non-operated patients were caused by serious congenital defects not connected with gastroschisis.

[Evaluation of surgical treatment in gastroschisis based on personal experience]. / Ocena postepowania chirurgicznego w wytrzewieniu wrodzonym na podstawie badan wlasnych.

UNLABELLED: The ultimate goal of surgical treatment is the reduction of eviscerated bowel and full fascial closure of the abdominal defect; the sooner it is done -- the better, otherwise the risk of sepsis is overwhelming. On the other hand, however, forcible, one-step reduction may cause the development of the abdominal compartment syndrome. AIM OF THE STUDY: To summarize the personal experience concerning the surgical treatment of gastroschisis and to suggest the optimal procedure in this anomaly. MATERIAL AND METHODS: The analysis of the treatment of 67 neonates with gastroschisis who were operated on in our Department from 1994 through 2004 has been presented. In 51 of them, who were born in this Department, the diagnosis of gastroschisis had been established prenatally, in the remaining 16 -- postnatally. RESULTS: Prenatal diagnosis allows to undertake prenatal intervention, if indicated, and monitor the progress of anomaly and possible decision of earlier delivery. We found such indications in 8 of our patients in whom earlier delivery by caesarean section was performed and 9 others were given amnioinfusion. In the presented series -- in the years 1994-2000 multistep procedures with silo formation were performed more often, whereas in the years 2001-2004 we shifted our preference towards primary reduction of gastroschisis. The feasibility of primary reduction depends on the condition of eviscerated bowel and intra-abdominal pressure (monitored indirectly in the urinary bladder). In 8 cases (12%) coinciding bowel atresia was diagnosed. CONCLUSIONS: Prenatal diagnosis is of practical importance -- it allows for in utero treatment and if indicated earlier delivery. One step reduction of eviscerated bowel, if feasible is the treatment of choice. Otherwise, gradual reduction, with the use of silo is recommended.