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      Management of the Sequelae of Severe Congenital Abdominal Wall Defects

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          Abstract

          Background

          The survival rate of newborns with severe congenital abdominal wall defects has increased. After successfully addressing life-threatening complications, it is necessary to focus on the cosmetic and functional outcomes of the abdominal wall.

          Methods

          We performed a chart review of five cases treated in our institution.

          Results

          Five patients, ranging from seven to 18 years of age, underwent the following surgical approaches: simple approximation of the rectus abdominis fascia, the rectus abdominis sheath turnover flap, the placement of submuscular tissue expanders, mesh repair, or a combination of these techniques depending on the characteristics of each individual case.

          Conclusions

          Patients with severe congenital abdominal wall defects require individualized surgical treatment to address both the aesthetic and functional issues related to the sequelae of their defects.

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          Most cited references15

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          Abdominal wall defects: Prenatal diagnosis, newborn management, and long-term outcomes

          Piergiorgio Gamba, Paola Midrio (2014)
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Surgical treatment for giant incisional hernia: a qualitative systematic review.

            A. Eriksson, J C Rosenberg, T. Bisgaard (2014)
            Repair for giant incisional hernias is a challenge due to unacceptable high morbidity and recurrence rates. Several surgical techniques are available, but all are poorly documented. This systematic review was undertaken to evaluate the existing literature on repair for giant incisional hernia.
            Article 0 comments Cited 29 times – based on 0 reviews     Review now
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              Gastroschisis and omphalocele: treatments and long-term outcomes.

              Bertram Reingruber, G Wéber, Hans Huemmer … (2008)
              Between February 1994 and April 2004, we treated 40 children with gastroschisis and 26 children with omphalocele. We recorded the course of pregnancy, pre- and post-natal complications, delivery, operation, post-operative therapy, and long-term outcomes. Additionally, we conducted follow-up examinations of 37 of these 66 children (56%). We analysed their abdominal musculature, development, cosmetic result and quality of life. The median duration of follow-up was 6.3 years (range 1-10). In 35/40 children (88%) with gastroschisis and in 18/26 children (69%) with omphalocele, there had been prenatal diagnosis. The average maternal age of 23.9 years in the gastroschisis group was lower than in the omphalocele group (29.9 years). Delivery was by caesarean section in 93% of the gastroschisis group and 65% of the omphalocele group. Outcomes following vaginal delivery were no worse than those after caesarean section. Further, congenital abnormalities were shown in 28% of gastroschisis cases, and were limited to the gastrointestinal tract. Of the omphalocele cases 81% showed further abnormalities. Direct closure of the abdominal wall defect was possible in 31/40 (78%) of the gastroschisis cases and 15/26 (58%) of the omphalocele cases. Mortality in gastroschisis was nil; two children with omphalocele died (8%). Outcomes were better after primary closure than in stepwise reconstruction. Follow-up showed good results in all categories. Developmental delays were rapidly made up after treatment, and 75% of the children had no gastrointestinal problems, or suffered from these rarely. Almost all the children were of normal weight and height, and physical and intellectual development were delayed in only one third of the children. The surgical scar was rated as good or very good in about 80% of the cases. Except for those with severe defects, the children had good ratings for quality of life. Improvements in short-term results of gastroschisis and omphalocele treatment can be attributed to recent developments in prenatal diagnosis and the advancements of centralised perinatal care. Our long-term results clearly demonstrate that initial gastrointestinal problems and developmental delays were made up during the first two years of life. Prenatal counselling can now be more optimistic.
              Article 0 comments Cited 18 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Plast Surg
                Journal ID (iso-abbrev): Arch Plast Surg
                Journal ID (publisher-id): APS
                Title: Archives of Plastic Surgery
                Publisher: The Korean Society of Plastic and Reconstructive Surgeons
                ISSN (Print): 2234-6163
                ISSN (Electronic): 2234-6171
                Publication date (Print): May 2016
                Publication date (Electronic): 18 May 2016
                Volume: 43
                Issue: 3
                Pages: 258-264
                Affiliations
                [1 ]General Pediatric Surgery Department, Nino Jesus University Hospital, Madrid, Spain.
                [2 ]Pediatric Plastic Surgery Department, 12 de Octubre University Hospital, Madrid, Spain.
                Author notes
                Correspondence: Sara Fuentes. Nino Jesus University Hospital, Avda Menéndez Pelayo 65, 28009 Madrid, Spain. Tel: +34-64-977-0758, Fax: +34-91-503-5900, sarafuentesc@ 123456yahoo.es
                Article
                DOI: 10.5999/aps.2016.43.3.258
                PMC ID: 4876155
                PubMed ID: 27218024
                SO-VID: 0e1dcb67-256d-4e7f-b033-7244009eddcc
                Copyright © Copyright © 2016 The Korean Society of Plastic and Reconstructive Surgeons
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 January 2016
                Date revision received : 18 February 2016
                Date accepted : 29 March 2016
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: gastroschisis,umbilical hernia,abdominal wall,abdominal muscles,hernia, ventral
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: gastroschisis, umbilical hernia, abdominal wall, abdominal muscles, hernia, ventral

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