Omphalocele and gastroschisis. Trends in survival across two decades.

During the decade from July 1970 through June 1980, 57 patients with omphalocele and 64 with gastroschisis were treated at the Childrens Hospital of Los Angeles. Among the patients with omphalocele, the mortality was not significantly different between those with an abdominal wall defect smaller than 4 cm (5 of 24 patients) and those with a larger defect (6 of 33 patients); between those with a birth weight of less than 2,500 g (3 of 13 patients) and those with a higher birth weight (8 of 44 patients); between patients who had part of their liver in the omphalocele sac (6 of 29 patients) and those who did not (5 of 28 patients); and between patients who had primary fascial closure of the abdominal wall defect (3 of 24 patients) and those who had staged closure (4 of 25 patients). The overall mortality of 19 percent (11 of 57 patients) is not significantly different from that seen in patients treated during the preceding decade, 1960 through 1970 (23 percent, 5 of 22 patients), in our institution. Major chromosomal and other associated anomalies adversely affected the survival rate in these patients. In contrast, the overall survival rate of gastroschisis patients has markedly increased over the past two decades (91 percent in 1975 to 1980). In these patients, the difference in survival between those who had primary fascial closure (73 percent) and those who had staged closure by skin flaps or silon chimney (81 percent) was not statistically significant. Prematurity, bowel complications, and candida septicemia associated with the use of total parenteral nutrition contributed to the mortality.