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Differences between Omphalocele and Gastroschisis
EtiologyFailure of gut migration from yolk sac into abdomenOcclusion of omphalomesenteric artery with ischemia to the right periumbilical area
LocationWithin umbilical cordPeriumbilical
Prenatal diagnosis by U/SYesYes
Incidence1:6,000, M >F1:15,000, M >F
Peritoneal coveringYesNo
LocationCentral through umbilicusLateral to umbilicus
Associated anomaliesHigh incidenceLow incidence
CardiacGI—intestinal atresia
GI—Meckel’s diverticulum, malrotation
GU—bladder extrophy
Metabolic—Beckwith–Wiedemann (congenital disorder associated with macrosomia, macroglossia, organomegaly, and hypoglycemia)
Chromosomal abnormalities (trisomy 21), congenital diaphragmatic hernia
Survival rate70–95%>90%

  • Broad-spectrum antibiotics to prevent contamination of the peritoneal cavity preoperatively
  • Similar preoperative management of neonates: preventing infection and minimizing fluid and heat loss
  • Covering the exposed viscera or membranous sac with sterile saline-soaked dressings and plastic wrap immediately after delivery decreases evaporative fluid and heat loss
  • Surgical correction of an omphalocele or gastroschisis is urgent but can be delayed until full anesthesia workup and resuscitation
  • Rule out associated anomalies; may need echocardiogram, renal U/S
  • Correct fluid and electrolyte abnormalities
    • Because of significant ongoing fluid losses with an open abdominal wall defect, administer an IV fluid bolus (20 mL/kg lactated Ringer’s solution or normal saline), followed by 10% dextrose in 1/4 normal sodium chloride solution at two to three times the baby’s maintenance fluid rate
  • Decompress stomach with OGT

  • Standard ASA monitors with temperature + urine output
  • Individualized for patient needs
  • A-line helpful for monitoring pH and guiding fluid therapy:
    • Also useful if concomitant cardiac defects present
  • A pulse oximeter probe on the lower extremity will detect a decrease in oxygen saturation that could be caused by congestion of the lower extremities due to obstruction of venous return
  • Measurement of intragastric pressure, CVP, or cardiac index can aid in determining whether primary closure is appropriate

  • GETA + RSI. May also do awake intubation. Avoid N2O because of possibility of gastric distention
  • Maximal muscle relaxation mandatory

  • Anesthetic management involves volume resuscitation (˜50–100 mL/kg of isotonic fluids during the case) and the prevention of hypothermia
  • Major complications from increased intra-abdominal pressure when replacing viscera into abdomen:
    • Ventilatory compromise:
      • Watch for increased peak airway pressures and decreased tidal volumes
    • Decreased organ perfusion
    • Bowel edema
    • Anuria
    • Hypotension
  • If inspiratory pressure is >25–30 cm H2O or intragastric pressure >20 cm H2O, primary closure is not recommended

  • Postoperative management depends on the type of repair and whether or not the child has associated anomalies
  • Fluid resuscitation should continue postoperatively because fluid loss through the viscera continues, especially in a staged repair, where the viscera are left extraperitoneally
  • Parenteral nutrition can be needed, especially if prolonged ileus
  • Most children remains intubated for 24–48 hours to monitor airway pressures postoperatively

1. Liu LM, Pang LM. Neonatal surgical emergencies. Anesthesiol Clin North America. 2001 Jun;19(2):276–277.   [PubMed: 11469065]
2. Diu ...

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