Gastroschisis and omphalocele

The distinct embryology, epidemiology, associated anomalies, and natural history of gastroschisis and omphalocele are reviewed. Principles of management are discussed and specific surgical strategies are recommended: for gastroschisis, early bedside placement of a prefabricated, spring-loaded Silastic silo and later abdominal wall closure by way of delayed primary repair or formal silo placement and staged reduction; for omphalocele, primary repair of small defects and delayed repair of larger defects after topical treatment with silver sulfadiazine. In both cases, the main determinant of mortality and morbidity is usually not the abdominal wall defect: for gastroschisis, it is mainly related to the degree of associated intestinal injury; for omphalocele, it is mainly related to the frequently occurring serious associated anomalies.