Investigation of a connection between abdominal wall defects and severity of the herniation in fetuses with gastroschisis and omphalocele

Ratio between Abdominal Defect Size and Abdominal Circumference Measured Preoperatively May Predict Type of Closure in Neonates with Gastroschisis

Introduction

This study was undertaken to explore if abdominal anthropometric measurements and pressure parameters measured before closure can predict the choice of surgical procedure in neonates with gastroschisis.

Materials and Methods

Twenty-two neonates presenting to our tertiary center with gastroschisis over 18 months were included. Abdominal anthropometric measurements such as defect circumference (DC), abdominal circumference (AC), abdominal height (H), anteroposterior diameter (APD), and abdominal volume (AV) were measured soon after induction and again before final closure. Simultaneously, peak inspiratory pressure (PIP) and intravesical pressure (IVP) were measured. A protocol of pressure increase of >20% from the baseline for Silo was followed. The data were analyzed segregating the subjects into two those requiring Silo (n = 16) and not requiring Silo (n = 6).

Observation and Results

Non-Silo group did not differ from the Silo group for DC, AC, DC: AC ratio, Height, APD, and AV. Significant differences were noted between non-Silo and Silo groups in PIP (16 ± 1.9 vs. 12.88 ± 2.66) and IVP (1.83 ± 2.64 vs. 1.20 ± 2.08) preoperatively and pre-closure. DC: AC cut-off for predicting Silo was ≥0.31, with 73% sensitivity, and 50% specificity. DC: AC correlated positively with preoperative abdominal height, pre-closure AV, and abdominal height (P = 0.005, P = 0.008, and P = 0.007, respectively).

Conclusions

Silo group had unfavorable abdominal anthropometric parameters as compared to non-Silo. DC: AC ratio which can be computed in a nursery setting and can be a promising variable to predict the type of closure for neonates with gastroschisis as it correlated with AV. A larger study is required to substantiate these conclusions.

Meeting in the middle: pediatric abdominal wall reconstruction for omphalocele

BACKGROUND

Omphalocele is a congenital abdominal wall defect with an incidence of 1/4,200 births. Repair timing varies from the neonatal period to the first few years of life. Surgical technique has changed over the last two decades. We sought to establish improved surgical/ventilation protocols for patients with omphaloceles requiring abdominal reconstruction.

METHODS

An IRB-approved retrospective review was performed on patients with omphalocele requiring abdominal wall reconstruction by Plastics and/or Pediatric Surgery at a pediatric tertiary-care referral center (January 2006-July 2021). Birth history, comorbidities, surgical details, ventilation data, complications/recurrence were extracted.

RESULTS

Of 129 patients screened, seven required Plastic Surgery involvement. Defect size was 102.9 cm² (range: 24-178.5); five patients required component separation; zero patients received mesh; zero complications/recurrences were recorded. Two patients required postoperative ventilation for 2.5 days, based on increased peak inspiratory pressures at surgery stop versus start time.

CONCLUSION

Patients with large defects secondary to omphalocele benefit from collaboration between Pediatric and Plastic Surgery for component separation and primary fascial closure without mesh. Future research should follow patients who mature out of pediatric clinics to evaluate the incidence of hernias in adults with Plastic Surgery-repaired omphaloceles.

STUDY OF PENIS STRUCTURE AND DEVELOPMENT IN FETUS WITH PRUNE BELLY SYNDROME

OBJECTIVES

To evaluate the influence of prune belly syndrome (PBS) on the development of penises in human fetuses.

METHODS

We studied 39 human fetuses (including 4 with PBS) aged 11-22 weeks post conception. We measured the length and width of the free portion and penis root and the penis total length (PTL). In 21 fetuses of the control group and in 3 with PBS we analyze the penile with histochemical and immunohistochemical methods. The total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea were measured by stereological method. Means were compared using the Kolmogorov-Smirnov and ANOVA test (p<0.05).

RESULTS

We did not observe difference in PTL (p=0.999) when we compared the control group (4.69 to 29.77 mm, mean=16.2 mm; SD=6.34 mm) with the PBS (12.23 to 23 mm, mean=16.16; SD=4.99). The total penile area (p=0.002), the area of corpora cavernosa (p=0.023) and the area of corpus spongiosum (p=0.004) had a significant increase when comparing the PBS with the control group.

CONCLUSIONS

In fetuses with PBS there is no change in the length of the penis but we observed a low rate of growth in all the other histologic parameters analyzed, suggesting that PBS impacts the penile development.