Abdominal wall defects

Abstract The major congenital abdominal wall defects of gastroschisis and exomphalos (omphalocele) may be subject to viscero-abdominal disproportion, which determines the approach to management. Common principles of management are careful reduction of the viscera and closure of the defect to avoid potentially life-threatening abdominal compartment syndrome. The surgical strategies to deal with these can be considered as a hierarchy, with non-operative tactics before operative ones. The choice between primary or staged reduction is usually self-evident once all factors have been considered. Prematurity is typical, and growth restriction common, and both have a significant influence on outcome. Isolated simple defects have a better outcome than complex defects or multiple congenital birth anomalies. Cardiac defects are the most important extra-abdominal association and should be sought in all cases. Chromosomal anomalies should be searched for in all cases of exomphalos and any cases of gastroschisis with dysmorphism or associated structural anomalies. Intestinal atresia is the most common associated abdominal anomaly. Support from intravenous nutrition is often required. Avoiding morbidity from sepsis is of utmost priority. Mortality from intestinal failure and associated liver disease is potentially remediable. Organ transplantation may seldom be necessary when combined with sound surgical decision-making regarding enteroplasty and vigilant intestinal rehabilitation.