Chapter 172.

Gastroschisis/Omphalocele 
Wanda A. Chin, MD
 Basics
 Preoperative
 Monitoring
 Induction
 Maintenance
 Postoperative
 References
 Full Chapter
 Tables
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Differences between Omphalocele and Gastroschisis

Omphalocele Gastroschisis

Etiology Failure of gut Occlusion of

migration from omphalomesenteric
yolk sac into artery with ischemia to
abdomen the right periumbilical
area

Location Within Periumbilical

umbilical cord

Prenatal Yes Yes

diagnosis
by U/S

Incidence 1:6,000, M >F 1:15,000, M >F

Peritoneal Yes No
covering

Location Central through Lateral to umbilicus

umbilicus

Associated High incidence Low incidence

anomalies
Cardiac GI—intestinal atresia

GI—Meckel’s diverticulum,
 Omphalocele Gastroschisis

malrotation

GU—bladder extrophy

Metabolic—Beckwith–Wiedemann
(congenital disorder associated with
macrosomia, macroglossia,
organomegaly, and hypoglycemia)

Chromosomal abnormalities (trisomy

21), congenital diaphragmatic hernia

Survival 70–95% >90%

rate

 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
o 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:
o 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:
o Ventilatory compromise:
 Watch for increased peak airway pressures and decreased tidal volumes
o Decreased organ perfusion
o Bowel edema
o Anuria
o 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