"Neonatal Abdominal Wall Defects: Characterization and Primary Surgical Closure Outcomes in a High-Level Institution in Medellin, Colombia"

Medina AE, Bernal MP and Restrepo LGE

Published on: 2025-04-08

Abstract

Introduction: Gastroschisis and omphalocele are the most common abdominal wall defects in neonates and must be treated by a multidisciplinary team in a high-complexity center. Among them, gastroschisis is considered a surgical emergency, therefore making the implementation of protocols that ensure prompt management is essential due to its impact on patient morbidity and mortality. The ideal surgical approach is primary closure.

Objective: To describe the sociodemographic characteristics of the studied population and analyze the association between clinical and non-clinical variables with the possibility of primary closure, as well as its impact on patient outcomes.

Patients and Method: Medical records of 35 mothers and their neonates diagnosed with omphalocele or gastroschisis treated at the institution between 2020 and 2024 were reviewed. A database was created in Excel for variable systematization and collection. For analysis, SPSS version 25 was used. Absolute and relative frequencies were calculated for categorical variables, while continuous variables without normal distribution were analyzed using medians and interquartile ranges. The Chi-square and Fisher's exact tests were employed to evaluate the association between variables and primary closure.

Results: Statistical analysis did not find a statistically significant association between primary closure and the examined variables, likely due to the small number of patients analyzed. The primary closure rate was significantly higher in this study (89.4%) compared to the previous study (44%) 17. This may be explained by the implementation of management protocols in the institution, where the most important variables included early intubation and prompt surgical intervention (ideally within the first 6 to 8 hours of life). In this study, the average time from birth to surgical intervention for gastroschisis patients was 4.2 hours, compared to 18 hours in previous years when pediatric surgery was not permanently available.

Conclusions: Gastroschisis and omphalocele should be treated in high-level centers with a multidisciplinary perinatal approach. Surgical management presents a great challenge, with the ideal goal being primary closure during the first intervention. Although our study did not find a statistically significant relationship between different variables and the possibility of primary closure, we observed that in our care center, following the implementation of standardized management protocols, the success rate of primary closure increased (89.4% vs. 44%). This coincided with the introduction of early intubation and surgical intervention within the first 6 to 8 hours in gastroschisis patients. Further studies are required to clarify this association.