Gastroschisis (Greek: gastro = stomach and schisis = "splitting") is the most common congenital malformation of the anterior abdominal wall. A gap (defect) in the abdominal wall causes the internal abdominal organs to prolapse outwards during pregnancy. The cause or development of gastroschisis is unclear. Two hypotheses are discussed:

1) During pregnancy, parts of the intestines and abdominal organs shift into the umbilical cord and expand it into a sac shape. If this sac ruptures, these organs float freely in the amniotic fluid.
2) A vascular malformation (abnormal regression of the right umbilical vein or premature occlusion of a certain artery (omphalomesenteric artery) in early pregnancy) causes the abdominal wall to soften and a hole to form.

Gastroschisis occurs in approx. 1:2000-2500 births, both sexes are affected equally often. Children with gastroschisis are often born prematurely or are too small for the respective completed week of pregnancy. Other concomitant malformations are rare. In contrast to omphalocele, concomitant malformations in gastroschisis often only affect the intestines. These are predominantly so-called intestinal atresias, i.e. areas of the intestine that cannot pass through.

Gastroschisis is usually diagnosed during an ultrasound scan during pregnancy from the 10th to 12th week of pregnancy at the earliest. In children with gastroschisis, there is a defect in the anterior abdominal wall measuring a few centimeters at birth, which is typically located to the right of the navel. This defect causes intestinal loops to exit the abdominal cavity, although the umbilical cord is always intact. The intestines are not surrounded by an envelope or hernia sac. Abdominal organs such as the liver, spleen or spleen only rarely protrude. In some cases, the intestinal loops, which are located outside the abdominal cavity, are severely inflamed, stuck together or thickened.

All children with gastroschisis require surgical treatment by a pediatric surgeon on the first day of life. The principle of the operation is to "tuck" the prolapsed intestines back into the abdomen. Due to a disproportion between the prolapsed organs and the very small abdominal cavity, this is often not possible directly. In this case, the intestines must first be placed in a specially designed plastic bag (so-called silo) to protect them from drying out. The abdomen can then only be completely closed a few days later.

By making a prenatal diagnosis, parents can be referred to a specialized center with the possibility of neonatal and paediatric surgical care at an early stage and give birth to their child here. We therefore often know a few days in advance that a child with gastroschisis is due to be born and are therefore optimally prepared for the arrival of your child(women's clinic / prenatal diagnostics).

Ideally, you will have already familiarized yourself with the upcoming operation and what to expect after the birth by talking to us before the birth.

After your child has been born in the women's clinic, the entire lower half of your child's body will be placed in a sterile plastic bag in the delivery room to prevent bacterial colonization and to protect the prolapsed organs mechanically and from drying out. We also start prophylactic antibiotic therapy. A gastric tube is inserted to prevent the prolapsed intestinal loops from filling excessively with air. As the children have to fast before the operation on the first day of life, a venous line is inserted and the children are supplied with sufficient fluids.

Once the operating room has been prepared, your child will be taken to the operating room. Ideally, the bowel and all abdominal organs that have leaked out can be completely moved back into the abdominal cavity (so-called "primary closure"). The abdominal wall defect is closed directly with several sutures. In around 10-20% of cases, a primary abdominal wall closure cannot be performed as the abdominal cavity is too small and cannot accommodate the parts of the intestine that have been moved to the outside and the risk of excessive pressure in the abdominal cavity would be too great. In this situation, the abdominal wall defect is widened through a small incision and a plastic sheet is sewn into the abdominal wall. The intestines outside the abdominal cavity are then covered by this film (silo). This construction is then suspended with slight tension. Over the following days, the intestinal loops then slide continuously into the abdominal cavity following the force of gravity, stretching it mechanically. Only then can the abdominal wall be surgically closed.

In children with abdominal wall defects, the bowel is usually very sluggish even after abdominal wall closure and initially hardly transports the bowel contents at all. Most children with abdominal wall defects therefore need several weeks before they can be fed by mouth. In the meantime, they are therefore fed via a vascular access. However, it is not possible to predict exactly how long it will take for your child to drink all their meals completely on their own. Every child takes its own time. When your child is drinking all the food, no longer needs additional nutrition via the vein and is steadily gaining weight, you can be discharged home.

Due to the great variability of the disease spectrum and clinical course, it is not possible to predict when, how often and where the first post-operative check-ups will take place after discharge. They are usually carried out by your pediatrician, but are also carried out by us at regular intervals in our pediatric surgery outpatient clinic in our consultation hour for abdominal wall defects.

Children with duodenal atresia have to stay in hospital for about 7-10 days after the operation. During this time, the child and mother are cared for by our pediatric nurses and medical team on the infant ward. In the first few days after the operation, your child will not be fed by mouth or via a feeding tube, but intravenously via a drip. The feeding tube will be left in the child's stomach for a few days after the operation. This is necessary in order to drain the secretions (saliva, gastric juice, small intestinal secretions) that cannot yet pass easily through the small intestine due to temporary swelling of the duodenum and the general sluggishness of the small intestine after the abdominal operation.

A few days after the operation, your child can be fed by mouth. However, it is not possible to predict how long it will take for the bowel to function normally. Every child takes its own time. If your child drinks the food completely and gains weight steadily, he or she is healthy and can be discharged home.