Arch Gynecol Obstet. 2012 Jan; 285(1): 15-9
Kahl P, Buettner R, Tchatcheva K, Stressig R, Gembruch U, Kohl T

In order to further define the challenges, minimally invasive fetal surgery will have to overcome human fetuses with gastroschisis. The purpose of this study was to compare macroscopic and histopathologic characteristics of experimental laparoschisis in sheep fetuses with actual cases of gastroschisis from a postmortem series of human fetuses.Employing fetoscopy, we created a laparoschisis model in eight fetal sheep between 74 and 92 days of gestation (median 86.5 days). Twenty to 31 days after fetoscopic creation of fetal laparoschisis, six surviving fetuses were harvested for macroscopic and histopathologic assessments of the experimental lesion. These findings were compared to those of ten human fetuses with gastroschisis after termination of pregnancy.In the six sheep fetuses, both macroscopic and histopathologic intestinal changes achieved by this animal model resembled those of the human fetuses with gastroschisis. The surface of the intestine, liver and stomach exposed to the amniotic fluid was covered by a thick pseudocapsule made up of reactive fibroblasts and a dense capillary network. Parts of the capsule showed a foreign body-type reaction.Macroscopic and histopathological findings in a new minimally invasive laparoschisis model in sheep resemble those found in human fetuses with gastroschisis. The new model seems therefore suitable for assessing the potential of prenatal minimally invasive fetoscopic interventions in this condition.

Zentralbl Chir. 2009 Dec; 134(6): 550-2
Hass HJ, Krause H, Herrmann K, Gerloff C, Meyer F

The present paper reports the unusual and rare case of a colon triplication associated with other findings never reported before, including the diagnostic and therapeutic management with consideration of the relevant, but rare scientific references in the medical literature. In the basic finding of an ileum atresia with laparoschisis, a colon triplication was incidentally found. The surgical procedure performed after the primarily planned Caesarean section within the 34(th) week of gravidity consisted of a bowel-preserving resection of the triplication including the ileum atresia and a subsequent Santulli anastomosis followed by a later excision of the ileostoma. Interestingly, this is the 9(th) reported case in the accessible English medical literature but, however, the first and only one with an associated ileum atresia and laparoschisis, which was successfully treated with a surgical intervention.

Surg Endosc. 2009 Jul; 23(7): 1499-505
Kohl T, Tchatcheva K, Stressig R, Gembruch U, Kahl P

Gastroschisis is a malformation of the anterior abdominal wall that consists of a right paraumbilical defect with bowel loops bathed in the amniotic fluid. The prognosis relies mainly on morbidity attributable to intrauterine bowel loss or postpartum bowel dysfunction. The purpose of this study was to evaluate a potential role for fetoscopic surgery in severely affected fetuses with this condition.Employing fetoscopy, we created a laparoschisis model in eight fetal sheep between 74-92 days of gestation; median 86.5 days). Twenty to 31 days after fetoscopic creation of fetal laparoschisis, a second procedure was scheduled in six survivors of the first surgery with the goal of assessing the potential for fetoscopic intervention in this condition.In the six survivors, macroscopic intestinal changes achieved by this animal model resembled those of human fetuses with gastroschisis. Whereas fetoscopic enlargement of the defect within the abdominal wall was feasible, in none of the fetuses was return of herniated abdominal viscera followed by abdominal closure possible using fetoscopic instrumentation. Furthermore, any attempt to return the herniated viscera into the fetal abdomen resulted in immediate and severe hemodynamic compromise of the fetoplacental circulation by stretching of the intra-abdominal umbilical arteries and vein.Minimally invasive fetoscopic enlargement of the defect within the abdominal wall is feasible in sheep fetuses with iatrogenic laparoschisis. This approach might benefit human fetuses with gastroschisis considered at high risk for bowel loss by constriction at the defect site. In contrast, return of herniated abdominal viscera followed by abdominal closure is limited by physiological constraints and seems currently not feasible with current fetoscopic instrumentation.

J Gynecol Obstet Biol Reprod (Paris). 2007 Sep; 36(5): 486-95
Capelle X, Schaaps JP, Foidart JM

To assess the relevance and the quality of gastroschisis's care in a mid level referral centre.A retrospective analysis was performed for infants diagnosed or born with gastroschisis between 1992 and 2003 at the Citadelle hospital, Department of Obstetrics and Gynaecology, University of Liège.Twenty-four cases of gastroschisis were identified. For 22 of them (92%) antenatal sonographic diagnosis was performed at a mean gestational age of 23 weeks. Antenatal diagnosis did not allow to identify additional malformation or chromosomal anomaly. Postnatal diagnosis allows to identify 3 infants with minor cardiac anomalies without functional consequence and one X fragile syndrome. One pregnancy was electively terminated at 24 weeks and one late intrauterine death was reported at 35 weeks. Bowel atresia, stenosis or ischemia were present at birth for 8 cases (33%). Out of 24 cases 22 were live born. 10 infants out of 22 (45%) underwent uncomplicated primary surgical repair. Three infants out of 22 (14%) underwent delayed closure without complications. Nine infants out 22 (41%) underwent multiple surgery (2 to 6). In this group all had postnatal complications, some with multisystem complications, including 3 deaths, 6 with infectious complications, 5 with gastrointestinal complications and 2 with genitourinary or haematological complications. Hospital stay range from 19 to 378 days (median, 51 days). Length of stay and time to full enteral feeding were longer if oligohydramnios or sonographic signs of intestinal damage were found. Among infants born before 35 weeks, only those with intestinal damage at birth had length of stay or time to full enteral feeding longer. Out of 22 live born infants 19 survived (86%) after one year. Survival rate without handicap due to gastroschisis is 84%.Sonographic examination is a valid method for prenatal diagnosis and surveillance. Our survival rate agrees with recent data in the literature. It has to be noticed that hospital stay is lengthy and complications are frequent. The most important prognostic factor is the condition of the bowel at birth and there is no antenatal means to predict severe damage.

Dakar Med. 2002; 47(1): 64-7
Diop-Ndoye M, Diouf E, Ka-Sall B, Fall I, Beye MD, Kane O

The goal of this study was for the authors to evaluate their series of digestive surgical emergencies in the neonates. It is a retrospective study on 69 babies treated for a digestive surgical emergency between january 1998 and december 2000. Only 52 babies were born in a medical unit. There was one case of antenal diagnosis and 16 of immediate post-natal diagnosis. The babies ages in the delayed cases ranged from 1 to 17 days with a mean of 7 days and medium of 3 and 6 days. The following malformations were diagnosted: 41 anorectal malformations; 11 omphaloceles; 2 laparoschisis; oesophageal atresia in 8 cases; duodenalatresia in 5 cases; hirschsprungs disease in 2 cases. On presentation, 25 patients were dehydrated, 24 had respiratory difficulties, 5 a severe infection and 20 had hypothermia. The post operatives complications were mostly respiratory. Global mortality rate was 44.92%. The delay in diagnosis and hospital care, the occurrance of hypothermia and respiratory complications are the main reasons of this high mortality.

Rev Med Chir Soc Med Nat Iasi. 2004 Jan-Mar; 108(1): 214-9
Lupaşcu I, Fătu IC, Socolov D, Solomiţchi V

The prenatal diagnosis of laparoschisis may be established by ultrasound early in the end of the first pregnancy trimester. The visualisation of the abdominal wall defect may predict a good fetal prognosis in the absence of the other anomalies and may establish the most favorable moment of birth. Identification of several risk factors for this malformation could lead to the decrease of its incidence.

Ceska Gynekol. 2004 May; 69(3): 182-6
Turkota L, Hinst J, Rusnák I, Cunderlík A, Slezák I, Feitscher P, Stencl J, Horn F, Babala J, Siman J

During amnioinfusion exchange (AE) a certain amount of amniotic fluid is repeatedly extracted and the same amount of physiological solution is consequently instilled into the amniotic fetal cavity. The aim of this procedure is to dilute the amniotic fluid that surrounds the eviscerated organs of fetuses with laparoschisis so as to avoid the genesis of fibrous coating on these organs.Prospective study.Gynekologicko-pôrodnícka klinika SZU, FNsP akad. L. Dérera, Bratislava, Slovakia.We have executed AE in five fetuses with laparoschisis since June 2002. Two patients underwent the treatment 2 times during the 32nd and 36th weeks of gestation. Two other patients were treated once during the 32nd week and one patient once during the 36th week. Under ultrasound control we used a spinal needle to extract 120-180 ml of dense, cloudy amniotic fluid. Consequently, we instilled the same amount of physiological solution warmed up to the temperature of 37 degrees C into the amniotic cavity through antibacterial filter. The fetuses were monitored cardiotocographically and with the help of ultrasound flowmetry in umbilical vessels, before and after the treatment.The AE were successful and without complications in all five cases. All patients delivered via elective caesarean section during the 36th - 37th gestation week. One patient delivered 24 hours after second AE due to the danger of intrauterine fetal hypoxia that was verified cardiotocographically. The other patients delivered 1-4 weeks after AE.The significance of AE lies primarily in the reduction of the occurrence of fibrous coating on eviscerated organs. It enables postnatal primary surgical closure of the defect in the front abdominal wall, an earlier onset of intestine peristalsis, transition from parenteral to peroral nutrition and shorter hospitalization.

Presse Med. 2002 Feb 16; 31(6): 249-53
Estève R, Alouini S, Moutel G, Uzan M, Hervé C

The legal delay for abortion in France has recently been prolonged from 10 (12 weeks of amenorrhea) to 12 weeks (14 weeks of amenorrhea). With the progress in sonography, certain foetuses may exhibit malformations during the first trimester. Diagnosis of foetal gender at 12 weeks of amenorrhea is sometimes possible. We studied the possibility that the prolonged legal delay before abortion might incite women to abort, simply on sonographic criteria.Our enquiry was conducted in March 2001 in the department of Obstetrics and Gynaecology of the Jean Verdier hospital in Bondy. Two questionnaires were drawn-up by the Medical Ethics Laboratory of the Necker Hospital in Paris and were distributed to 128 women and 24 nurses.Recourse to abortion was high if laparoschisis or the absence of a hand was revealed, low in the case of opacity of the neck, and almost inexistent in the case of unwanted gender, in a female population with less than one child.A national consensus on foetal abnormalities to be searched for, and not to be searched for (Number of fingers? Upper lip?...) and the eventual detection of the gender during sonography of the 1st trimester is urgent in view of the technological progress made. Clear and reassuring information is essential when confronted with foetal abnormalities and must lead to complete and precise antenatal diagnosis (caryotyping, sonographic control 2 or 3 weeks later).

Rozhl Chir. 2000 Dec; 79(12): 606-8
Stranák Z, Janota J, Snajdauf J, Morávek J, Kalousová J, Tláskal T, Melichar J, Miletín J, Bĕlohlávková S, Simák J

The authors describe the case of newborn with laparoschisis in whom severe idiopathic pulmonary hypertension during postoperative period developed and initiation of extracorporeal membrane oxygenation (ECMO) to maintain circulatory stability and adequate oxygenation was necessary. ECMO was performed for 75 hours with maximum extracorporeal support up to 50% of cardiac output (Biomedicus pump BP 50, Jostra oxygenator M8). Patient was successfully weaned and switched to conventional ventilation and nitric oxide inhalation with consequent extubation. No bleeding complications were observed during ECMO in connection with surgical repair of laparoschisis.

Ann Chir Plast Esthet. 1999 Aug; 44(4): 425-9
Glicenstein J, de Lagausie P, Aigrain Y

Congenital malformations of the abdominal wall consist of a combination of a parietal opening and visceral abnormalities. The most frequent are omphalocele and laparoschisis. Embryological analysis of the formation of the abdominal wall distinguishes omphalocele, due to absence of differentiation of the lateral folds of the embryo, from laparoschisis, due to absence of differentiation of the mesenchyma at one point of the somatopleural lining. Clinically, omphalocele consists of an opening of the abdominal wall, lined by a double layer (peritoneum and external layer of the amniotic membrane), which may rupture before birth. Laparoschisis is a true antenatal hernia lying to one side of the umbilical cord. The other abnormalities of the abdominal wall are less common: muscle and purely cutaneous aplasia. The treatment of omphaloceles requires multidisplinary management. Several surgical techniques are used, mainly primary closure and rectomyoplasty. Primary closure of the abdominal wall is only possible in one-half or one-third of cases.

Ceska Gynekol. 1998 Oct; 63(5): 377-82
Stranák Z, Kovarík J, Pýcha K, Kostelka M, Melichar J, Janota J

The diagnosis and treatment of congenital diaphragmatic hernia, CDH, is an interdisciplinary problem. The patient concentration with prenatally diagnosed CDH for comprehensive examination with subsequent decision on the type of delivery improves the prognosis of patients with CDH. Introduction of corticoid therapy in prenatally assessed CDH reduces dysfunction and surfactant deficiency and can reduce the degree of respiratory failure during delivery. In very early prenatally assessed CDH it is possible to consider the possibility of combined corticoid and TRH (thyroxin releasing hormone) treatment of CDH. The authors submit also contemporary possibilities of prenatal intervention treatment of CDH (indication criteria for reconstruction operations of foetal surgery, intrauterine closure of the trachea and artificial laparoschisis). The concentration of patients with postnatally diagnosed CDH and a severe grade of acute respiratory insufficiency in a department with conventional and non-conventional artificial pulmonary ventilation incl. inhalation of NO oe extracorporeal membrane oxygenation, ECMO, is a further step towards optimation of treatment. Continuous evaluation of parameters of pulmonary functions during the pre- and postoperative period may prove that a therapeutic protocol with delayed surgery is useful.

Srp Arh Celok Lek. 1997 Sep-Oct; 125(9-10): 295-8
Smoljanić Z, Zivić G, Kos R, Krstić Z

The relatively large adrenal glands of the newborn are vulnerable to mechanical trauma during delivery. Great birth weight, difficult labor, perinatal hypoxia and prematurity are predisposing factors of adrenal haemorrhage. Minor adrenal haemorrhage may not cause symptoms. Massive adrenal haemorrhage is uncommon. Symptoms include anaemia and jaundice associated with a suprarenal mass. In cases with severe blood loss acute shock may develop. In 5 to 10 per cent of cases the haemorrhage is bilateral. Ultrasonography has replaced urography in the diagnosis of this condition demonstrating the site and size of the lesion and allowing an accurate follow-up. Within a month after haemorrhage the blood and necrotic adrenal tissue are resorbed and thin calcification appears at the periphery of the gland. Surgery is necessary if haemorrhagic pseudocyst is large and does not resorb spontaneously.From 1992 to 1996, five patients with neonatal adrenal haemorrhage were treated at the University Children's Hospital in Belgrade. Two of them were females. All patients were born at term by vaginal delivery. Their birth weights ranged between 3200 and 4050 g. At hospitalization infants were aged from 6 hours to 18 days. The first symptom of adrenal haemorrhage was an abdominal mass in three patients. One of them had laparoschisis with guts and stomach protruding out; the surgeon discovered a mass in the right retroperitoneum during operation. Two patients had jaundice associated with anaemia, and sepsis another two. Ultrasonography was done in all patients. We punctured the haemorrhagic pseudocyst (diameter above 5 cm) in three patients and made cystography. Liquid components of pseudocysts were aspirated and sent to bacteriological and cytological analyses.The diagnosis of adrenal haemorrhage was confirmed by ultrasonography in all patients, demonstrating a right adrenal mass (unilateral in all patients), mostly hypoechoic, which displaced the right kidney. Calcification at the periphery of the pseudocyst appeared in one patient. The adrenal haemorrhage disappeared spontaneously in two patients after two months. An attempt to support the adrenal hemorrhagic pseudocystic regression by puncturing and aspirating its content in three patients was successful in one infant. The patient with laparoschisis died because of sepsis and thrombocytopenia. In a patient the haemorrhagic pseudocyst persisted (6 cm in diameter) and was surgically removed.Ultrasound is the method of choice in the diagnosis of adrenal haemorrhage, antenatally and neonatally. It also allows diagnosis of coexisting complications such as renal vein or inferior vena cava thrombosis and a proper follow-up. Puncture of pseudocyst and aspiration of liquid components may support involution of large haemorrhagic pseudocysts. If it is unsuccessful, surgery is necessary.