الفهرس 
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Abstract
Congenital defects of the anterior abdominal wall include a group of the congenital defects ordered descendingly according to the incidence into: gastroschisis, omphalocele, congenital hernia into the umbilical cord, bladder exstrophy, cloacal exstrophy, ectopia cordis thoracis and pentalogy of Cantrell.
2D and 3D ultrasonography helped to diagnose these congenital defects in the antenatal period. Also, the fetal magnetic resonance imaging plays an important role in the diagnosis of these defects.
Elevated alpha fetoprotein- in both maternal serum and amniotic fluid- has been correlated with these defects.
The mode of delivery-either vaginal delivery or cesarean section- is a decision to be made by the obstetrician on the basis of obstetric indications, not on the presence of an abdominal wall defect.
After delivery the affected neonates are transferred to the neonatal intensive care unit for resuscitation with intravenous fluids, administration of broad-spectrum antibiotics, covering of the intestine or eviscerated organs, nasogastric tube insertion and thermoregulation. Also, routine blood samples are withdrawn and further radiological evaluation is done to exclude other associated congenital anomalies.
Then these neonates are transferred to the operating theatre where pediatric surgeons deal with the defects. In gastroschisis, a surgical emergency, silo-assisted reduction is associated with fewer complications than early primary repair and should be employed in most of the cases. Also the defect can be closed using the umbilical cord remnant. Postoperatively the surgeon must remain sensitive to the potential disasters that can result from high intra-abdominal pressures. As regard
omphalocele, defects smaller than 5 cm in diameter, primary repair is usually possible and should be attempted if the baby is healthy and without significant associated anomalies. For giant defects (larger than 5 cm or containing a portion of the liver), it is best to use a staged approach (amnio-inversion technique): a mesh is sutured securely to the fascia, the amnion is preserved and the fascia reapproximated every other day until the edges are approximated. For infants who are compromised due to cardiovascular or pulmonary disease, one might consider using a delayed closure approach, in which the amnion is coated with an antiseptic and allowed to epithelialize. For umbilical cord hernia, the defect is easily reduced by holding the sac upward and gently massaging the bowel into the peritoneal cavity and the fascia can always be closed primarily. In case of bladder exstrophy, the surgical management consists of functional closure of the native bladder, closure of the epispadic urethra and genitalia, and creation of a continence mechanism to allow for proper urine storage. There are two main approaches to repair: either modern staged repair of exstrophy or complete primary repair of exstrophy. All published operative algorithms for cloacal exstrophy repair begin with initial separation of the intervening cecal plate from the two bladder halves, closure of the omphalocele, and hindgut preservation. This can be done either in a single or multi-staged procedure. The aims of surgical treatment of ectopia cordis thoracis are: to provide soft tissue cover of the heart; to reduce the heart into the thoracic cavity; palliation or repair of any intracardiac defect; and to reconstruct the chest wall. The strategy for repair is divided into two stages. Finally, the key points in surgical management of pentalogy of Cantrell are to obtain satisfactory correction of the cardiac malformation, adequate space for heart restoration, and solid thoracoabdominal wall repair, and to prevent the heart from excessive compression or distortion.
The prognosis of gastroschisis and omphalocele has improved considerably due to the improvement in ventilatory care and total parenteral nutrition. Also, the umbilical cord hernia carries a good prognosis. For bladder and cloacal exstrophy, the former has a good prognosis and the survival of the latter became more than 90%. Both ectopia cordis thoracis and pentalogy of Cantrell carry poor prognoses.