title: The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review.
abstract: OBJECTIVE
  Adhesive small bowel obstruction (SBO) is a feared complication after correction of abdominal wall defects in neonates. Knowledge of its incidence and potential risk factors in a well-documented group with strict follow-up is needed to guide preventive measures.
  
  
  METHODS
  Records of 170 neonates with abdominal wall defects, 59 gastroschisis (GS) and 111 omphalocele (OC), were reviewed focusing on SBO. Risk of SBO was calculated, and potential risk factors were analyzed. Long-term complaints possibly associated with adhesions were assessed through questionnaire.
  
  
  RESULTS
  One hundred forty-seven neonates were operated on, 12 were treated nonoperatively, and 11 patients died shortly after birth. Defects were primarily closed in 128, 7 neonates needed prosthetic mesh, and 12 had a silastic sac inserted. Twenty-six (18%) neonates had SBO, 14 (25%) of 55 with GS, and 12 (13%) of 92 with OC (P = .06). Of the 26 with SBO, 26 (88%) needed laparotomy. Four patients died because of SBO. Most episodes (85%) were in the first year. Sepsis and fascia dehiscence were predicting risk factors for SBO. Abdominal pain and constipation were frequent long-term complaints not significantly associated with SBO.
  
  
  CONCLUSIONS
  Adhesive SBO is a frequent and serious complication in the first year after treatment of congenital abdominal wall defects. Sepsis and fascial dehiscence are predictive factors.
authors: Department of General Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: Floortje C
authors: FC
authors: van Eijck
authors: Rene M H
authors: RM
authors: Wijnen
authors: Harry
authors: H
authors: van Goor
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology / Q000601:surgery