title: Liver herniation in gastroschisis: incidence and prognosis.
abstract: OBJECTIVE
  Liver herniation is a rare occurrence in gastroschisis. We sought to determine the incidence and prognosis of liver herniation in patients with gastroschisis.
  
  
  METHODS
  From December 1995 to March 2010, 117 patients with gastroschisis received care by our division. Operative reports were reviewed to identify patients with liver herniation. Logistic regression was used to determine the impact of liver herniation on survival, taking into account gestational age and birth weight.
  
  
  RESULTS
  The incidence of liver herniation was 6%. Survival rates were 43% with liver herniation and 97% without liver herniation. Liver herniation was associated with a significantly higher rate of mortality, taking into account estimated gestational age and birth weight (P < .001). Patients who had liver herniation documented by prenatal ultrasound had significant liver herniation at birth and died postnatally. Patients with liver herniation who died required large silos and were noted to have comorbidities including lower birth weight, pulmonary hypoplasia, and sepsis. Biologic patches were necessary for closure in patients with greater extent of liver herniation.
  
  
  CONCLUSIONS
  Liver herniation was found in 6% of patients with gastroschisis and was associated with a high rate of mortality. Liver herniation appears to be a risk factor for poor outcome in gastroschisis. Documentation of liver herniation may be helpful in prenatal consultation for gastroschisis.
authors.affiliation: Division of Pediatric Surgery, David Geffen School of Medicine at UCLA, Box 709818, Los Angeles, CA 90095-7098, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: McClellan
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
authors.forename: Steve S
authors.initials: SS
authors.lastname: Lee
authors.forename: James C Y
authors.initials: JC
authors.lastname: Dunn
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Deugarte
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000015:Abnormalities, Multiple / Q000453:epidemiology; D001724:Birth Weight; D015897:Comorbidity; D005260:Female; D020139:Gastroschisis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000196:embryology / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000601:surgery; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000196:embryology / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D016216:Ultrasonography, Prenatal