Immediate permanent fascial prosthesis for gastroschisis and massive omphalocele.

To obviate any limitation in abdominal volume, the girth in 44 neonates was increased significantly by the insertion of either Marlex mesh or Prolene mesh as a permanent midline fascial prosthesis. Concomitant primary wound closure was then accomplished through mobilization of laterally based skin flaps. Without exception, the resultant coelom was adequately spacious, as reflected postoperatively by both ventilation and venous return being unimpaired. Four babies died, three as a result of antecedent cerebral hypoxia complicating diaphragmatic herniation and one as a result of sepsis. Indications for the procedure were a massive omphalocele in 31 infants, gastroschisis in nine and a huge diaphragmatic hernia in four. Wound dehiscence with exposure of the fascial prosthesis occurred twice, once because of a cautery burn of the skin and after minor wound infection in the second. Revision of the initial abdominal wall repair was required in both of these babies as well as for incomplete extrusion of Marlex mesh in three older children. Prolene is now preferred for fascial prostheses. Prime advantages of the technique include immediate enlargement of the peritoneal capacity, rare necessary for ventilatory support, maintenance of abdominal support by a fascial gusset, elimination of infectious complications attending more delayed closures of wound and peritoneum and the uncommon need for later operative revision.