Gastroschisis and omphalocele represent two of the most significant congenital abdominal wall defects confronting pediatric surgeons worldwide [1]. These conditions not only pose substantial challenges in surgical management but also have profound implications for neonatal care, long-term morbidity, and parental support. Although both result from errors during the embryologic development of the fetal abdominal wall, gastroschisis and omphalocele are unique disorders with different clinical sequelae. Gastroschisis is generally a solitary anomaly with postnatal outcomes related to the underlying integrity of the prolapsed bowel. In contrast, omphalocele is frequently associated with other structural anomalies or genetic syndromes that contribute more to postnatal outcomes than the omphalocele defect itself [2]. The incidence and outcomes of gastroschisis and omphalocele vary significantly across different geographic regions and healthcare systems, influenced by factors such as prenatal diagnosis rates, surgical techniques, and postoperative care protocols. In Korea, despite advanced healthcare services and high rates of prenatal screening, comprehensive data on these congenital anomalies have been sparse and fragmented. The Korean Association of Pediatric Surgeons (KAPS) conducted a national survey of its members to assess the birth prevalence of gastroschisis and omphalocele and to analyze data regarding patient characteristics, the rate of associated anomalies, treatment and prognosis of gastroschisis and omphalocele in Korea over the last 10 years. The 2022 annual nationwide survey conducted by the KAPS focused on gastroschisis and omphalocele. The results were first discussed at the KAPS annual meeting in Yeosu on June 9–10, 2022.

The study included patients who had been treated for gastroschisis and omphalocele from January 2012 to December 2021. It was based on the Case Report Form (CRF), which included data on gender, gestational age, birth weight, any associated anomalies, type of defect, type of surgery, management, and outcome. The national survey using CRF was sent to the members of the KAPS and was completed in 20 pediatric surgical centers, totaling 269 patients. Follow-up data for these patients were also included in the study. Microsoft Excel (Microsoft, Redmond, WA, USA) was used for patient registry and data collection. All data were analyzed using the IBM SPSS version 27 statistical software (IBM Co., Armonk, NY, USA), and p-values <0.05 were considered statistically significant. The study protocol was approved by the Institutional Review Board (IRB) of Jeonbuk National University Hospital (IRB No. 2024-08-028).

The study presents comprehensive data on the incidence, clinical characteristics, and outcomes of gastroschisis and omphalocele in Korea over a ten-year period. This retrospective analysis, based on data collected from 20 pediatric surgical centers, highlights several key findings that contribute to our understanding of these congenital abdominal wall defects. When compared with international data, several noteworthy similarities and differences emerge, shedding light on the global landscape of these congenital anomalies.

The study reveals that the prevalence rates of gastroschisis and omphalocele among live births in Korea are 2.15 per 100,000 and 5.08 per 100,000, respectively. The data shows a higher prevalence at birth of omphalocele compared to gastroschisis, a pattern also observed in other regions [1, 3, 4, 5]. However, in other regions, there was a pattern where the incidence of gastroschisis was higher compared to omphalocele [6, 7, 8, 9, 10, 11, 12]. The study revealed a slight increase in the prevalence at birth of omphalocele and a stable prevalence at birth of gastroschisis in Korea over the decade. These rates are inconsistent with global trends reported in previous studies, which indicate that while the incidence of gastroschisis has been increasing in many countries, the prevalence at birth of omphalocele has remained relatively stable [4, 11].

The characteristics of gastroschisis and omphalocele in Korea mirrors global trends, with gastroschisis being more common in younger mothers and associated with fewer additional anomalies compared to omphalocele. Studies from other studies support this, indicating that gastroschisis typically presents in younger mothers and with lower birth weights compared to omphalocele [1, 4, 8, 11]. Conversely, omphalocele is often linked with older maternal age and a higher prevalence at birth of associated anomalies, such as cardiac defects and chromosomal abnormalities, consistent with findings from our study [1, 4, 8, 11].

In our study, the mean parity of mothers of infants with gastroschisis or umbilical aneurysm was approximately 0.57, indicating a relatively higher number of nulliparous mothers in the cohort (Table 2). These data differ from the broader observation in various studies that younger, non-parietal women were more often associated with the development of gastroschisis than with omphalocele [4, 8, 13].

The sex ratio of abdominal wall defects, specifically gastroschisis and omphalocele, provides insight into their epidemiological characteristics. In the provided demographic data from Table 2 of your study, both conditions showed an almost equal male to female ratio (M/F ratio=0.95). This balanced gender distribution suggests no significant sex predilection for these congenital anomalies in the population studied, and other studies have found similar findings [1, 4, 7].

The study underscores significant differences in the clinical characteristics between gastroschisis and omphalocele patients. Infants with gastroschisis had a lower mean birth weight and smaller head circumference compared to those with omphalocele. This is consistent with previous literature that associates gastroschisis with low birth weight and smaller head size, which are critical factors influencing neonatal outcomes [3].

The prevalence at birth and nature of associated anomalies in abdominal wall defects like omphalocele and gastroschisis are critical for understanding the clinical outcomes and guiding prenatal counseling and postnatal care strategies. In our study, the frequency of associated anomalies was significantly higher in omphalocele cases (82.5%) compared to gastroschisis (63.7%), with cardiovascular anomalies particularly more prevalent in omphalocele patients. Other studies are consistent with our findings of a high prevalence at birth of associated malformations, especially cardiovascular disease, in umbilical herniation, suggesting a pattern in which umbilical herniation is often part of a more complex syndrome presentation compared to gastric dissection [4, 12, 13]. In contrast, gastroschisis is typically an isolated defect, though it can still be associated with gastrointestinal complications [7, 12].

The prenatal diagnosis rates for gastroschisis and omphalocele are notably high, with gastroschisis diagnosed in 93.7% of cases and omphalocele in 86.4%. This reflects the efficacy of current antenatal ultrasound techniques in detecting these abdominal wall defects (Table 3). The data from this study indicate that while prenatal diagnosis of associated anomalies was confirmed postnatally in 43 out of 48 cases (89.6%), only 48 out of 193 cases (24.9%) that were not diagnosed with anomalies prenatally were found to be anomaly-free after birth (Table 4). This suggests a high sensitivity but low specificity in prenatal anomaly detection, which is consistent with broader trends observed in abdominal wall defects. Studies such as those conducted in Japan and reported by Watanabe et al. [14] also highlight the role of advanced prenatal screening, which has increasingly allowed for detailed assessment of not just the primary defect but also associated anomalies, impacting surgical planning and parental counseling [4]. In Japan, the antenatal detection rates have been significant, with similarly high sensitivity noted. The approach there also emphasizes the utility of detailed prenatal screening in improving postnatal outcomes [4]. The high sensitivity of anomaly detection in prenatal screenings for gastroschisis and omphalocele supports their utility in clinical practice. However, the challenge remains to enhance specificity to reduce the psychological and financial burden of false positives. Continual advancements in imaging technology and diagnostic protocols are essential to refine these outcomes.

Antenatal diagnosis of gastroschisis and omphalocele through ultrasound was notably high, with gastroschisis cases diagnosed at 93.7% and omphalocele cases at 86.4%. This high rate of detection allows for significant prenatal counseling, which was received by 60.8% of gastroschisis patients and 52.2% of omphalocele patients as shown in Table 3. The role of antenatal counseling in managing abdominal wall defects is pivotal as it helps in preparing parents for the outcomes and managing their expectations regarding the condition of their child. According to a study from New Zealand, effective parental counseling can impact parental perceptions of the defect and assist in guiding pregnancy management [12]. This includes preparing the parents for potential surgeries and the associated care that will be required postnatally [15].

The place of birth for patients with gastroschisis and omphalocele shows a significant difference. In this study, a notably higher proportion of gastroschisis patients (96.3%) were born in the hospital where they were treated compared to omphalocele patients (84.1%) (Table 5). This difference could reflect the urgency and the need for immediate postnatal care associated with gastroschisis, which often presents more acutely and requires rapid surgical intervention post-delivery. The mode of delivery, involving planned and emergency C-sections along with vaginal deliveries, showed no significant difference between the gastroschisis and omphalocele groups in this study (Table 5). This suggests that the decision on the mode of delivery might be influenced more by obstetric considerations rather than the type of abdominal wall defect. Consistent with this, literature suggests that the mode of delivery for abdominal wall defects should be guided by standard obstetric indications rather than the presence of the defect itself [7, 8, 12, 14].

The study details various treatment approaches for gastroschisis and omphalocele, including primary and staged closure techniques. The findings indicate that primary closure is more commonly performed in gastroschisis patients, while staged closure is often necessary for more complex cases or when primary closure is not feasible. Both gastroschisis and omphalocele treatments highlight a complex interplay between surgical techniques and the condition's severity. Primary closure often aims for immediate resolution, whereas staged closure prepares the anatomy for a more gradual recovery, potentially reducing immediate post-operative complications. The literature supports these approaches, emphasizing that while primary closure is ideal, the condition of the neonate and the defect's size often necessitate a staged approach to avoid complications like abdominal compartment syndrome, which is consistent with findings in advanced treatments such as vacuum-assisted closure (VAC) for complex cases where traditional methods fail [12, 15, 16, 17].

The study analyzing 80 patients with gastroschisis and 189 patients with omphalocele revealed significant differences in the time from birth to operation and the time to start feeding between the two groups, although the length of hospital stay and follow-up duration were similar for both conditions. The significantly shorter time from birth to operation for gastroschisis patients (average 3.5 days) compared to omphalocele patients (average 56.5 days) highlights the urgency and clinical necessity of early surgical intervention in gastroschisis. This urgency is often due to the exposed viscera in gastroschisis, which can lead to rapid fluid loss, temperature instability, and increased risk of infection and damage to the bowel [7]. On the other hand, the delay in operation for omphalocele could be attributed to the protective sac covering the herniated organs, which reduces the immediate postnatal risks and allows for more detailed preoperative planning and stabilization [7].

Gastroschisis patients experienced a significantly longer delay in starting feeding (average 16.5 days) compared to omphalocele patients (average 6.6 days). This is consistent with the nature of gastroschisis, where bowel exposure can often lead to complications such as bowel edema, atresia, or necrosis, delaying the initiation of enteral nutrition [12, 14]. Omphalocele patients, generally having their bowel covered and protected, can often commence feeding earlier, reflecting fewer immediate postnatal complications affecting the gastrointestinal tract [12, 14].

The length of hospital stays did not significantly differ between the groups, suggesting that while the initial conditions and interventions vary, the overall burden of care post-operation may converge, particularly when considering long-term monitoring and care for potential complications. Although not statistically significant, the hospitalization period was long in gastroschisis, which was similar to the findings seen in other studies [7, 12].

The survival rates for gastroschisis (89.7%) and omphalocele (87.1%) patients, as illustrated in Fig. 5, show no significant differences between the two conditions when optimal surgical and neonatal care are provided. Studies from Japan and other countries also demonstrate comparable survival outcomes, highlighting that advancements in prenatal diagnostics and postnatal care have significantly improved survival rates over the years for both conditions [4, 11].

In conclusion, this study provides valuable insights into the management and outcomes of gastroschisis and omphalocele in Korea. The findings underscore the importance of early diagnosis, centralized care, and tailored surgical approaches to improve patient outcomes. Future research should focus on long-term follow-up and the development of standardized treatment protocols to further enhance the care and prognosis of infants with these challenging congenital defects.