Outcome of Staged versus Primary Repair in Neonatal Abdominal Wall Defects

Abstract

Background: Notable examples of congenital surgical defects that are accompanied by significant morbidity and mortality are neonatal abdominal wall defects, mainly gastroschisis and omphalocele. Depending on the size of the defect, bowel condition, related anomalies and the stability of the neonate, surgery treatment can be conducted using primary repair or staged repair. The benefits of primary repair are that it could offer early closure, and the benefit of staged repair is that it could reduce abdominal compartment pressure in the select neonates.

Objective: To compare the results of the staged and primary repair among the neonates who present with abdominal wall defects.

Methodology: This comparative study was carried out on in Paediatric Surgery department of The Children's Hospital Lahore from June 2024 to June 2025, including 150 newborns with congenital abdominal wall defects, such as gastroschisis and omphalocele. The WHO formula of sample size will be used with a confidence level of 95 percent, and a margin of error of 5 percent. Informed parental consent will be sought; PAD was frequently observed among patients with LMS coronary artery disease undergoing PCI. Routine PAD screening may help identify high-risk patients and guide comprehensive vascular management and the enrolment of the eligible neonates will be done. The patients will be divided into two groups, Group A which will be receiving primary repair and Group B which will be receiving staged repair. The first management will be Resuscitation, temperature control, fluid replacement, nasogastric decomposition, antibiotics, and bowel protection. A comparison of postoperative outcomes including sepsis, wound infection, ventilatory support, feeding recovery, hospital stay, reoperation, and mortality will be compared.

Results: The postoperative complications, ventilatory support need, sepsis, feeding tolerance, length of stay and mortality, in both groups will be compared to evaluate the outcomes.

Conclusion: This study will be used to make a choice between the more effective and safer surgical procedure to be used in neonatal abdominal wall defects. The outcomes are that primary repair is more effective in the stable neonates, but that the staged repair is necessary in the complicated cases. Neonatal intensive care support, early diagnosis, good resuscitation, proper planning of surgical procedures and neonatal intensive care can help in improving survival, reduce complications, and improve postoperative recovery in the affected neonates.