There are many challenges faced by a surgeon in SSA. Patients are often outborn with no antenatal diagnosis, and hence presentation is delayed resulting in hypothermia, sepsis, hypovolaemia and bowel compromise. There is a natural tendency for babies with gastroschisis to be born early; in Harare 43% were preterm and 72% were <2.5kg. Similarly in Durban 64% were preterm and 72% <2.5kg. Many centres lack a neonatal intensive care unit (NICU) and have limited anaesthetic resources. Exposure of the bowel to amniotic fluid results in dysmotility and problems with absorption of nutrients; in the UK the average duration of parenteral (PN) requirement in simple gastroschisis is 23 days and 51 days in complex gastroschisis (gastroschisis associated with bowel perforation, necrosis or atresia). PN was only available in 36% of SSA centres when surveyed. However, in Harare the median hospital stay was 4.5days for the 85% who died, suggesting death was related to inadequate resuscitation and support rather than lack of PN. A multi-centre Gastroschisis International (GiT) study showed septicaemia to be the leading cause of death.