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Goneidy A, Saxena AK. Choice of topical substances in the conservative management of Exomphalos - A systematic review. Acta Paediatr 2023; 112:2293-2299. [PMID: 37674328 DOI: 10.1111/apa.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
AIM Exomphalos is a congenital anomaly found in 1/4500 newborns. Choice of non-operative management of exomphalos major unamenable to primary repair is controversial. This study aims at reviewing conservative management modalities and compare outcomes and complications. METHODS A systematic review was performed according to PRISMA guidelines of all English publications in MEDLINE and EMBASE databases. Search words were exomphalos OR omphalocoele AND conservative OR non-operative AND management. Studies were scrutinised for patient demographics, co-morbidities, mode of treatment, time to full feeds, time to full epithelialisation, length of stay, complications and mortality. Studies not specifically describing mode of management and/or describing primary or staged surgical repairs were excluded. RESULTS Initial search resulted in 1243 studies. Forty-two studies were deemed suitable offering 822 patients for analysis after excluding duplicates and non-eligible studies. Management methods varied including painting with Alcohol, Mercurochrome, silver products, Povidone Iodine, honey and other materials. Mortality was mostly due to associated anomalies. There was mixed reporting of alcohol, silver, Povidone Iodine and mercury toxicity as well as infection during the course of treatment. CONCLUSION This report has recognised the variations in topical substances employed for conservative management with no clear consensus. Reports on safety of different methods remain unclear.
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Affiliation(s)
- Ayman Goneidy
- Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| | - Amulya K Saxena
- Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
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Malhotra R, Malhotra B, Ramteke H. Enhancing Omphalocele Care: Navigating Complications and Innovative Treatment Approaches. Cureus 2023; 15:e47638. [PMID: 38021990 PMCID: PMC10667945 DOI: 10.7759/cureus.47638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral abdominal wall can be diagnosed by their distinctive anatomical presentations. Among them, omphalocele, gastroschisis and umbilical cord hernias are the most frequently observed clinically detected abdominal wall anomalies. Omphalocele refers to the herniation of abdominal contents through a defect in the abdominal wall at the umbilicus with or without the presence of a sac. This article gives an insight into the embryology, risk factors, treatment, investigations and complications of omphalocele, a common congenital abdominal wall defect. There is minimal proof that environmental factors contribute to the development of omphalocele. However, there is a considerable amount of evidence which points to the importance of genetic or familial risk factors. Newborns and infants with prenatal diagnoses are the most frequently presenting patients with omphalocele to paediatric surgeons. This article describes the problems and the steps of management for handling each circumstance, as well as any further complications. Omphalocele and gastroschisis are frequently described together in many research papers. However, it's crucial to consider that they are two different conditions which vary in anatomy, pathology and associated conditions which account for the difference in their treatments and noticeably varied outcomes. Additionally, there is evidence that each has a different set of factors associated with risk for occurrence. There are no known etiologic causes that cause these abnormalities to develop. The size of the baby, the extent of the lesion, and any other disorders all affect how individuals with these congenital abdominal wall anomalies are treated.
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Affiliation(s)
- Ritika Malhotra
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
| | | | - Harshal Ramteke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
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Nakagawa Y, Uchida H, Hinoki A, Shirota C, Sumida W, Makita S, Amano H, Okamoto M, Takimoto A, Ogata S, Takada S, Kato D, Gohda Y. Combined negative pressure wound therapy with irrigation and dwell time and artificial dermis prevents infection and promotes granulation formation in a ruptured giant omphalocele: a case report. BMC Pediatr 2022; 22:680. [PMID: 36435753 PMCID: PMC9701383 DOI: 10.1186/s12887-022-03755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background Omphalocele is a congenital abdominal wall defect of the umbilical cord insertion site. A giant omphalocele, with a fascial defect > 5 cm in diameter and/or containing > 50% of the liver within the hernia sac, can be challenging for pediatric surgeons. Recently, negative pressure wound therapy has been reported as an effective management for giant omphaloceles; however, it is not recommended for an infected wound with necrotic tissue as it may exacerbate infection. We adopted negative pressure wound therapy with irrigation and dwell time (NPWTi-d) for a case of a ruptured giant omphalocele. Artificial membranes, followed by artificial dermis, were used to promote fibrous capsule formation, and then NPWTi-d was used to promote granulation while controlling infection. However, studies have not been conducted regarding NPWTi-d for ruptured giant omphaloceles; hence, we present our treatment experience with NPWTi-d for a giant omphalocele. Case presentation The patient was a boy born at 38 weeks and 3 days of gestation, weighing 1896 g. He was diagnosed with a ruptured giant omphalocele with a total liver and intestine defect hole of 10 cm × 10 cm. The patient underwent silo placement using an artificial mesh, followed by plicating the artificial mesh at 4 days of age. The herniated viscera were gradually reduced into the abdominal cavity; however, the defect size was still large. Hence, a collagen-based artificial dermis was patched on the defect hole. After creating a fresh and smooth granulated tissue, NPWTi-d was applied at 33 days of age to promote granulation and control infection. We used the 3 M™ V.A.C.® Ulta Therapy Unit with 3 M™ VeraFlo™ therapy. NPWTi-d was stopped at 60 days of age when the granulation tissue was well formed including at the artificial dermis site. The wound was managed with prostandin ointment and appropriate debridement, resulting in complete epithelialization at 5 months of age. Conclusions Artificial membranes followed by artificial dermis were used to promote a fibrous capsule and artificial dermis granulation, which protects against organ damage. NPWTi-d achieved better control of infection and promoted wound healing. NPWTi-d combined with artificial dermis can effectively treat ruptured giant omphaloceles.
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Affiliation(s)
- Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan.
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Yousuke Gohda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
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Incidence of surgical procedures for gastrointestinal complications after abdominal wall closure in patients with gastroschisis and omphalocele. Pediatr Surg Int 2021; 37:1531-1542. [PMID: 34435217 PMCID: PMC8520871 DOI: 10.1007/s00383-021-04977-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to define the extent of additional surgical procedures after abdominal wall closure (AWC) in patients with gastroschisis (GS) and omphalocele (OC) with special focus on gastrointestinal related operations. METHODS A retrospective chart review was performed including all operations in GS and OC patients in the first year after AWC (2010-2019). The risk for surgery was calculated using the one-year cumulative incidence (CI). RESULTS 33 GS patients (18 simple GS, 15 complex) and 24 OC patients (12 without (= OCL), 12 OC patients with liver protrusion (= OCL +)) were eligible for analysis. 43 secondary operations (23 in GS, 20 in OC patients) occurred after a median time of 84 days (16-824) in GS and 114.5 days (12-4368) in OC. Patients with complex versus simple GS had a significantly higher risk of undergoing a secondary operation (one-year CI 64.3% vs. 24.4%; p = 0.05). 86.5% of surgical procedures in complex GS and 36.3% in OCL + were related to gastrointestinal complications. Complex GS had a significantly higher risk for GI-related surgery than simple GS. Bowel obstruction was a risk factor for surgery in complex GS (one-year CI 35.7%). CONCLUSION Complex GS and OCL + patients had the highest risk of undergoing secondary operations, especially those with gastrointestinal complications.
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Kanamori Y, Tahara K, Kutsukake M, Yamada Y, Mori T, Kudo Y, Miyake K, Fujita T, Fujino A, Abiko Y, Fukui K, Wada Y, Ito Y. Giant omphalocele treated by staged operation and successive conservative therapy using artificial dermis (Terudermis®) for effective epithelization. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Modified sequential sac ligation and staged closure technique for the management of giant omphalocele. J Pediatr Surg 2021; 56:1576-1582. [PMID: 33386134 DOI: 10.1016/j.jpedsurg.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aimed to describe sac ligation and sequential closure for the management of giant omphalocele (GO) and analyze its outcomes. METHODS The medical records of 13 neonates with GO treated at a tertiary general hospital between July 2012 and April 2020 were reviewed. Sac ligation and progressive external compression were performed on most cases immediately after birth. Staged closure with or without a prosthetic patch was conducted after a period of sac suspension. RESULTS Sac ligation-traction-compression was performed on 12 cases, of which 10 underwent staged closure, one with delayed closure. One patient with coexistent esophageal atresia was deemed ineligible for surgery. Among those who had undergone staged closure, 9 survived; however, one neonate who complicated with bilateral diaphragmatic eventration and severe ventilator-associated pneumonia died from multiple-organ failure. Pentalogy of Cantrell was excluded. One patient in whom primary closure was performed after birth died aged 29 h. Pneumonia was the most common infection among patients (5/13), with three having ventilator-associated pneumonia. The median durations of mechanical ventilation and hospital stay were 22.2 days (range, 1-151) and 44.2 days (range, 2-152), respectively, and 25.6 days and 46.4 days, respectively, among patients with staged closure. Among five infants who required oxygen support for more than 28 days, four had pulmonary hypoplasia. CONCLUSIONS Aside from abdominal wall defects, other major comorbidities and pulmonary hypoplasia influence the prognosis of GO. Sac ligation and staged closure is a effective choice for GO. TYPE OF STUDY Retrospective Study Level of Evidence: Level IV.
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Kasanga TK, Bilond TM, Zeng FTA, Mujinga HMW, Mukakala AK, Kapessa ND, Musapudi ÉM, Mwamba FK, Katambwa PM, Nafatalewa DK, Badypwyla IT, Mukangala SI, Ngoie CN, Cabala VDPK, Banza MI, Musanzayi SM. [Conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: a case serie]. Pan Afr Med J 2021; 39:63. [PMID: 34422186 PMCID: PMC8363966 DOI: 10.11604/pamj.2021.39.63.23215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 11/11/2022] Open
Abstract
La fermeture chirurgicale primaire dans le traitement de l´omphalocèle géante est émaillée des complications. Le traitement conservateur est une option adaptée aux pays à faible revenu où la chirurgie te la réanimation néonatales sont pourvoyeuses d´une grande mortalité. Ceci est une étude prospective menée aux cliniques universitaires de Lubumbashi, incluant les patients reçus entre janvier et avril 2020 et qui ont bénéficié d´un traitement conservateur à l´éosine aqueuse disodique selon un protocole défini. Trois patientes ont été inclues dans notre série. L´âge moyen était de 24 heures (1 - 48), toutes nées à terme (38 - 39 SA), et par voie basse, sans aucun diagnostic anténatal posé. La moyenne du poids de naissance était de 2.800 grammes (2.400 - 3.000). Le diamètre moyen du sac était de 13,7 cm (11 - 15 cm), le sac contenant le foie dans tous les cas. Le délai moyen de nutrition entérale était de 4,3 jours (4 - 5 jours), celui de granulation était de 31,7 jours (30 - 33 jours) et celui d´épithélialisation était de 71,7 jours (60 - 90 jours). Aucun décès n´a été déploré. Ces résultats préliminaires encouragent l´utilisation de l´éosine aqueuse disodique dans le traitement conservateur des omphalocèles géantes non rompues.
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Affiliation(s)
- Trésor Kibangula Kasanga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Tshiband Mosh Bilond
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Florent Tshibwid A Zeng
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Hugor Mujinga Wa Mujinga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Augustin Kibonge Mukakala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Éric Mbuya Musapudi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - François Katshitsthi Mwamba
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Prince Muteba Katambwa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Dimitri Kanyanda Nafatalewa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Israël Tshiamala Badypwyla
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Stephanne Ilunga Mukangala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Christelle Ngoie Ngoie
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Vincent De Paul Kaoma Cabala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Manix Ilunga Banza
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Sébastien Mbuyi Musanzayi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
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Nolan HR, Wagner ML, Jenkins T, Lim FY. Outcomes in the giant omphalocele population: A single center comprehensive experience. J Pediatr Surg 2020; 55:1866-1871. [PMID: 32475506 DOI: 10.1016/j.jpedsurg.2020.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Morbidity and mortality in the giant omphalocele population is complicated by large abdominal wall defects, physiologic aberrancies, and congenital anomalies. We hypothesized different anomalies and treatment types would affect outcomes. METHODS A 2009-2018 retrospective chart review of giant omphaloceles was performed. Exclusions included cloacal exstrophy, transfer after 3 weeks, surgery prior to transfer, conjoined twins, or not yet achieving fascial closure. Thirty-five patients met criteria and mortality and operative morbidity categorized them into favorable (n = 20) or unfavorable (n = 15) outcomes. Odds ratios analyzed potential predictors. Survivors were stratified into staged (n = 11), delayed (n = 8), and primary closure (n = 6) for subgroup analysis. RESULTS Unfavorable outcomes were associated with other major congenital anomalies, sac rupture, and major cardiac anomalies, but had significantly lower odds with increasing gestational age (p = 0.03) and birth weight (p < 0.001). In survivors, the primary group was younger at repair (p < 0.001) and had shorter length of stay (hospital p = 0.02, neonatal intensive care unit p = 0.005). There was no significant difference for sepsis, ventilator days, return to the operating room, or ventral hernia. CONCLUSIONS Predictions of overall outcomes in the giant omphalocele population require analysis of multiple variables. Our findings demonstrated increased odds of unfavorable outcomes in major cardiac anomalies, pulmonary hypertension, genetic diagnosis, other major anomalies, polyhydramnios, postnatal sac rupture, increasing omphalocele sac diameter, lower O/E TLV, lower gestational age at birth, lower birth weight, and repair other than primary. In those surviving to repair, surgical outcomes analyses demonstrated an earlier age of repair and a shorter length of stay for those patients able to be closed primarily; however further research is necessary to determine overall superiority between operative treatment types. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Heather R Nolan
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA.
| | - Monica L Wagner
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
| | - Todd Jenkins
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
| | - Foong-Yen Lim
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
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Binet A, Scalabre A, Amar S, Alzahrani K, Boureau C, Bastard F, Lefebvre F, Koffi M, Moufidath S, Nasser D, Ouattara O, Kouame B, Lardy H. Operative versus conservative treatment for giant omphalocele: Study of French and Ivorian management. ANN CHIR PLAST ESTH 2020; 65:147-153. [DOI: 10.1016/j.anplas.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
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Zhang ZZ, Haddock C, Verchere C, Arneja JS, Skarsgard ED. Management of narrow stalked giant omphalocele using tissue expansion, staged closure, and amnion preservation technique. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Objective The aim of the study was to present the clinical outcomes of patients diagnosed with giant omphalocele, treated with early primary closure combined with bandaging and povidone-iodine staining and powder spray antibiotics. Materials and methods The study included a total of 22 infants with omphalocele. The omphalocele sacs of the patients were cleaned daily with topical povidone-iodine. A powdered spray antibiotic combination was then applied topically twice a day and the sac was wrapped in a sterile elastic bandage. Following the observation of eschar formation and epithelization, the patients were operated on in the early period and the sac was removed by placing a graft. Results Evaluation was made of a total of 14 female and eight male patients with mean duration of conservative monitoring of 11 days and mean total hospital stay of 35. The mean giant omphalocele (GO) defect size of the patients followed-up was 10 cm. Since seven of the patients in the present study died in the 1st week, conservative and elastic bandages were applied for the GO treatment of 15 patients for 9-14 days. After the conservative follow-up, it was determined that the patients who were applied with a graft at an average of 11 days were hospitalized for an average of 24 days postoperatively. Conclusion In conclusion, it is possible to reduce the length of hospital stay with primary closure in the early period by providing faster epithelialization with the combination of povidone-iodine and antibiotic powder together with elastic bandage application in infants with GO.
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Abstract
Management of the very large defect or those in patients with severe comorbidities has evolved to the use of methods that result in escharification and eventual skin coverage over the viscera. This treatment strategy employs principles that were described in the early 20th century. This review will describe the history, principles, methods, and outcomes from the so called 'paint and wait' management of omphalocele.
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Affiliation(s)
- Justin P Wagner
- Department of Pediatric Surgery, Children's Hospital and Medical Center of Omaha, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert A Cusick
- Department of Pediatric Surgery, Children's Hospital and Medical Center of Omaha, University of Nebraska Medical Center, Omaha, NE, USA.
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Ofri A, Schindler T, Dilley A, Pereira J, Adams S. Defining normal neonatal abdominal wall musculature with ultrasonography. J Pediatr Surg 2018; 53:1588-1591. [PMID: 29229479 DOI: 10.1016/j.jpedsurg.2017.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/03/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The development of new surgical approaches for the management of congenital abdominal wall defects may be facilitated by using an animal model. However, because the anatomy of the neonatal abdominal wall has not been described, a suitable model is yet to be identified. We aimed to evaluate and define the neonatal abdominal wall musculature using ultrasound, to be used as a reference to identify an appropriate animal model for the neonatal abdominal wall in the future. METHODS Infants with a postconceptual age of less than one month weighing between 2 and 3 kg were eligible. With ethical approval, ultrasonography of three abdominal wall locations bilaterally was performed. The depth of the skin to external oblique and the thickness of the three abdominal wall muscles, external oblique (EO), internal oblique (IO) and transversus abdominis (TA), were measured. RESULTS Ten males and seven females were recruited with median postconceptual age of 36 weeks (IQR 36-38), median postnatal age of 8 days (IQR 3-30) and median weight of 2.35kg (IQR 2.26-2.56). The mean depth of EO from skin was 2.06 mm (± 0.44). The mean thicknesses of the muscles were: EO 1.02 mm (± 0.33), IO 1.16 mm (± 0.39) and TA 1.02 mm (± 0.37). There was no statistical difference between the thickness of EO, IO or TA (p= 0.43). CONCLUSIONS It is possible to consistently identify and measure the components of the neonatal abdominal wall musculature with ultrasonography. We hope this can aid in developing an appropriate animal model, with the ultimate aim of facilitating innovation in surgical management of neonatal abdominal wall pathology. LEVELS OF EVIDENCE Study of Diagnostic test, Level IV.
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Affiliation(s)
- Adam Ofri
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia; Conjoint Lecturer, University of New South Wales, Randwick, New South Wales, Australia.
| | - Tim Schindler
- Department of Neonatal Intensive Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Anthony Dilley
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - John Pereira
- Department of Radiology, Sydney Children's Hospital, Randwick, New South Wales, Australia; Conjoint Lecturer, University of New South Wales, Randwick, New South Wales, Australia
| | - Susan Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Women's and Children's Health, Randwick, New South Wales, Australia
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Abstract
OBJECTIVE The purpose of this study was to describe outcomes and resource utilization in patients treated with twice-weekly silver impregnated (SI) nanocrystalline dressings for initial non-operative management of giant omphalocele (GO). METHODS A retrospective review of patients with GO treated with SI dressings was undertaken. Clinical parameters, cost, and complications were recorded. RESULTS Five patients with GO were treated with SI dressings between 2014 and 2016. Clinical characteristic (mean ± SD) included gestational age 36 ± 4 weeks, birth weight 2.6 ± 0.63 kg, GO size 10.2 ± 4.7 cm, ventilator days 7.5 ± 8.7 d, days in NICU 41 ± 20 d, days to full feeds, 30 ± 15 d, and LOS 62 ± 41 d. The average in-hospital cost of SI dressings was $110 CAD/week. This is comparable to daily silver sulfadiazine dressings ($109CAD/week) which were used historically. All patients were discharged with once- or twice-weekly dressing changes. No ruptures occurred. There was one mortality secondary to pulmonary sepsis. CONCLUSIONS For initial non-operative management of GO, twice weekly SI nanocrystalline dressings is safe and effective. Use of SI dressings results in decreased handling of infants, reduced physician and nursing resource utilization, and favourable outcomes. LEVEL OF EVIDENCE IV (Retrospective Case Series).
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The conservative treatment of giant omphalocele by tanning with povidone iodine and aqueous 2% eosin solutions. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000516080.62574.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bauman B, Stephens D, Gershone H, Bongiorno C, Osterholm E, Acton R, Hess D, Saltzman D, Segura B. Management of giant omphaloceles: A systematic review of methods of staged surgical vs. nonoperative delayed closure. J Pediatr Surg 2016; 51:1725-30. [PMID: 27570242 DOI: 10.1016/j.jpedsurg.2016.07.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/06/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Despite the numerous methods of closure for giant omphaloceles, uncertainty persists regarding the most effective option. Our purpose was to review the literature to clarify the current methods being used and to determine superiority of either staged surgical procedures or nonoperative delayed closure in order to recommend a standard of care for the management of the giant omphalocele. METHODS Our initial database search resulted in 378 articles. After de-duplification and review, we requested 32 articles relevant to our topic that partially met our inclusion criteria. We found that 14 articles met our criteria; these 14 studies were included in our analysis. 10 studies met the inclusion criteria for nonoperative delayed closure, and 4 studies met the inclusion criteria for staged surgical management. RESULTS Numerous methods for managing giant omphaloceles have been described. Many studies use topical therapy secondarily to failed surgical management. Primary nonoperative delayed management had a cumulative mortality of 21.8% vs. 23.4% in the staged surgical group. Time to initiation of full enteric feedings was lower in the nonoperative delayed group at 14.6days vs 23.5days. CONCLUSION Despite advances in medical and surgical therapies, giant omphaloceles are still associated with a high mortality rate and numerous morbidities. In our analysis, we found that nonoperative delayed management with silver therapy was associated with lower mortality and shorter duration to full enteric feeding. We recommend that nonoperative delayed management be utilized as the primary therapy for the newborn with a giant omphalocele.
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Affiliation(s)
- Brent Bauman
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Daniel Stephens
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Hannah Gershone
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Connie Bongiorno
- Health Science Libraries, University of Minnesota, Minneapolis, MN 55455, USA
| | - Erin Osterholm
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Robert Acton
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Donavon Hess
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Daniel Saltzman
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bradley Segura
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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Management of the Sequelae of Severe Congenital Abdominal Wall Defects. Arch Plast Surg 2016; 43:258-64. [PMID: 27218024 PMCID: PMC4876155 DOI: 10.5999/aps.2016.43.3.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/18/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
Background The survival rate of newborns with severe congenital abdominal wall defects has increased. After successfully addressing life-threatening complications, it is necessary to focus on the cosmetic and functional outcomes of the abdominal wall. Methods We performed a chart review of five cases treated in our institution. Results Five patients, ranging from seven to 18 years of age, underwent the following surgical approaches: simple approximation of the rectus abdominis fascia, the rectus abdominis sheath turnover flap, the placement of submuscular tissue expanders, mesh repair, or a combination of these techniques depending on the characteristics of each individual case. Conclusions Patients with severe congenital abdominal wall defects require individualized surgical treatment to address both the aesthetic and functional issues related to the sequelae of their defects.
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Oquendo M, Agrawal V, Reyna R, Patel HI, Emran MA, Almond PS. Silver-impregnated hydrofiber dressing followed by delayed surgical closure for management of infants born with giant omphaloceles. J Pediatr Surg 2015; 50:1668-72. [PMID: 26386876 DOI: 10.1016/j.jpedsurg.2015.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We successfully employed silver-impregnated hydrofiber dressing for management of giant omphaloceles (GO) followed by delayed surgical closure. STUDY DESIGN Between 2005 and 2008, eight consecutive GO infants were cared for at Driscoll Children's Hospital. Four patients had additional congenital anomalies including Beckwith-Wiedemann (n = 1), tetralogy of Fallot (n = 1), pulmonary hypoplasia (n = 1), and ruptured omphalocele (n=1). Infants underwent amnion epithelization using a silver-impregnated hydrofiber dressing over the course of several months followed by delayed surgical closure. Mean ± SD of parameters including maternal age, gestational age, infant weight, size of GO, preoperative intubation, preoperative hospitalization, time to epithelization, days to surgical closure, postoperative hospitalization, postoperative intubation and months of follow-up were studied. RESULTS Five patients underwent successful closure, 2 were lost to follow-up and 1 was lost because of withdrawal of support. The maternal age, gestation age and weight of infant were 28 ± 5.3 years, 34 ± 4 weeks and 2.5 ± 0.62 kg, respectively. The GO size was 11 cm in length and 11 cm in width, respectively. Preoperative hospitalization days were 78 ± 74 days. Preoperative intubation was 3.5 ± 3.1 days with 2 neonates requiring tracheostomy and home ventilation owing to additional congenital abnormalities. Time to epithelization was 2.9 ± 0.9 months. Days to surgical closure and postoperative hospitalization were 331 ± 119 days and 5 ± 3.4 days, respectively. Average follow-up was 37 ± 27 months. No treatment associated morbidities are noted. CONCLUSIONS Silver-impregnated hydrofiber mediated epithelization of GO followed by delayed surgical closure is safe for management of infants.
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Affiliation(s)
- Marcial Oquendo
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Vaidehi Agrawal
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Roxana Reyna
- Nursing Resources, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Haroon I Patel
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Mohammad A Emran
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - P Stephen Almond
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA.
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