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Tatekawa Y, Tsuzuki Y, Oshiro K, Fukuzato Y. Surgical technique for epigastric incisional hernia after omphalocele repair: bilateral modified composite flaps using the upper rectus abdominis muscle and the vertically inverted flap of the lower rectus abdominis fascia. J Surg Case Rep 2024; 2024:rjae259. [PMID: 38666103 PMCID: PMC11045252 DOI: 10.1093/jscr/rjae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision. The composite flaps from each side were reversed in the midline to bring them closer and then sutured; the abdominal wall and skin were then closed. Five months after surgery, the patient had no recurrent incisional hernia and no wound complications.
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Affiliation(s)
- Yukihiro Tatekawa
- Department of Pediatric Surgery, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa 901-1193, Japan
| | - Yukihiro Tsuzuki
- Department of Pediatric Surgery, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa 901-1193, Japan
| | - Kiyotetsu Oshiro
- Department of Pediatric Surgery, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa 901-1193, Japan
| | - Yoshimitsu Fukuzato
- Department of Pediatric Surgery, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa 901-1193, Japan
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Tauriainen A, Harju S, Raitio A, Hyvärinen A, Tauriainen T, Helenius I, Vanamo K, Saari A, Sankilampi U. Longitudinal growth of children born with gastroschisis or omphalocele. Eur J Pediatr 2023; 182:5615-5623. [PMID: 37819418 PMCID: PMC10746581 DOI: 10.1007/s00431-023-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0-24 months, n = 909), and body mass index measures (2-15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were - 1.2 (0.2) and - 1.3 (0.2) and length Z-scores - 0.7 (0.2) and - 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers' weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years. CONCLUSION Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health. WHAT IS KNOWN • Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood. WHAT IS NEW • The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.
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Affiliation(s)
- Asta Tauriainen
- Department of Pediatric Surgery, University of Eastern Finland and Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
- Department of Pediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland.
| | - Samuli Harju
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Arimatias Raitio
- Department of Pediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, University of Tampere and Tampere University Hospital, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Pediatric Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Cardiac Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka Helenius
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Vanamo
- Department of Pediatric Surgery, University of Eastern Finland and Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Antti Saari
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Matsukubo M, Muto M, Yamada K, Nishida N, Kedoin C, Matsui M, Nagano A, Murakami M, Sugita K, Yano K, Onishi S, Harumatsu T, Yamada W, Kawano T, Kaji T, Ieiri S. Abdominal wall defect repair with component separation technique for giant omphalocele with previous relaxing incisions on the abdominal skin. Surg Case Rep 2023; 9:99. [PMID: 37284984 DOI: 10.1186/s40792-023-01679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The repair of large abdominal wall defects that cannot be closed primarily is quite challenging. The component separation technique (CST) is a surgical approach using autologous tissue to close large abdominal wall defects. The CST requires extensive dissection between the abdominal skin and the anterior sheath of the rectus abdominis muscle. Subsequently, incisions are made at both sides of the external oblique aponeurosis, releasing the external oblique muscle from the internal oblique muscle, and then the right and left rectus abdominis muscles are brought together in the midline for defect closure. However, impairment of blood flow in the abdominal wall skin and necrotic changes are recognized as potential complications. CASE PRESENTATION The CST was performed in a 4-year-old boy with a large ventral hernia who had undergone skin closure with abdominal wall relaxing incisions for the primary treatment of giant omphalocele in the neonatal period. Given his history of incisions on the abdominal wall, he was speculated to be at high risk for postoperative skin ischemia. Dissection was therefore kept to a minimum to preserve the blood supply from the superior and inferior epigastric arteries and perforating branches of those arteries through the rectus abdominis muscle. In addition, care was taken to adjust the muscle relaxant dosage while monitoring the intravesical pressure, ensuring that it did not exceed 20 mmHg to avoid impaired circulation in the abdominal wall caused by abdominal compartment syndrome. He was discharged 23 days after the surgery without any complications, and neither recurrence of the ventral hernia nor bowel obstruction was observed in 4 years. CONCLUSIONS A giant omphalocele with primary skin closure was treated by applying the CST. The procedure can be performed safely while preserving the blood flow to the abdominal wall, even in patients with a history of relaxing incisions on the abdominal skin. The CST is expected to be effective for repairing the large abdominal wall defects seen in giant omphalocele when primary closure is not possible.
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Affiliation(s)
- Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan.
| | - Koji Yamada
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
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Kerkeni Y, Thamri F, Houidi S, Zouaoui A, Jouini R. Secondary closure of large omphalocele using component separation technique: A pediatric case report. Int J Surg Case Rep 2022. [PMCID: PMC9184860 DOI: 10.1016/j.ijscr.2022.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Component separation technique is utilized in adults to repair large abdominal wall defects but rarely used in children. We report a successfully performed component separation technique in a child after neonatal Gross closure for large omphalocele without biologic mesh placement. Case presentation A 6-year-old girl was treated at the age of 4 days for omphalocele type 2 according to Gross technique. She reconsulted six years later. Clinical examination showed a large eventration measuring 150 ∗ 100 mm. CT scan revealed a broad collar of 150 mm and a large pocket containing liver, transverse colon, stomach and part of the small intestine. The child was proposed for a cure of the eventration using synthetic mesh type GORTEX. Intraoperatively, releasing bowel adhesions with abdominal wall resulted in perforation of the small intestine. Faced with the inability to use the mesh we resorted to abdominal closure with component separation technique. The postoperative was simple without complications or recurrence of the eventration. Follow up was of 4 years. Clinical discussion Staged surgical closure and non-operative delayed closure are the two distinct strategies for managing giant omphaloceles. By providing closure with less intra-abdominal pressure, the Component separation technique is a procedure which can be used in the two strategies. It may minimize the complications associated with large omphalocele management. Conclusion Faced with the impossibility of using a mesh, the component separation technique must be recognized as part of the therapeutic arsenal for secondary closure in children with a giant omphalocele. We report a case of a secondary closure of large omphalocele using component separation technique in 12 years-old girl. Our pediatric patient illustrates the safety and feasibility of this technique in children without any complication. Component separation technique must be recognized in the therapeutic arsenal closure of large abdominal wall defect in children
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Giant inguinal hernia in a preterm child - Technical challenges and long-term outcome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Roorda D, Königs M, Eeftinck Schattenkerk L, van der Steeg L, van Heurn E, Oosterlaan J. Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:635-642. [PMID: 34112720 PMCID: PMC8543204 DOI: 10.1136/archdischild-2021-322158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022]
Abstract
AIM Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. METHOD PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. RESULTS The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. INTERPRETATION This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.
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Affiliation(s)
- Daniëlle Roorda
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens Eeftinck Schattenkerk
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Lideke van der Steeg
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ernest van Heurn
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Boglione M, Aleman S, Reusmann A, Rubio M, Marcelo B. Giant omphalocele: Delayed closure using the San Martin technique following epithelialization of the membrane. J Pediatr Surg 2021; 56:1247-1251. [PMID: 33487462 DOI: 10.1016/j.jpedsurg.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
AIM The management of patients with congenital anterior abdominal wall defects remains challenging, particularly in cases of giant omphalocele. In 1948, San Martín described a surgical technique for the repair of large midline incisional hernias in adults without the need for a mesh. The purpose of this report is to describe our experience with this technique for the delayed closure of giant omphaloceles. METHODS We retrospectively reviewed the outcomes of all patients with giant omphalocele managed with the San Martin technique between September 2013 and March 2019. Data collected included birth weight, gestational age, associated malformations, neonatal hospital stay, age at the time of the abdominal wall closure, days on mechanical ventilation (MV) after the closure, time to initiation of enteral feedings, intra- and postoperative complications, and postoperative hospital stay. RESULTS A total of 8 patients were included in the study. The median birth weight was 3.190 (2.150 to 3.400) grams. The median gestational age was 35 (32 to 38) weeks. The median age at surgery was 6 (5 to 13) years. The median postoperative days on MV was 3 (3 to 11) days. Enteral feeding were initiated postoperatively at a median of 4 (2 to 4) days. There was one intraoperative complication (minor vascular injury). There were no short-term or long-term complications directly related to the surgical technique. The median postoperative hospital stay was 10 (6 to 16) days. The follow-up was 18 months to 8 years. CONCLUSION We believe that the San Martín technique is a valid alternative for the delayed closure of giant omphaloceles. LEVEL OF EVIDENCE According to the Journal of Pediatric Surgery this research corresponds to type of study level IV for case series with no comparison group.
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Affiliation(s)
- Mariano Boglione
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina.
| | - Santiago Aleman
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina
| | - Aixa Reusmann
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina
| | - Martín Rubio
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina
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Hijkoop A, Rietman AB, Wijnen RMH, Tibboel D, Cohen-Overbeek TE, van Rosmalen J, IJsselstijn H. Omphalocele at school age: What do parents report? A call for long-term follow-up of complex omphalocele patients. Early Hum Dev 2019; 137:104830. [PMID: 31374454 DOI: 10.1016/j.earlhumdev.2019.104830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many children with omphalocele experience morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children treated for minor or giant omphalocele. STUDY DESIGN We sent paper questionnaires to the parents of all children treated for omphalocele in 2000-2012. Giant omphalocele was defined as defect diameter ≥ 5 cm with liver protruding. Motor function (MABC-2 Checklist) was compared with Dutch reference data; cognition (PedsPCF), health status (PedsQL), quality of life (DUX-25) and behavior (Strengths and Difficulties Questionnaire; SDQ) were compared with those of controls (two per child) matched for age, gender and maternal education level. Possible predictors of cognition and behavior were evaluated using linear regression analyses. RESULTS Of 54 eligible participants, 31 (57%) returned the questionnaires. MABC-2 Checklist scores were normal for 21/26 (81%) children. Cognition, health status, quality of life and behavior were similar to scores of matched controls. One quarter (26%) of children with omphalocele scored ≤ - 1 standard deviation on the PedsPCF, compared with 9% of matched controls (p = 0.07). Giant omphalocele and presence of multiple congenital anomalies (MCA) were most prominently associated with lower PedsPCF scores (giant omphalocele: β -22.11 (95% CI: -43.65 to -0.57); MCA -23.58 (-40.02 to -7.13)), although not significantly after correction for multiple testing. CONCLUSIONS Parent-reported outcomes of children with omphalocele at school age are reassuring. Children with an isolated, minor omphalocele do not need extensive long-term follow-up of daily functioning. Those with a giant omphalocele or MCA might be at risk for delayed cognitive functioning at school age; we recommend long-term follow-up to offer timely intervention.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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9
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Abstract
After a diagnosis of omphalocele during pregnancy, questions regarding long-term prognosis are of primary importance for parents. It is imperative that their questions are answered with substantiated data to promote confident decisions for their children. They frequently express concerns regarding long-term survival, quality of life, need for more operations, feeding issues, motor and cognitive development, cosmesis, and the unique difficulties of giant omphaloceles. The available outcome studies that address these questions are discussed.
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Affiliation(s)
- Joanne E Baerg
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, 11175 Campus St., Rm 21111, Loma Linda, CA 92354, United States.
| | - Amanda N Munoz
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, 11175 Campus St., Rm 21111, Loma Linda, CA 92354, United States
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10
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Hijkoop A, Peters NCJ, Lechner RL, van Bever Y, van Gils-Frijters APJM, Tibboel D, Wijnen RMH, Cohen-Overbeek TE, IJsselstijn H. Omphalocele: from diagnosis to growth and development at 2 years of age. Arch Dis Child Fetal Neonatal Ed 2019; 104:F18-F23. [PMID: 29563149 DOI: 10.1136/archdischild-2017-314700] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the prenatal frame of reference of omphalocele (ie, survival of fetuses) with that after birth (ie, survival of liveborn neonates), and to assess physical growth and neurodevelopment in children with minor or giant omphalocele up to 2 years of age. DESIGN We included fetuses and neonates diagnosed in 2000-2012. Physical growth (SD scores, SDS) and mental and motor development at 12 and 24 months were analysed using general linear models, and outcomes were compared with reference norms. Giant omphalocele was defined as defect ≥5 cm, with liver protruding. RESULTS We included 145 fetuses and neonates. Of 126 (87%) who were diagnosed prenatally, 50 (40%) were liveborn and 35 (28%) survived at least 2 years. Nineteen (13%) neonates were diagnosed after birth. Of the 69 liveborn neonates, 52 (75%) survived and 42 children (81% of survivors) were followed longitudinally. At 24 months, mean (95% CI) height and weight SDS were significantly below 0 in both minor (height: -0.57 (-1.05 to -0.09); weight: -0.86 (-1.35 to -0.37)) and giant omphalocele (height: -1.32 (-2.10 to -0.54); weight: -1.58 (-2.37 to -0.79)). Mental development was comparable with reference norms in both groups. Motor function delay was found significantly more often in children with giant omphalocele (82%) than in those with minor omphalocele (21%, P=0.002). CONCLUSIONS The prenatal and postnatal frames of reference of omphalocele differ considerably; a multidisciplinary approach in parental counselling is recommended. As many children with giant omphalocele had delayed motor development, we recommend close monitoring of these children and early referral to physical therapy.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rosan L Lechner
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yolande van Bever
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dick Tibboel
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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11
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LDT classification and therapeutic strategy of congenital body wall defects. J Plast Reconstr Aesthet Surg 2017; 71:384-393. [PMID: 29029959 DOI: 10.1016/j.bjps.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/09/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repairing body wall defects is a critical step in the treatment of some congenital deformities, and this procedure may need the help from plastic surgeons. Although there are many articles about congenital deformities, body wall defects of these malformations are rarely studied as independent targets. METHODS In this article, the authors present an LDT classification for congenital body wall defects according to the position of the defects, the tissue layers involved, and the surgical urgency, each of which is represented by letters L, D, and T, respectively. That is, the defects in different areas (L), full-thickness (D1), or partial (D0A, D0B) defects, defects needing instant repair (T2), semi-elective repair (T1), or elective repair (T0). Based on this classification system, the authors have performed body wall reconstruction on two pairs of thoraco-omphalopagus twins, one pair of ischiopagus tetrapus twins, and an infant and an adult, both of whom were diagnosed with pentalogy of Cantrell associated with ectopia cordis. RESULTS Except for one pair of thoraco-omphalopagus twins who died after emergency separation, all the other patients survived. Another pair of thoraco-omphalopagus twins suffered from wound dehiscence and partial flap necrosis, respectively, after surgery. An expanded polytetrafluoroethylene mesh in one sister of the ischiopagus twins was removed because of infection. CONCLUSIONS LDT classification not only can help doctors categorise different congenital body wall defects rapidly and easily, but can also guide the reconstruction of these defects. It may have clinical value to plastic surgeons to some extent.
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IJsselstijn H, Gischler SJ, Wijnen RMH, Tibboel D. Assessment and significance of long-term outcomes in pediatric surgery. Semin Pediatr Surg 2017; 26:281-285. [PMID: 29110823 DOI: 10.1053/j.sempedsurg.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment modalities for newborns with anatomical congenital anomalies have greatly improved over the past decades, with a concomitant increase in survival. This review will briefly discuss specific long-term outcomes to illustrate, which domains deserve to be considered in long-term follow-up of patients with anatomical congenital anomalies. Apart from having disease-specific morbidities these children are at risk for impaired neurodevelopmental problems and school failure, which may affect participation in society in later life. There is every reason to offer them long-term multidisciplinary follow-up programs. We further provide an overview of the methodology of long-term follow-up, its significance and discuss ways to improve care for newborns with anatomical congenital anomalies from childhood into adulthood. Future initiatives should focus on transition of care, risk stratification, and multicenter collaboration.
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Affiliation(s)
- Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands.
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
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Tatekawa Y, Komuro A, Okamura A. Staged abdominal closure with intramuscular tissue expanders and modified components separation technique of a giant incisional hernia after repair of a ruptured omphalocele. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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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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Stolwijk LJ, Lemmers PM, Harmsen M, Groenendaal F, de Vries LS, van der Zee DC, Benders MJN, van Herwaarden-Lindeboom MYA. Neurodevelopmental Outcomes After Neonatal Surgery for Major Noncardiac Anomalies. Pediatrics 2016; 137:e20151728. [PMID: 26759411 DOI: 10.1542/peds.2015-1728] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Increasing concerns have been raised about the incidence of neurodevelopmental delay in children with noncardiac congenital anomalies (NCCA) requiring neonatal surgery. OBJECTIVE This study aimed to determine the incidence and potential risk factors for developmental delay after neonatal surgery for major NCCA. DATA SOURCES A systematic search in PubMed, Embase and the Cochrane Library was performed through March 2015. STUDY SELECTION Original research articles on standardized cognitive or motor skills tests. DATA EXTRACTION Data on neurodevelopmental outcome, the Bayley Scales of Infant Development, and risk factors for delay were extracted. RESULTS In total, 23 eligible studies were included, reporting on 895 children. Meta-analysis was performed with data of 511 children, assessed by the Bayley Scales of Infant Development at 12 and 24 months of age. Delay in cognitive development was reported in a median of 23% (3%-56%). Meta-analysis showed a cognitive score of 0.5 SD below the population average (Mental Development Index 92 ± 13, mean ± SD; P < .001). Motor development was delayed in 25% (0%-77%). Meta-analysis showed a motor score of 0.6 SD below average (Psychomotor Development Index 91 ± 14; P < .001). Several of these studies report risk factors for psychomotor delay, including low birth weight, a higher number of congenital anomalies, duration of hospital admission, and repeated surgery. LIMITATIONS All data were retrieved from studies with small sample sizes and various congenital anomalies using different neurodevelopmental assessment tools. CONCLUSIONS Cognitive and motor developmental delay was found in 23% of patients with NCCA. Meta-analysis showed that the mean neurodevelopmental outcome scores were 0.5 SD below the normative score of the healthy population.
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Affiliation(s)
- Lisanne J Stolwijk
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
| | - Petra Ma Lemmers
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Marissa Harmsen
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Floris Groenendaal
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Linda S de Vries
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
| | - David C van der Zee
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Manon J N Benders
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
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Extended Component Separation for Repair of High Ventral Hernia in Pediatric Omphalocele. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e503. [PMID: 26495216 PMCID: PMC4596428 DOI: 10.1097/gox.0000000000000481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Abstract
Abdominal wall reconstruction ideally involves maintenance of domain by restoration of competent fascia and innervated muscle. Component separation allows closure of ventral hernias, but the technique is limited for high abdominal defects in the epigastric region. We describe an extended component separation that facilitated mobilization of the rectus abdominis muscle along its costal insertion to close an upper midline defect in a child with giant omphalocele, who had already undergone previous traditional component separation.
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Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014; 23:283-90. [PMID: 25459013 DOI: 10.1053/j.sempedsurg.2014.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.
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Affiliation(s)
- Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy.
| | - Paola Midrio
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy
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Ikoma N, Chen L, Andrassy RJ. Technical note: component separation technique with double-layered biologic mesh placement for neonate with large gastroschisis. J Plast Reconstr Aesthet Surg 2014; 67:e230-1. [PMID: 24838069 DOI: 10.1016/j.bjps.2014.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/28/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Naruhiko Ikoma
- Department of Surgery and Pediatric Surgery, University of Texas Health Science Center, Houston, Texas, USA.
| | - Leon Chen
- Department of Surgery and Pediatric Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Richard J Andrassy
- Department of Surgery and Pediatric Surgery, University of Texas Health Science Center, Houston, Texas, USA
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Component separation for complex congenital abdominal wall defects: not just for adults anymore. J Pediatr Surg 2013; 48:2525-9. [PMID: 24314197 DOI: 10.1016/j.jpedsurg.2013.05.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE Operative repair of large abdominal wall defects in infants and children can be challenging. Component separation technique (CST) is utilized in adults to repair large abdominal wall defects but rarely used in children. The purpose of this report is to describe our experience with the CST in pediatric patients including the first description of CST use in newborns. METHODS After IRB approval, we reviewed all patients who underwent CST between June 1, 2010 and December 31, 2012 at a large children's hospital. CST included dissection of abdominal wall subcutaneous tissue from the muscle and fascia and an incision of the external oblique aponeurosis one centimeter lateral to the rectus sheath. Biologic mesh onlay or underlay was used to reinforce this closure. Patients were followed for complications. RESULTS Nine children, two patients with gastroschisis and seven with omphalocele, were repaired with CST at median (range) 1.1 years (5 days-10.1 years) of age. CST was the first surgical intervention for five children. There were minor wound complications and no recurrences after a median (range) follow up of 16 months (3-34 months). CONCLUSION CST can be a very useful technique to repair large abdominal wall defects in children with a loss of abdominal domain.
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