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Martou L, Saxena AK. Morbidity in giant omphaloceles: Predictive factors and management strategies. Acta Paediatr 2024. [PMID: 39115971 DOI: 10.1111/apa.17387] [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: 07/11/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
AIM To identify predictors of morbidity in GO through an analysis of associated anomalies, defect characteristics and management strategies. METHODS PubMed and Ovid EMBASE databases were searched from 2013 to 2023. Primary end points assessed correlation of morbidity with gestational age (GA), birth weight (BW), eviscerated organs, defect size, associated anomalies and management strategy. RESULTS Twenty articles were included for analysis with a total of 1009 GO. Median GA was 37 weeks (27-41), with a median BW of 2700 g (900-6000). 143 cardiovascular anomalies, 238 pulmonary anomalies, 98 musculoskeletal anomalies, 53 urogenital anomalies, 94 gastrointestinal anomalies, 11 neurological anomalies and 43 chromosomal anomalies were identified. 82 had unspecified additional anomalies, of which 20 and 17 were defined as major and minor, respectively. 123 neonates were managed with primary closure, 206 neonates with staged closure and 312 neonates with conservative treatment. Complications included sepsis, respiratory compromise, feeding dysfunction and closure-related adverse events. Long-term morbidity included home ventilation (n = 72), long-term parental nutrition (n = 36), and delayed motor neurodevelopment (n = 21). Main predictors of morbidity were pulmonary hypertension/hypoplasia, major congenital anomalies, greater defect size and liver herniation. CONCLUSION Key predictors of poor outcomes include the presence of additional congenital anomalies, defect size, liver herniation and pulmonary hypertension/hypoplasia.
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Affiliation(s)
- Laura Martou
- Department of Paediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation trust, Imperial College London, London, UK
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation trust, Imperial College London, London, UK
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Ghattaura H, Ross A, Aldeiri B, Mutanen A, Saxena A. Managing giant omphalocele: A systematic review of surgical techniques and outcomes. Acta Paediatr 2024. [PMID: 38992931 DOI: 10.1111/apa.17346] [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: 03/27/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIM We analysed closure techniques in the treatment of giant omphalocele. A challenging pathology where there lacks consensus. METHODS Cochrane, MEDLINE and EMBASE were searched between 1 January 1992 and 31 December 2022 using terms and variations: omphalocele, exomphalos, giant, closure and outcome. Papers were selected using Preferred Reporting Items for Systematic review and Meta-Analyses 2020 criteria. Data collected included demographics, timing and technique of surgical repair, morbidity and mortality. RESULTS We identified 342 papers; 34 met inclusion criteria with a total 356 neonates. Initial non-operative management was described in 26 papers (14 dressings, eight silo, four serial sac-ligation). Operative techniques by paper were as follows: Early closure: nine primary suture closure without patch, two primary closure with patch and four mixed methods. Delayed closure: five simple, four-component separation technique, four tissue expanders, one Botox/pneumoperitoneum and two with patch. Median number of procedures was two (1-6) in the early group versus three (1-4) in the delayed. The most favourable was early primary closure with biological patch. The most unfavourable was delayed closure with patch. Cumulative reported mortality remained high, mostly due to non-surgical causes. CONCLUSION Definitions of giant omphalocele in the literature were heterogeneous with a variety of management approaches described.
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Affiliation(s)
- Harmit Ghattaura
- Department of Paediatric General Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andrew Ross
- Department of Paediatric General Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Bashar Aldeiri
- Department of Paediatric General Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Annika Mutanen
- Department of Paediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Amulya Saxena
- Department of Paediatric General Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
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Rombaldi MC, Barreto CG, Feldens L, Holanda F, Takamatu EE, Schopf L, Peterson CAH, Costa EC, Cavazzola LT, Isolan P, Fraga JC. Giant omphalocele: A novel approach for primary repair in the neonatal period using botulinum toxin. Rev Col Bras Cir 2023; 50:e20233582. [PMID: 37991062 PMCID: PMC10644868 DOI: 10.1590/0100-6991e-20233582-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. METHODS patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. RESULTS while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. CONCLUSION this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.
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Affiliation(s)
- Marcelo Costamilan Rombaldi
- - Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas - Porto Alegre - RS - Brasil
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Caroline Gargioni Barreto
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Letícia Feldens
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Felipe Holanda
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Eliziane Emy Takamatu
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Luciano Schopf
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | | | - Eduardo Corrêa Costa
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
| | - Leandro Totti Cavazzola
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Geral - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - Paola Isolan
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
| | - José Carlos Fraga
- - Hospital de Clínicas de Porto Alegre, Departamento de Cirurgia Pediátrica - Porto Alegre - RS - Brasil
- - Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia - Porto Alegre - RS - Brasil
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Menchaca AD, Style CC, Chawla M, Kenney BD, Diefenbach KA, Olutoye OO. Giant Omphaloceles-Morbidity, Mortality, and Financial Impact of Early Versus Delayed Repair. J Surg Res 2023; 291:342-351. [PMID: 37506434 DOI: 10.1016/j.jss.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION We compared strategy outcomes and financial impact over the first two years of life (F2YOL) for patients with giant omphaloceles undergoing early repair (ER) (primary or staged) versus delayed repair (DR). METHODS A retrospective review of giant omphaloceles (fascial defect > 5 cm/> 50% liver herniation) at a tertiary children's hospital between 1/1/2010 and 12/31/2019 was performed. Survival, length of stay, age at repair, ventilation days (VD), time to full enteral feeds, readmissions during the F2YOL, incidence of major associated anomalies, and total hospitalization charges during the F2YOL were compared. A subanalysis removing potential confounders and only including patients who underwent fascial closure within the F2YOL was also conducted. RESULTS Thirty four giant omphaloceles (23DR and 11ER) were identified. The median age (days) at repair was 289 [148, 399] DR versus 10 [5, 21] ER, P < 0.001. Total cohort two-year survival was significantly higher in the DR group (95.7% versus 63.6%, P = 0.03). Including patients with a tracheostomy there was no significant difference in VD during the index hospitalization. Excluding tracheostomy patients, the DR group had significantly fewer VD during the index hospitalization, 15 [0, 15] versus 18 [10, 54], P = 0.02 and over the F2YOL 6.5 [ 0, 21] versus 18 [14, 43], P = 0.03. There were no significant differences in the incidence/type of major associated anomalies, time to full enteral feeds, index length of stay, total hospital days, total admissions, or associated hospital charges. On subanalysis, there was no significant difference in VD or survival at any time. CONCLUSIONS Delayed and early repair strategies for giant omphaloceles have equivalent outcomes in the index hospitalization and over the course of the first two years of life. These findings are useful for family counseling and expectation setting.
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Affiliation(s)
- Alicia D Menchaca
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of General Surgery, Indiana University, Indianapolis, Indiana
| | - Candace C Style
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Mehak Chawla
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Brian D Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Oluyinka O Olutoye
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
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Menchaca AD, Style CC, Chawla M, Diefenbach KA, Kenney BD, Olutoye OO. A Review of Covered Abdominal Wall Defects: Cord Hernias Are Associated With Major Anomalies. J Surg Res 2023; 284:230-236. [PMID: 36587483 DOI: 10.1016/j.jss.2022.11.068] [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: 08/08/2022] [Revised: 11/04/2022] [Accepted: 11/25/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Covered abdominal wall defects (CAWD) can be categorized into giant omphaloceles (GOs), nongiant omphaloceles (NGOs), and umbilical cord hernias (UCHs). We sought to evaluate differences in management and outcomes of the different CAWD, treated at a large tertiary children's hospital, with regards to survival and association with other major congenital anomalies. METHODS A retrospective review of CAWD patients between January 2010 and January 2021 was conducted. GO was defined as a fascial defect >5 cm or >50% liver herniation. UCH were defined as fascial defects ≤ 2 cm. All others were classified as NGO. Type of repair, time to fascial closure, index hospitalization length of stay (LOS), and survival rates were compared. Four major anomaly categories were identified: cardiac, midline, Beckwith-Weidemann Syndrome, and other genetic anomalies. RESULTS We identified 105 CAWD patients (UCH n = 40; GO n = 34; and NGO n = 31). Ninety percent of UCH underwent primary repair, 10% were never repaired. NGOs were repaired by primary or staged methods in 92.9% of cases and 7.1% by delayed repair. Primary or staged repair occurred in 32.4% of GOs and delayed repair occurred in 67.6%. The median days to repair was 181 [24,427] GO, 1 [1,3] NGO, and 1 [0,1] UCHs (P < 0.01). Index hospitalization median LOS (days) was 90 [55,157] GO, 23 [10,48] NGO, 9 [5,22] UCH, (P < 0.01). There were no statistical differences in survival rates, number of patients with major anomalies (GO 35.4%, NGO 51.5%, UCH 50%), or types of anomalies. CONCLUSIONS UCHs and omphaloceles have similar incidences of major associated anomalies. Thus, all patients with a covered abdominal wall defect should undergo workup for associated anomalies.
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Affiliation(s)
- Alicia D Menchaca
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of General Surgery, Indiana University, Indianapolis, Indiana
| | - Candace C Style
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Mehak Chawla
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Brian D Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Oluyinka O Olutoye
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
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Nissen M, Romanova A, Weigl E, Petrikowski L, Alrefai M, Hubertus J. Vacuum-assisted staged omphalocele reduction: A preliminary report. Front Pediatr 2022; 10:1053568. [PMID: 36507134 PMCID: PMC9730811 DOI: 10.3389/fped.2022.1053568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Omphalocele represents a rare congenital abdominal wall defect. In giant omphalocele, due to the viscero-abdominal disproportion, gradual reintegration of eviscerated organs is often associated with medical challenges. We report our preliminary experience combining staged gravitational reduction with vacuum (VAC) therapy as a novel approach for treatment of giant omphalocele. PATIENTS AND METHODS Retrospective chart review of six patients (five females) born between September 2018 and May 2022 who underwent staged reduction of giant omphalocele in conjunction with VAC therapy was conducted. Treatment was performed at two German third-level Pediatric Surgery Departments. Biometric and periprocedural data were assessed. Main outcome measure was the feasibility of VAC therapy for giant omphalocele. Data are reported as median and interquartile range (Q1-Q3). RESULTS Gestational age was 37 (37-38) weeks, and birth weight was 2700 (2500-3000) g. VAC dressing was changed every 3 (3-4) days until abdominal fascia closure at the age of 9 (3-13) days. Time to first/full oral feeds was 3 (1-5)/20 (12-24) days with a hospital stay of 22 (17-30) days. Follow-up was 8 (5-22) months and complications were of minor extent (none: n = 2; Clavien-Dindo I: n = 3; Clavien-Dindo II: n = 1), comprising a delayed neo-umbilical cord rest separation (n = 2) and/or concomitant neo-umbilical site infection (n = 2) with no repeat surgery. CONCLUSION In neonates with giant omphalocele, VAC constitutes a promising and technically feasible enhancement of the staged gravitational reduction method. This study shows evidence that VAC may accelerate restoration of the abdominal wall integrity in giant omphalocele, thus minimizing associated comorbidities inherent to a prolonged hospitalization.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Anna Romanova
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Elena Weigl
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Laura Petrikowski
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
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Lelj-Garolla B, Campbell L, Kanungo J, Yoshida N. Use of a neoprene binding to reduce giant omphaloceles followed by delayed closure. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000284. [DOI: 10.1136/wjps-2021-000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
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