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A staged reconstruction technique utilizing bioprosthetic mesh reinforcement in the repair of giant omphalocele. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102307] [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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2
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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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Chen XY, Yang JX, Zhang HY, Xiong XF, Abdullahi KM, Wu XJ, Feng JX. Ex utero intrapartum treatment for giant congenital omphalocele. World J Pediatr 2018; 14:399-403. [PMID: 29508360 DOI: 10.1007/s12519-018-0129-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/07/2017] [Accepted: 08/20/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles. METHODS We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed. During the 6-12-month follow-ups, postoperative complications including bowel obstruction, abdominal infections, postoperative abdominal distension were monitored, and survival rate was analyzed. RESULTS A total of seven patients underwent the EXIT procedure and 11 patients underwent the traditional postnatal surgery. We found no differences in maternal age, gestational age at diagnosis, gestational age at delivery and birth weight between the two groups. In the EXIT group, the average operation time for mother was 68.3 ± 17.5 minutes and the average maternal blood loss was 233.0 ± 57.7 mL. The operation time in the EXIT group (22.0 ± 4.5 minutes) was shorter than that in the traditional group (35 ± 8.7 minutes), but the length of hospital stay in the EXIT group (20.5 ± 3.1 days) was longer than that in the traditional group (15.7 ± 2.5 days, P < 0.05). During the follow-up, one patient in the EXIT group had an intestinal obstruction, one developed abdominal compartment syndrome and one died in the traditional group. CONCLUSIONS In our experience, EXIT is a safe and effective procedure for the treatment of giant congenital omphaloceles. However, more experience is needed before this procedure can be widely recommended.
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Affiliation(s)
- Xu-Yong Chen
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Ji-Xin Yang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Hong-Yi Zhang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Xiao-Feng Xiong
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Khalid Mohamoud Abdullahi
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Xiao-Juan Wu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Jie-Xiong Feng
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China.
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4
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Abstract
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options. Nevertheless, short and long-term complications following neonatal surgery continue to have profound and sometimes lasting effects on individual patients, families, and society.
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Affiliation(s)
- Mauricio A Escobar
- Pediatric Surgery, Mary Bridge Children׳s Hospital, PO Box 5299, MS: 311-W3-SUR, 311 South, Tacoma, Washington 98415-0299.
| | - Michael G Caty
- Section of Pediatric Surgery, Department of Surgery, Yale-New Haven Children׳s Hospital, New Haven, Connecticut
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A case of traumatic rupture of a giant omphalocele and liver injury associated with transverse lie and preterm labor. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] 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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Case Report: Rapid staged abdominal closure using Gore-Tex® mesh as a bridge to primary omphalocele sac closure. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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The Use of Intra-abdominal Tissue Expansion for the Management of Giant Omphaloceles. Ann Plast Surg 2012; 69:104-8. [DOI: 10.1097/sap.0b013e31822128f5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Abstract
Abdominal wall defects (AWDs) are a common congenital surgical problem in fetuses and neonates. The incidence of these defects has steadily increased over the past few decades due to rising numbers of gastroschisis. Most of these anomalies are diagnosed prenatally and then managed at a center with available pediatric surgical, neonatology, and high-risk obstetric support. Omphaloceles and gastroschisis are distinct anomalies that have different management and outcomes. There have been a number of recent advances in the care of patients with AWDs, both in the fetus and the newborn, which will be discussed in this article.
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Mortellaro VE, St Peter SD, Fike FB, Islam S. Review of the evidence on the closure of abdominal wall defects. Pediatr Surg Int 2011; 27:391-7. [PMID: 21161242 DOI: 10.1007/s00383-010-2803-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
Infants with congenital abdominal wall defects pose an interesting and challenging management issue for surgeons. We attempt to review the literature to define the current treatment modalities and their application in practice. In gastroschisis, the overall strategies for repair include immediate closure or delayed operative repair. The best level of data for gastroschisis is grade C and appears to support that there is no major difference in survival between immediate closure or delayed repair. In patients with omphalocele, the management techniques are more varied consisting of immediate closure, staged closure or delayed closure after epithelialization. The literature is less clear on when to use one technique over the other, consisting of mostly grade D and E data. In patients with omphalocele, a registry to collect information on patients with larger defects may help determine which of the management strategies is optimal.
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Affiliation(s)
- Vincent E Mortellaro
- Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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12
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van Eijck FC, Aronson DA, Hoogeveen YL, Wijnen RMH. Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors. J Pediatr Surg 2011; 46:482-8. [PMID: 21376197 DOI: 10.1016/j.jpedsurg.2010.08.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 07/02/2010] [Accepted: 08/10/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Operative treatment of giant omphalocele (OC) is still a challenge for pediatric surgeons. We were interested to ascertain whether published operative techniques for giant OC once advocated by their authors were still being used by these authors and whether the techniques had been modified or even abandoned for other techniques. METHODS Relevant studies concerning the treatment of giant OC were identified by an electronic search. Publication date of the articles was from 1967 to 2009. A questionnaire was sent to the first author or coauthor, unless contact details were unavailable. The described surgical techniques were categorized into primary closure, staged closure, and delayed closure. RESULTS Almost half of the authors (42%), independent of the initial technique used (primary, staged, or delayed closure), changed or stopped using their technique after the publication of the article. The change was not to one particular proven better technique. Herniation rate was lower in delayed closure (9% delayed vs 18% staged vs 58% primary). CONCLUSIONS The results of the questionnaire did not show a generally accepted method of treatment after more than 30 years of innovations in managing patients with a giant OC. There are generally 2 main treatment modalities: staged closure and delayed closure. Because of the lack of large patient numbers and late follow-up, long-term results of the published techniques are needed, and randomized multicenter trials based on these outcomes are recommended. Until then, we remain dependent on expert opinions.
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Affiliation(s)
- Floortje C van Eijck
- Department of Surgery, Division of Paediatric Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Baird R, Gholoum S, Laberge JM, Puligandla P. Management of a giant omphalocele with an external skin closure system. J Pediatr Surg 2010; 45:E17-20. [PMID: 20638510 DOI: 10.1016/j.jpedsurg.2010.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 04/30/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE The management of neonates with giant omphalocele remains challenging and multiple strategies have been described. We present the case of a 34-week-old neonate with isolated giant omphalocele managed with an external surgical skin closure system as a component of a staged closure strategy. CASE PRESENTATION An Inuit boy of 34 weeks gestation was born by urgent Caesarean delivery at an affiliated obstetrical hospital with a giant ruptured omphalocele and loss of abdominal domain. He was transferred to our institution and a silastic silo was fashioned and placed in the operating room. He returned to the operating room several times and was treated by placement of a combined Gore-Tex (WL Gore and Associates, Flagstaff, Ariz)/silastic inlay mesh. An eschar formed over this temporary closure, and we elected to place a dynamic skin closure device to continue gradual bedside reduction. The initial abdominal wall defect was 8.5 cm in transverse diameter and was reduced to 4.5 cm over 3 weeks. Complete closure was subsequently achieved without the need for skin grafting. DISCUSSION The use of a dynamic reduction skin closure device has not been documented previously in the pediatric population or in the context of a congenital defect. We describe the use of an external surgical skin closure device in the context of the staged closure of a giant neonatal omphalocele and postulate that such a device may prove useful in the treatment of other congenital tissue defects.
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Affiliation(s)
- Robert Baird
- Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Kaya M, Baba F, Bolukbas F, Boleken ME, Kanmaz T, Yucesan S. Use of Homologous Acellular Dermal Matrix for Abdominal Wall Reconstruction in Rats. J INVEST SURG 2009; 19:11-7. [PMID: 16546925 DOI: 10.1080/08941930500444370] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homologous acellular dermal matrix graft (HADMG) has been used for the reconstructions of bowel, bladder, or urethra, but its suitability in the reconstruction of abdominal wall has not been tested. Therefore an experimental study was performed to evaluate the use of HADMG for the reconstruction of abdominal wall defects in weanling rats. Thirty weanling Wistar rats were used. A patch of abdominal wall 20 x 20 mm in dimension was removed. The defects were reconstructed with HADMGs that were derived from rat skin and prepared through a detergent enzymatic method. The reconstructed abdominal walls were evaluated as hernia rate and graft take ratio, excised and prepared for histological examination at 21 (n = 10), 40 (n = 10), and 90 (n = 10) days postoperation. The healing of repaired abdominal walls was uneventful. Histological evaluation demonstrated the migration of fibroblasts and neovascularization within the HADMG. Hernia in four rats were developed at 90 days. Neither significant wound contraction nor inflammation was seen at 21, 40, and 90 days after surgery in wounds receiving HADMGs. Thus, the use of a HADMG for reconstructing the abdominal wall in weanling rats has not given rise to any complications. HADMG has progressively remodeled into fibrous tissue. It appears to represent an important alternative substitute for the reconstruction of abdominal wall.
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Affiliation(s)
- Mete Kaya
- Department of Pediatric Surgery, Harran University, School of Medicine, Sanliurfa, Turkey.
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Campos BA, Tatsuo ES, Miranda ME. Omphalocele: how big does it have to be a giant one? J Pediatr Surg 2009; 44:1474-5; author reply 1475. [PMID: 19573683 DOI: 10.1016/j.jpedsurg.2009.02.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 02/27/2009] [Indexed: 11/18/2022]
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Martin AE, Khan A, Kim DS, Muratore CS, Luks FI. The use of intraabdominal tissue expanders as a primary strategy for closure of giant omphaloceles. J Pediatr Surg 2009; 44:178-82. [PMID: 19159740 DOI: 10.1016/j.jpedsurg.2008.10.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/07/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Giant omphaloceles present a unique challenge to pediatric surgeons because of the difficulty in obtaining timely, tension-free closure of tissues over the defect. Reports of the use of tissue expanders in the subcutaneous space, intramuscular space, or intraabdominal cavity have illustrated the usefulness of this technique to provide biologic closure of abdominal wall defects. However, these reports have focused on use of tissue expanders as a second-line treatment after other options, such as silastic silos or attempted primary closure, have failed. METHODS We report 2 cases in which intraabdominal tissue expanders were used as a primary strategy to obtain closure of giant omphalocele defects. CASE REPORTS The first patient was a baby boy born at 36 weeks by date who was prenatally diagnosed with a giant omphalocele. An intraabdominal tissue expander was placed at 2 weeks of age. The tissue expander was removed and his abdomen was primarily closed at 8 weeks of age. The second patient was born at 25 weeks gestation as part of a twin gestation with severe intrauterine growth retardation (600 g birth weight). Bedside reduction was not attempted because of severe pulmonary hypertension and significant loss of abdominal domain because of herniated liver and bowel. At 8 months of age, she underwent laparoscopically assisted placement of an intraabdominal tissue expander. At 9 months of age, the tissue expander was removed, all abdominal viscera were reduced, and the defect was closed using only an 8 x 8-cm piece of AlloDerm (LifeCell, Branchburg, NJ). Both children are currently at home and doing well. CONCLUSIONS We believe that early use of intraabdominal tissue expanders provides a more expedient method of obtaining closure of the defect in giant omphaloceles.
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Affiliation(s)
- Abigail E Martin
- Department of Surgery, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Charlesworth P, Ervine E, McCullagh M. Exomphalos major: the Northern Ireland experience. Pediatr Surg Int 2009; 25:77-81. [PMID: 19002694 DOI: 10.1007/s00383-008-2292-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE In exomphalos major (EM), closure of the defect in the abdominal wall presents a challenge. The aim of this study is to evaluate a single centre experience of EM. MATERIALS A 15-year retrospective case-note review; data presented as median (range). RESULTS Fourteen infants (7 female) were born with EM: birth weight 2.9 (1.2-3.8) kg, gestational age 38 (31-39) weeks. One infant died in utero and one within the first hour of life. Severe pulmonary hypoplasia was present in 7/13 (54%), and there was a mortality of 6/13 (46%) live births. Infants were treated non-operatively primarily. Two infants underwent early surgery: one infant, born with a ruptured sac, had a surgical silo constructed on day 1 and closure on day 8, while a second infant had partial closure (skin only) on day 11. Ten infants had application of silver sulphadiazine to the sac 2-3 times per week. Enteral feeds were established soon after birth. They were discharged from hospital to allow granulation. Ventral hernia closure was performed on a subsequent admission. CONCLUSIONS Exomphalos major can be successfully treated non-operatively, allowing immediate enteral feeding and early discharge while granulation takes place. In this series, exomphalos major has an incidence of 1 in 26,000, mortality is 46% and severe pulmonary hypoplasia is present in 54% of infants.
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Affiliation(s)
- P Charlesworth
- The Royal Alexandra Hospital for Sick Children, Brighton, UK.
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Marven S, Owen A. Contemporary postnatal surgical management strategies for congenital abdominal wall defects. Semin Pediatr Surg 2008; 17:222-35. [PMID: 19019291 DOI: 10.1053/j.sempedsurg.2008.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Early definitive closure of abdominal wall defects is possible in most cases. Staged reduction does offer distinct advantages, and mortality and morbidity may be better. Risk stratification may produce outcome and tailor management of difficult cases in the form of a clinical pathway. Stem cell technology may, in the future, offer the ideal allogenic prosthesis in complex cases.
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Affiliation(s)
- Sean Marven
- Sheffield Children's Hospital NHS Foundation Trust, Western Bank, United Kingdom.
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Mann S, Blinman TA, Douglas Wilson R. Prenatal and postnatal management of omphalocele. Prenat Diagn 2008; 28:626-32. [DOI: 10.1002/pd.2008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE OF REVIEW Abdominal wall defects comprising both gastroschisis and omphalocele remain a source of significant morbidity and mortality, despite the advances in neonatal and pediatric surgical care. Survival has improved over the past few decades, especially with parenteral nutrition and surgical repair. Yet, still, many questions remain regarding the outcome of these anomalies. RECENT FINDINGS Outcomes of abdominal wall defects have been discussed more often in the recent publications, with analysis of databases and evaluation of prenatal series. There have been a number of new prenatal interventions in gastroschisis, and a better understanding of gestational outcomes from omphalocele. Papers have discussed the optimal surgical management of these defects as well. SUMMARY This review helps to bring together the most recent findings regarding outcomes and interventions for abdominal wall defects. It also illustrates the pressing need for a large prospective database to better understand these anomalies and provide better care.
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Yamagishi J, Ishimaru Y, Takayasu H, Otani Y, Tahara K, Hatanaka M, Hamajima A, Hasumi A, Ikeda H. Visceral coverage with absorbable mesh followed by split-thickness skin graft in the treatment of ruptured giant omphalocele. Pediatr Surg Int 2007; 23:199-201. [PMID: 17043872 DOI: 10.1007/s00383-006-1820-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2006] [Indexed: 11/25/2022]
Abstract
We report a case of ruptured giant omphalocele in whom herniated organs were successfully covered by an absorbable mesh and a subsequent skin graft. A 2,200 g male baby was born at 35 weeks of gestation. An abdominal wall abnormality was detected by prenatal ultrasound at 21 weeks of gestation. At birth, the entire liver, stomach, and small and large bowel had herniated from the defect of the abdominal wall. The thorax and abdomen were highly underdeveloped, and attempts to reduce the organs into the abdomen were unsuccessful due to the extremely small abdominal cavity and associated pulmonary hypoplasia. To protect the herniated organs and prevent abdominal infections, the organs were covered by a polyglycan mesh and subsequently a meshed split-thickness skin graft. Ten weeks later, it was confirmed that the organs were completely covered by epithelialized tissue. However, the patient suffered from frequent respiratory infections and finally died of respiratory insufficiency. Based on the experience of the patient, we conclude that coverage of the herniated organs with an absorbable mesh and a skin graft is a recommendable treatment in ruptured giant omphalocele.
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Affiliation(s)
- Junko Yamagishi
- Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
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Foglia R, Kane A, Becker D, Asz-Sigall J, Mychaliska G. Management of giant omphalocele with rapid creation of abdominal domain. J Pediatr Surg 2006; 41:704-9; discussion 704-9. [PMID: 16567180 DOI: 10.1016/j.jpedsurg.2005.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate peritoneal domain. METHODS This is a retrospective review of our experience using an intraperitoneal tissue expander (IPTE) to create adequate abdominal domain in 2 patients with GO. RESULTS In 2 children with unrepaired GO, an IPTE was placed into the pelvis and was inflated to the target volume over 3 to 4 weeks. At the definitive operation for the closure of the abdominal defect, the IPTE was removed, allowing reduction of all the viscera into the peritoneal cavity and achieving complete abdominal wall closure. The patients are now 1 year postoperative, each having a normal abdomen and enjoying normal growth and development. CONCLUSION Intraperitoneal tissue expander placement can create the needed domain over several weeks in GO. Its use in 2 cases was associated with satisfactory complete abdominal wall closure in short order. This technique should be considered as a treatment option.
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Affiliation(s)
- Robert Foglia
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA.
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Kilbride KE, Cooney DR, Custer MD. Vacuum-assisted closure: a new method for treating patients with giant omphalocele. J Pediatr Surg 2006; 41:212-5. [PMID: 16410135 DOI: 10.1016/j.jpedsurg.2005.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Closure of giant omphalocele can present a surgical challenge. Neither silo, skin flap, nor primary closure has been successful in treating all patients. We present a novel application of the vacuum-assisted closure (VAC) device, which allows for improved results in these difficult cases. METHODS The VAC device (KCI, San Antonio, Tex) consisted of a sponge applied directly to the bowel and liver, covered with impermeable transparent dressing, and attached to a low negative pressure system. The sponge was changed every 3 to 5 days under local sedation. PATIENTS All 3 patients had giant omphaloceles. The first infant, a 34 week gestational age (WGA) male, was initially treated with silo reduction, which disrupted after 21 days. The large mass of bowel and liver made primary closure impossible. The VAC was applied for 45 days. The viscera was easily reduced and subsequently covered with acellular dermal matrix (AlloDerm). The VAC was reapplied, and the small remaining defect was skin-grafted. The second male infant was a 34 WGA male infant who became septic after failure of prosthetic mesh closure. The VAC was applied for 22 days after removal of the mesh. The infection resolved, and the defect size was reduced, allowing for skin flap closure. Mesh infection and development of an enterocutaneous fistula in the last patient, a 37 WGA female child, were treated by mesh removal and application of the VAC for 36 days. The VAC allowed for control of the fistula output and development of a healthy granulation bed. RESULTS Vacuum-assisted closure was associated with (1) rapid shrinkage and reduction of the viscera (22-45 days); (2) cleansing of the wound; (3) excellent granulation; (4) maintenance of a sterile environment; and (5) ease of use, with changes possible at the bedside. CONCLUSION The VAC device should be considered a safe and effective alternative in treating complicated cases of giant omphalocele until a more definitive closure method can be used.
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Affiliation(s)
- Kandice E Kilbride
- Division of Pediatric Surgery, Department of Surgery, Texas A and M Health Science Center, Temple, TX 76508, USA
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