1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Odion-Obomhense HK, Awunor NS, Onyeaso S. A Method of Conservative Management of Giant Omphalocele Useful in Preventing Rupture of Sac. West Afr J Med 2022; 39:816-822. [PMID: 36057973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Omphalocele consists of congenital malformation of anterior abdominal wall defects occurring at the midline with herniation of the viscera through this defect. Giant omphaloceles constitute a challenging situation as such conservative management has been advocated as an effective method of treatment. This study aimed to compare the conventional method of dressing the omphalocele sac using gauze, an escharotic agent, and a crepe bandage to our improvised method of the usage of a sterilization wrap over the escharotic agent with a crepe bandage. METHODS This was a retrospective comparative review of 7 babies with giant omphalocele that was treated with topical honey and the non-adherent sterilization wrap covering (group B) and compared with 6 babies that had honey, sofratulle ,and dry gauze covering (group A) that was initially done in our center. RESULTS All of the babies who were in group B had an uneventful epithelization of the sac with no rupture; also, no death occurred in this group. However, three in group A had sacs that ruptured before epithelization. Two of these died from complications of sepsis following rupture of the sac, one had a small point on the sac which was ruptured and it healed with a dressing left in place for a week. CONCLUSION The use of Kimberley-Clark sterilization wrap prevents rupture of the sac while using the escharotic agent, thereby reducing mortality. We advocate that gauze should not make any contact with the omphalocele sac.
Collapse
Affiliation(s)
| | - N S Awunor
- Department of Community Medicine, Delta State University, Abraka, Nigeria
| | - S Onyeaso
- Department of Pediatrics, Delta State University, Abraka, Nigeria
| |
Collapse
|
3
|
Kasanga TK, Bilond TM, Zeng FTA, Mujinga HMW, Mukakala AK, Kapessa ND, Musapudi ÉM, Mwamba FK, Katambwa PM, Nafatalewa DK, Badypwyla IT, Mukangala SI, Ngoie CN, Cabala VDPK, Banza MI, Musanzayi SM. [Conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: a case serie]. Pan Afr Med J 2021; 39:63. [PMID: 34422186 PMCID: PMC8363966 DOI: 10.11604/pamj.2021.39.63.23215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 11/11/2022] Open
Abstract
La fermeture chirurgicale primaire dans le traitement de l´omphalocèle géante est émaillée des complications. Le traitement conservateur est une option adaptée aux pays à faible revenu où la chirurgie te la réanimation néonatales sont pourvoyeuses d´une grande mortalité. Ceci est une étude prospective menée aux cliniques universitaires de Lubumbashi, incluant les patients reçus entre janvier et avril 2020 et qui ont bénéficié d´un traitement conservateur à l´éosine aqueuse disodique selon un protocole défini. Trois patientes ont été inclues dans notre série. L´âge moyen était de 24 heures (1 - 48), toutes nées à terme (38 - 39 SA), et par voie basse, sans aucun diagnostic anténatal posé. La moyenne du poids de naissance était de 2.800 grammes (2.400 - 3.000). Le diamètre moyen du sac était de 13,7 cm (11 - 15 cm), le sac contenant le foie dans tous les cas. Le délai moyen de nutrition entérale était de 4,3 jours (4 - 5 jours), celui de granulation était de 31,7 jours (30 - 33 jours) et celui d´épithélialisation était de 71,7 jours (60 - 90 jours). Aucun décès n´a été déploré. Ces résultats préliminaires encouragent l´utilisation de l´éosine aqueuse disodique dans le traitement conservateur des omphalocèles géantes non rompues.
Collapse
Affiliation(s)
- Trésor Kibangula Kasanga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Tshiband Mosh Bilond
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Florent Tshibwid A Zeng
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Hugor Mujinga Wa Mujinga
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Augustin Kibonge Mukakala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Éric Mbuya Musapudi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - François Katshitsthi Mwamba
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Prince Muteba Katambwa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Dimitri Kanyanda Nafatalewa
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Israël Tshiamala Badypwyla
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Stephanne Ilunga Mukangala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Christelle Ngoie Ngoie
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Vincent De Paul Kaoma Cabala
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Manix Ilunga Banza
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| | - Sébastien Mbuyi Musanzayi
- Département de Chirurgie, Faculté de Médecine, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, République Démocratique du Congo
| |
Collapse
|
4
|
Abello C, A Harding C, P Rios A, Guelfand M. Management of giant omphalocele with a simple and efficient nonsurgical silo. J Pediatr Surg 2021; 56:1068-1075. [PMID: 33341259 DOI: 10.1016/j.jpedsurg.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Giant omphaloceles can be a challenge for pediatric surgeons and neonatologists worldwide. It is a rare and low-frequency congenital anomaly with no standardized management schemes or treatment protocols. Over the past few decades, we have developed a simple and efficient staged management for giant omphaloceles that allows definitive closure in the neonatal period, the results of which we outline in this report. MATERIAL AND METHODS With IRB approval, a retrospective and multicentric cohort study was carried out between 1994 and 2019 with patients with giant omphalocele defined as an abdominal wall defect greater than 5 cm in diameter and/or that contains more than 50% of the liver within the sac. We included all patients managed with the nonsurgical silo technique. Data on demographics, gestational age, associated malformations, amnion reduction and inversion time, anatomic closure, requirement of a mesh, intra- and post-silo complications, mortality and follow-up were collected. The technique consists of the construction of a silo with an adhesive hydrocolloid dressing (DuodermⓇ) to achieve an omphalocele staged-reduction until complete abdominal reintegration of the liver and bowel preservation of the amnion sac. This also enables the simulation of abdominal closure before definitive surgical closure, being managed in the neonatal intensive care unit (NICU). RESULTS Forty patients, 21 of whom were female, were managed with this technique. The average weight was 2900 gs (890-3900), and the median gestational age was 38 weeks (28-40). In total, 37.5% of cases had an associated comorbidity. The average silo reduction time was 7.3 days (0-35), the average time of amnion inversion was 5 days (2-9), and the average time to closure was 14.6 days (6-38). Anatomical closure was achieved in 95% of cases. In 4 patients, an absorbable mesh was used to reinforce the anatomical closure, and in 2 patients (5%), a mesh (DualmeshⓇ) was required to achieve an abdominal closure. There was no mortality associated with this nonsurgical silo technique. The average follow-up time was 60 (6 - 288) months. CONCLUSION The staged silo management of giant omphalocele in this series is safe and effective and reduces the time to closure and potential morbidity and mortality compared with traditional surgical or medical management.
Collapse
Affiliation(s)
- Cristobal Abello
- Pediatric Surgery Department, Clinica Cmipediatrica International, Barranquilla, Colombia
| | - Constanza A Harding
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile
| | - Alejandra P Rios
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile
| | - Miguel Guelfand
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile; Pediatric Surgery Department, Clínica Las Condes, Santiago, Chile.
| |
Collapse
|
5
|
Barrios Sanjuanelo A, Abelló Munarriz C, Cardona-Arias JA. Systematic review of mortality associated with neonatal primary staged closure of giant omphalocele. J Pediatr Surg 2021; 56:678-685. [PMID: 32981659 DOI: 10.1016/j.jpedsurg.2020.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and atomized. OBJECTIVE To analyze the studies about of mortality associated with neonatal primary staged closure of giant omphalocele. METHODS Systematic review in three databases using ex-ante search protocol and selection of studies following the phases suggested by PRISMA and MOOSE criteria. Reproducibility and evaluation of methodological quality were guaranteed by using CARE and STROBE. RESULTS Seven studies of clinical cases with nine patients, and six cross-sectional studies with 85 individuals were analyzed. These were conducted in the USA mainly, between 1985 and 2018. In the case studies, the death was 11.1% owing to hepatic necrosis and portal system angiomatosis. On the cross-sectional studies, mortality was registered in 18.8% of patients owing to coarctation of the aorta, heart, kidney, intestinal, respiratory or multiple organ failure, an anomaly of venous return, prematurity, ruptured omphalocele, pulmonary hypoplasia, trisomy 13, ARDS, sepsis, and septic shock. The main complication was wound infection with subsequent confection of the silo, found in 5.4% of patients. CONCLUSION Only a few studies on staged closure of giant omphalocele were found on a low number of patients. The high survival rate and the low percentage of complications on the 94 analyzed patients suggest the effectiveness and safety of the procedure. LEVELS OF EVIDENCE According to the Journal of Pediatric Surgery this research corresponds to type of study level II for retrospective studies, and level IV for case series with no comparison group.
Collapse
Affiliation(s)
| | - Cristóbal Abelló Munarriz
- Professor of Surgery Universidad Metropolita, Minimally Invasive and High-Complexity Pediatric Surgery Group, International Pediatrics Clinic, Barranquilla, Colombia
| | | |
Collapse
|
6
|
Rombaldi MC, Barreto CG, Peterson CA, Cavazzola LT, Santis-Isolan PMB, Fraga JC. Complex ventral hernia repair in a child: An association of botulinum toxin, progressive pneumoperitoneum and negative pressure therapy. A case report on an arising surgical technique. Int J Surg Case Rep 2021; 81:105828. [PMID: 33887832 DOI: 10.1016/j.ijscr.2021.105828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/20/2021] [Indexed: 01/13/2023] Open
Abstract
Giant omphalocele establish a therapeutic challenge to the surgeon - mainly because of the increased visceroabdominal disproportion and underlying malformations - and the best approach is still debatable worldwide. This is the second report on the literature and states the management of a child born with giant omphalocele that developed a very complex ventral hernia secondary to an unsuccessful attempt of closing the primary defect. It seems that the use of botulinum toxin agents in the abdominal wall is safe and effective in children with giant omphaloceles and it eliminates the use of a mesh even in more difficult cases. This technique seems safe and effective and it should be encouraged and best evaluated. It is time to start defining better criteria to categorize giant omphalocele in order to choose the best management for each patient.
Introduction The purpose of this manuscript is to report the management of a child born with giant omphalocele (GO) that developed a complex ventral hernia secondary to an unsuccessful attempt of closing the primary defect. Presentation of case The patient underwent a one-step surgery to correct a ventral hernia associated with a largely prolapsed enteroatmospheric fistula (EAF) along with an ileostomy. It was managed by a pre-operative association of botulinum toxin agent (BTA) application with preoperative progressive pneumoperitoneum (PPP) and trans-operative negative pressure wound therapy (NPWT) dressing with staged abdominal closure. The patient needed 4 reoperations due to enteric fistulas. Nine days after the first surgery, it was possible to completely close the abdominal wall without mesh substitution. No signs of hernia in 9 months of follow-up. Discussion This is the second report in the literature and it reinforces the safety and effectiveness of the BTA injection associated with PPP in children. Conclusion The use of BTA in association with PPP should be encouraged and best investigated in patients with GO. The fistulas were not attributed to the negative pressure. Maybe it is time to start defining better criteria to categorize GO in order to choose the best management for each patient.
Collapse
|
7
|
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes. METHODS The medical records of all patients diagnosed with GO at a large children's hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac. RESULTS During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs. CONCLUSIONS Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with uses of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care.
Collapse
Affiliation(s)
- R E Witt
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - M Singhal
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - A J Vachharajani
- Department of Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| |
Collapse
|
8
|
Horiike M, Kitada T, Santo K, Hashimoto T, Satoshi O. Successful abdominal wall closure following collagen-based artificial dermis induced epithelialization for giant omphalocele: A case report. Int J Surg Case Rep 2020; 75:464-468. [PMID: 33076196 PMCID: PMC7527617 DOI: 10.1016/j.ijscr.2020.09.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022] Open
Abstract
A giant omphalocele (GO) is related to higher rates of morbidity and mortality. No consensus exists on optimal GO management, which may be surgically challenging. We report the successful GO management of a neonate with numerous complications. We applied a collagen-based artificial dermis for epithelization as a new treatment.
Introduction A giant omphalocele (GO) with marked viscero-abdominal disproportion is associated with surgical difficulty and higher morbidity and mortality rates. Despite various treatment strategies, no consensus exists on optimal GO management. We report the clinical course of a neonate with a GO who was successfully treated with abdominal-wall closure through the novel application of collagen-based artificial dermis (CAD) for epithelization. Presentation of case A female neonate (estimated gestational age, 38 weeks; birthweight, 3.047 kg) with a GO where most viscera, including the liver, were completely herniated. G-band analysis showed no chromosomal abnormality and normal karyotype. Conventional silo formation was attempted, but incomplete silo was formed due to adhesion between the portal vein and fascia, and repatriation of the herniated viscera had not progressed. A new silo was formed using biomaterial, but it was infected and removed. Abdominal wall epithelialization using NPWT was attempted again but was interrupted by the occurrence of jejunal perforation. After incising the epithelialized part of the abdominal wall and repairing the perforated jejunum, the GO was covered and fixed using CAD. Epithelialization progressed well, and she was discharged on day 328. Discussion In this case, the major therapeutic challenges (including formation of an incomplete silo, silo infection, and jejunal perforation) were overcome with conventional treatment except for epithelialization of the abdominal wall, which was achieved by using CAD. Conclusion The treatment with CAD for epithelialization can be considered in cases where it is extremely difficult to return the viscera in conventional management.
Collapse
Affiliation(s)
- Masaki Horiike
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, Wakayama, 640-8558, Japan.
| | - Tomohiro Kitada
- Department of Surgery, Matsushitakai, Shiraniwa Hospital, 6-10-1, Shiraniwa-dai, Ikoma, Nara, 630-0136, Japan
| | - Kenji Santo
- Department of Pediatric Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takuro Hashimoto
- Department of Pediatric Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Onishi Satoshi
- Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
9
|
Nolan HR, Wagner ML, Jenkins T, Lim FY. Outcomes in the giant omphalocele population: A single center comprehensive experience. J Pediatr Surg 2020; 55:1866-1871. [PMID: 32475506 DOI: 10.1016/j.jpedsurg.2020.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Morbidity and mortality in the giant omphalocele population is complicated by large abdominal wall defects, physiologic aberrancies, and congenital anomalies. We hypothesized different anomalies and treatment types would affect outcomes. METHODS A 2009-2018 retrospective chart review of giant omphaloceles was performed. Exclusions included cloacal exstrophy, transfer after 3 weeks, surgery prior to transfer, conjoined twins, or not yet achieving fascial closure. Thirty-five patients met criteria and mortality and operative morbidity categorized them into favorable (n = 20) or unfavorable (n = 15) outcomes. Odds ratios analyzed potential predictors. Survivors were stratified into staged (n = 11), delayed (n = 8), and primary closure (n = 6) for subgroup analysis. RESULTS Unfavorable outcomes were associated with other major congenital anomalies, sac rupture, and major cardiac anomalies, but had significantly lower odds with increasing gestational age (p = 0.03) and birth weight (p < 0.001). In survivors, the primary group was younger at repair (p < 0.001) and had shorter length of stay (hospital p = 0.02, neonatal intensive care unit p = 0.005). There was no significant difference for sepsis, ventilator days, return to the operating room, or ventral hernia. CONCLUSIONS Predictions of overall outcomes in the giant omphalocele population require analysis of multiple variables. Our findings demonstrated increased odds of unfavorable outcomes in major cardiac anomalies, pulmonary hypertension, genetic diagnosis, other major anomalies, polyhydramnios, postnatal sac rupture, increasing omphalocele sac diameter, lower O/E TLV, lower gestational age at birth, lower birth weight, and repair other than primary. In those surviving to repair, surgical outcomes analyses demonstrated an earlier age of repair and a shorter length of stay for those patients able to be closed primarily; however further research is necessary to determine overall superiority between operative treatment types. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Heather R Nolan
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA.
| | - Monica L Wagner
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
| | - Todd Jenkins
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
| | - Foong-Yen Lim
- Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA
| |
Collapse
|
10
|
Danzer E, Hoffman C, Miller JS, D'Agostino JA, Schindewolf EM, Gerdes M, Bernbaum J, Adams SE, Rintoul NE, Herkert LM, Taylor L, Schreiber J, Peranteau WH, Flake AW, Adzick NS, Hedrick HL. Autism spectrum disorder and neurodevelopmental delays in children with giant omphalocele. J Pediatr Surg 2019; 54:1771-1777. [PMID: 31196668 DOI: 10.1016/j.jpedsurg.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence and identify risk factors of autism spectrum disorders (ASDs) and neurodevelopmental delays in giant omphalocele (GO) survivors. MATERIALS AND METHODS The study cohort consists of 47 GO survivors enrolled in our follow-up program between 07/2004 and 12/2015. All patients underwent assessments at 2 years of age or older. Outcomes were assessed by either the Bayley Scales of Infant Development II (prior 2006) or III (after 2006), or the Wechsler Preschool and Primary Scale of Intelligence (children older than 4 years). ASD diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders IV (prior to 2014) or 5 criteria. RESULTS The prevalence of ASD in GO children is 16 times higher than the general population (P = 0.0002). ASD patients were more likely to be diagnosed with neurodevelopmental and neurofunctional delays, language disorders, and genetic abnormalities (P < 0.01). While 53.2% of GO children scored within the average range for all developmental domains, 19.1% scored within the mildly delayed and 27.7% in the severe delayed range in at least one domain. Prolonged respiratory support, pulmonary hypertension, gastroesophageal reflux disease, feeding problems, prolonged hospitalization, abnormal BAER hearing screen, presence of delayed motor coordination, and hypotonicity were associated with delayed scores (P < 0.05). CONCLUSIONS There is a significant rate of ASD in GO survivors. Neurodevelopmental delays, language delays, and genetic abnormalities were strongly associated with ASD. Neurological impairments were present in nearly half of GO children. Surrogate markers of disease severity were associated with below average neurodevelopmental scores. Level of evidence Level IV.
Collapse
Affiliation(s)
- Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia.
| | - Casey Hoffman
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Judith S Miller
- Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jo Ann D'Agostino
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Erica M Schindewolf
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Marsha Gerdes
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Judy Bernbaum
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Samantha E Adams
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Natalie E Rintoul
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Lisa M Herkert
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jane Schreiber
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Abstract
PURPOSE We describe our series of giant omphalocele patients treated with a serial taping method for gradual reduction of the abdominal contents and early fascial closure. METHODS Between 2010 and 2017 we cared for ten newborns with giant omphaloceles. The average gestational age was 35.5 weeks (range 29-38) and average birthweight was 2.84 kg. Seven infants had other major anomalies, including one with a variant of Pentology of Cantrell. Four had abnormal chromosomes. None had any attempt to primarily close the defect. Omphalocele defects were serially taped at bedside in the NICU with the child awake until the viscera were completely reduced, and the defect could be closed. RESULTS Mean time to closure was 13.7 days (median 14 days). Six were closed primarily without a patch. The remaining four infants required Gore-Tex patch (covered by skin) which was later removed and fascia closed in three infants (at 70 days, 75 days, and 11 months of age). Total length of stay was a mean 71.8 days (median 71). CONCLUSIONS Serial taping achieves early fascial closure and avoids complications of a staged surgical approach, such as multiple anesthetics, loss of fascial margin integrity, silo dehiscence, and fistula formation. Compression of the viscera is slow enough to avoid abdominal compartment syndrome and the fascia and amnion are left intact leaving the option available to use escharotic agents if required. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
Collapse
|
13
|
Hutson S, Baerg J, Deming D, St Peter SD, Hopper A, Goff DA. High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele. Neonatology 2017; 112:281-286. [PMID: 28704835 DOI: 10.1159/000477535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. OBJECTIVES To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele. METHODS This is a multicenter retrospective chart review of demographic data and clinical characteristics of infants with omphalocele admitted to the neonatal intensive care units of Loma Linda University Children's Hospital and Children's Mercy Hospital between 1994 and 2011. Echocardiogram images were reviewed for pulmonary hypertension, and statistical analyses were performed to identify risk factors associated with the presence of pulmonary hypertension. RESULTS Pulmonary hypertension was diagnosed in 32/56 (57%) infants with omphalocele. Compared to infants without pulmonary hypertension, infants with pulmonary hypertension were more likely to have a liver-containing defect (16/32 [50%] vs. 5/24 [21%], p = 0.03), require intubation at birth (18/32 [56%] vs. 6/24 [17%], p = 0.03), and die during initial hospitalization (12/32 [38%] vs. 2/24 [8%], p = 0.01). CONCLUSION The majority of infants with omphalocele have evidence of pulmonary hypertension which is associated with increased mortality. Echocardiograms to screen for pulmonary hypertension should be obtained at ≥2 days of life in infants with omphalocele, especially in those with liver within the omphalocele sac and/or in those infants who require intubation at birth to screen for pulmonary hypertension.
Collapse
Affiliation(s)
- Shandee Hutson
- Department of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | | | | | | | | | | |
Collapse
|
14
|
Ojha S, Parashar S, Doshi D, Bansal RK. Giant Omphalocele Complicated by Postoperative Duodenal Obstruction. APSP J Case Rep 2017; 8:5. [PMID: 28164002 PMCID: PMC5253613 DOI: 10.21699/ajcr.v8i1.518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/12/2016] [Indexed: 11/11/2022] Open
Abstract
Omphalocele is a congenital defect in the abdominal wall, usually treated at birth or within 1-2 years of life depending on condition of patient and size and contents of the defect. We repaired a giant omphalocele without mesh in a 9-year-old girl. She developed duodenal obstruction in the postoperative period requiring another laparotomy and duodeno-jejunostomy to bypass obstruction.
Collapse
Affiliation(s)
- Sunita Ojha
- Department of Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur
| | - Shobha Parashar
- Department of Anesthesiology, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur
| | - Dharmil Doshi
- Department of Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur
| | - Rajiv Kumar Bansal
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur
| |
Collapse
|
15
|
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: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
16
|
Binet A, Supply E, De Napoli Cocci S, De Cornulier M, Lardy H, Le Touze A. [Tissue expansion in management of giant omphalocele parietal sequelae]. ANN CHIR PLAST ESTH 2016; 62:139-145. [PMID: 27569456 DOI: 10.1016/j.anplas.2016.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE According to major difficulty for the giant omphalocele management in the visceral reintegration and the parietal closure, many teams use currently conservative treatment by topical application. These techniques are suppliers of a covered eventration and a scar sequela requiring a complementary treatment. We report the place of the tissue expansion as complementary treatment. PATIENTS AND METHODS Two patients with a giant omphalocele benefited from a protocol of cutaneous expansion for the correction of their abdominal scar±of their residual eventration. RESULTS An eventration closure was possible thanks to this protocol. The skin expansion allowed the complete excision of the abdominal scar and the defect cover. An additional skin graft was necessary in the first case. CONCLUSION The cutaneous expansion in the parietal sequela management of the giant omphaloceles seems to be an interesting alternative. This technique should be realized remotely and except any septic context.
Collapse
Affiliation(s)
- A Binet
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France.
| | - E Supply
- Service de chirurgie infantile viscérale, néonatale, digestive et thoracique, CHRU de Nantes, 44000 Nantes, France
| | - S De Napoli Cocci
- Service de chirurgie infantile viscérale, néonatale, digestive et thoracique, CHRU de Nantes, 44000 Nantes, France
| | - M De Cornulier
- Établissement de santé pour enfants et adolescents de la région nantaise, 44200 Nantes, France
| | - H Lardy
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France
| | - A Le Touze
- Service de chirurgie pédiatrique viscérale, plastique et brûlés, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours, France
| |
Collapse
|
17
|
Peranteau WH, Tharakan SJ, Partridge E, Herkert L, Rintoul NE, Flake AW, Adzick NS, Hedrick HL. Systemic hypertension in giant omphalocele: An underappreciated association. J Pediatr Surg 2015; 50:1477-80. [PMID: 25783355 DOI: 10.1016/j.jpedsurg.2015.02.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the incidence, severity and duration of systemic hypertension in infants born with giant omphalocele (GO). METHODS A retrospective review of patients born from 2003 through 2013 with a GO or intestinal atresia (control population) and managed at a single institution was performed. The hospital course was reviewed including all blood pressures, method of omphalocele repair, requirement for antihypertensive medications and renal function. RESULTS Forty-five GO and 20 control patients met criteria for the study. Thirty-three GO patients underwent Schuster repair and 12 GO patients underwent delayed repair after epithelialization. Overall, 78% of GO patients had episodes of hypertension (82% Schuster and 67% delayed repair) compared to 15% of control patients (P<0.001). The majority of episodes were transient and occurred in the postoperative period (97%). Hypertension was persistent in 4 GO patients. These patients required antihypertensive medication at discharge, which was discontinued as an outpatient. No patient demonstrated significant evidence of renal abnormalities as indicated by renal ultrasound, urinalysis and/or serum creatinine level at the time of hypertension. CONCLUSION Episodes of systemic hypertension are frequent in patients with GO. Episodes are often post-operative, transient and can be present in patients undergoing either a delayed or Schuster repair. A small subset of patients will have persistent hypertension requiring antihypertensive medication that can be weaned off in an outpatient setting.
Collapse
|
18
|
Danzer E, Gerdes M, D'Agostino JA, Bernbaum J, Hoffman C, Rintoul NE, Herkert LM, Flake AW, Adzick NS, Hedrick HL. Patient characteristics are important determinants of neurodevelopmental outcome during infancy in giant omphalocele. Early Hum Dev 2015; 91:187-93. [PMID: 25676186 DOI: 10.1016/j.earlhumdev.2014.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/26/2014] [Accepted: 12/28/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine patient-specific factors as potential predictors of neurodevelopmental (ND) outcome in children with giant omphalocele (GO). MATERIALS Between 06/2005 and 07/2012, 31 consecutive GO survivors underwent ND assessment using the BSID-III at a median of 24months (range 6-35). ND delay was defined by a score of ≤84 in any composite score. Severe impairments were defined as a score of ≤69 in at least one domain. Correlations between ND outcome and patient-specific factors were analyzed by one-way ANOVA, chi-square, or logistic regression as appropriate. RESULTS The mean cognitive score (86.8±16.8) was in the low average range. Mean language (83.2±21.1) and motor (81.5±16.2) scores were below average. Forty-six-percent scored within the average range for all scales. Mild deficits were found in 19%, and 35% had severe delays in at least one domain. Hypotonicity was present in 55%. Autism was suspected/confirmed in 13%. Predictors of lower ND scores were prolonged ventilator support (P<0.01), high-frequency oscillatory ventilation (P<0.01), tracheostomy placement (P<0.001), O2 supplementation at day of life 30 (P<0.02), pulmonary hypertension (P<0.02), delayed enteral feeding (P=0.01), need for feeding tube (P<0.001), GERD (P=0.05), abnormal BAER hearing screen (P<0.006), prolonged hospitalization (P=0.01), and failure to thrive (P=0.001). Autism was associated with delays in cognitive and language outcomes (P<0.03). Delayed staged closure (P=0.007), older age at final repair (P=0.03), and hypotonicity (P=0.02) were associated with motor dysfunction. CONCLUSIONS Neurological impairments were present in more than half of GO survivors. Disease severity was associated with ND dysfunction. Autism and hypotonicity were often co-morbidities with ND delays and poor motor function.
Collapse
|
19
|
Parida L, Pal K, Al Buainain H, Elshafei H. Staged Closure of Giant Omphalocele using Synthetic Mesh. APSP J Case Rep 2014; 5:27. [PMID: 25374794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/21/2014] [Indexed: 12/02/2022] Open
Abstract
Giant omphalocele is difficult to manage and is associated with a poor outcome. A male newborn presented to our hospital with a giant omphalocele. We performed a staged closure of giant omphalocele using synthetic mesh to construct a silo and then mesh abdominoplasty in the neonatal period that led to a successful outcome within a reasonable period of hospital stay.
Collapse
|