Selective management of omphalocele

doi:10.1016/0002-9610(82)90165-9

The American Journal of Surgery

Volume 143, Issue 5, May 1982, Pages 572-574

https://doi.org/10.1016/0002-9610(82)90165-9 Get rights and content

Abstract

Fifty-four patients with omphalocele were reviewed. In infants who weighed over 2,500 g, had no associated anomalies, and had defects of the abdominal wall smaller than 5 cm, the survival rate was 100 percent. Mortality occurred in infants with severe associated congenital anomalies, with a low birth weight, and with larger defects of the abdominal wall. Selection of treatment should be based on a thorough assessment of each patient with omphalocele.

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The surgery of infancy and childhood

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Cited by (9)

Surgical options in the management of large omphaloceles
1987, The American Journal of Surgery
Forty-six neonates with omphaloceles seen at the Children's Hospital and Medical Center in Seattle from 1975 to 1985 were reviewed. There was an 87 percent survival rate in those surgically managed. The 23 neonates who underwent primary closure all survived. The 13 neonates with giant omphaloceles with the liver in the defect who received silon chimneys had a 46 percent mortality rate and a high complication rate, with prolonged hospitalization.
Two neonates with giant omphaloceles were managed by leaving the sac intact, and silver sulfadiazine cream was used as an escharotic agent. We believe it is a safer alternative than the silon chimney in neonates whose defects cannot be closed primarily.
Omphalocele: A 25-year experience
1986, Journal of Pediatric Surgery
Between 1958 and 1983, 92 neonates with omphalocele were admitted to Ste-Justine Hospital. The male to female ratio was 3:2. Birth weight ranged from 1,450 to 5,100 g (mean 2,786 g). Associated anomalies, apart from malrotation, were present in 45%. They were cardiovascular (18.4%), vesico-intestinal fissure or bladder exstrophy (11.9%), Beckwith Wiedeman (6.5%), and chromosomal abnormalities (7.5%). Seven patients were not treated. Topical applications were used in seven cases (1 survivor). In 65%, primary closure was achieved; the mortality rate was 20% with a mean hospital stay of 17.5 days. Silastic was used in 12 cases with a mortality of 5/12 and a mean hospital stay of 82.1 days. The mean number of reductions was 6.7. Omphalocele rupture did not influence mortality. Prior to 1974 the mortality rate was 50%. Since 1974 it has decreased to 31.5%. The advent of total parenteral nutrition (TPN) was an important factor in decreasing the mortality. Prior to 1974, 23 patients survived, only one with a major associated anomaly (Fallot). After 1973, 35 survived, 13 having a major associated anomaly. Overall mortality was 9% when no other major malformations were present. A retrospective study of 92 cases of omphalocele over a 25-year period reveals an overall mortality rate of 37%. Death was associated almost exclusively with additional congenital anomalies. Birthweight in itself was not a determining prognostic factor. With the advent of TPN and a better knowledge of the mechanical ventilation of the neonate the results are better and involve the survival of a greater number of patients with serious associated malformations.
The giant omphalocele: A new approach for a rapid and complete closure
1986, Journal of Pediatric Surgery
Giant omphaloceles are usually treated in stages. Theskin is closed first and the ensuing giant ventral hernia is repaired when the patient is 1 year old or older. This attitude has many advantages, but treatment of the giant ventral hernia may be very difficult and often requires many operations. We have used a new approach to this problem in two cases. A polyamide mesh is glued over the skin of the abdominal wall, thorax, and lumbar regions. The distance between the apposed rectus muscles is then progressively decreased by repeated infolding of the polyamide mesh with running longitudinal sutures on the mesh itself. This progressively reduces the hernial content. When the rectus muscles are sufficiently approximated, a definitive procedure is carried out. In the first patient, the giant hernia was completely closed in 3 weeks and in the second patient, it was closed in 5 weeks. A third patient is presently undergoing the same treatment. This simple bedside technique does not require any antiseptic measure and may replace advantageously the use of prosthetic material in a majority of cases.
Long-term follow-up of patients with gastroschisis
1986, The American Journal of Surgery
Long-term follow-up of children with gastroschisis has been made possible by the increased survival of these infants over the past 20 years. We have observed that children with isolated gastroschisis defects exhibit normal growth and development beyond 5 years of age without significant bowel sequelae. Infants with gastroschisis with concomitant bowel atresia or complications who require small bowel resection are at a greatly increased risk for long-term bowel problems and abdominal complaints.
Long-term survival of a baby with body stalk anomaly: Report of a case
2007, Surgery Today
Closure of the ventral hernia in the management of giant exomphalos: A word of caution
2005, Pediatric Surgery International

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^☆: Presented at the 68th Annual Meeting of the North Pacific Surgical Association, Vancouver, British Columbia, Canada, November 13 and 14, 1981.

¹: From the Department of Surgery, Division of Pediatric Surgery. School of Medicine, Oregon Health Sciences University, Portland, Oregon.

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Scientific paperSelective management of omphalocele☆

Abstract

J Pediatr Surg

A new method for staged repair of large omphaloceles

Surg Gynecol Obstet

The surgery of infancy and childhood

Scientific paper
Selective management of omphalocele☆