Omphalocele: clinical review and surgical experience using dura patch grafts

Area of Science:

• Pediatric Surgery
• Biomaterials Science
• Congenital Abnormalities

Background:

• Omphalocele is a congenital abdominal wall defect requiring surgical intervention.
• Management of large omphaloceles presents challenges, often necessitating complex reconstructive techniques.
• Associated anomalies, particularly cardiac defects, are common and impact outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of solvent-dried dura grafts in surgically managing omphaloceles over a 15-year period.
• To assess the outcomes of using solvent-dried dura for fascia enlargement in large omphalocele defects.
• To report complications and overall results associated with this reconstructive approach.

Main Methods:

• A retrospective review of 50 omphalocele cases treated surgically over 15 years.
• Surgical techniques included primary closure, skin closure with fascia enlargement using solvent-dried dura grafts, and two-layered graft implantation for extremely large defects.
• Data collected included patient demographics, defect size, associated anomalies, surgical methods, postoperative course, complications, and mortality.

Main Results:

• Fifty omphaloceles were treated; 60% were in males. Mean birth weight was 2995g, mean gestational age 38 weeks. 92% were delivered via C-section.
• 22% underwent primary closure, 40% had skin closure with single solvent-dried dura graft, and 38% required two-layered grafts.
• 50% had associated anomalies (mostly cardiac). Mortality was 8%, primarily due to cardiac issues. Solvent-dried dura showed good integration with one conservative complication (abscess).

Conclusions:

• Solvent-dried dura grafts are a safe and effective biomaterial for repairing large omphaloceles.
• The grafts facilitate rapid scar formation and tissue integration, with a low complication rate.
• This approach is favored for managing large omphalocele defects, offering a viable reconstructive option.