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Published on: January 19, 2022
Definitive surgical management of antenatally diagnosed exomphalos
Ashok Rijhwani1, Mark Davenport, Michael Dawrant
1Department of Paediatric Surgery, Kings College Hospital, SE5 9RS London, UK.
Insights
Aggressive surgical closure of exomphalos in infants is a safe and effective treatment option. This approach requires a multidisciplinary team and potentially more resources for successful abdominal wall closure.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Management of exomphalos, a congenital abdominal wall defect, remains controversial.
- Larger exomphalos cases often managed conservatively, but this approach has complications.
Purpose of the Study:
- To evaluate outcomes of infants with antenatally diagnosed exomphalos treated with aggressive surgical closure.
- To assess the efficacy and safety of surgical management for exomphalos.
Main Methods:
- Retrospective review of infants with exomphalos treated between January 1995 and September 2002.
- Infants categorized into groups based on exomphalos size and surgical approach: primary closure for minor and major exomphalos, and staged closure with a silo for major exomphalos.
Main Results:
- 35 infants underwent surgery, with 97% survival (34/35).
- Staged closure group (silo) had lower birth weight, less maturity, longer ventilation, longer hospital stay, and delayed enteral feeding.
- One infant with ruptured exomphalos died from non-surgical complications.
Conclusions:
- Aggressive surgical management of exomphalos is a safe and effective strategy for abdominal wall closure.
- This approach necessitates a skilled multidisciplinary team and potentially increased resource allocation.
Background/Purpose:
The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without problems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our institution using a policy of aggressive abdominal wall closure.
Methods:
This is a retrospective review of all infants with exomphalos treated from January 1995 to September 2002.
Results:
There were 35 infants, all of whom underwent surgery. These were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos major) underwent primary closure (n = 13), and group C (exomphalos major) underwent staged closure involving a silo (n = 11). Infants in group C had a lower birth weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P < .001), a longer hospital stay (P = .001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97%) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failure) early after the creation of a silo.
Conclusions:
An aggressive surgical approach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly greater resources than other options.
