Traction-compression-closure for exomphalos major.

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Abdominal Wall Reconstruction

Background:

• Exomphalos major (EM) is a congenital abdominal wall defect requiring specialized surgical management.
• Achieving a safe, aesthetically pleasing closure with umbilical preservation presents a surgical challenge.

Purpose of the Study:

• To evaluate the efficacy of traction-compression-closure (TCC) for exomphalos major (EM).
• To assess TCC's ability to achieve safe, embryologically correct, and aesthetic midline supraumbilical closure with umbilical preservation.

Main Methods:

• Nineteen neonates with EM underwent TCC, involving paralysis, ventilation, and upward cord traction for abdominal domain increase.
• Liver-bowel reduction was facilitated by gravity, followed by sac ligation and elastic body binder compression.
• The supraumbilical abdominal wall anomaly was managed via spontaneous cicatrization or surgical midline scar closure, preserving the umbilicus.

Main Results:

• Eighteen of 19 neonates survived over a 7-year period.
• Median time to reduction was 4 days, and median time to full enteral feeds was 6 days.
• No episodes of sac rupture or infection occurred; 5 patients required no surgery.

Conclusions:

• Traction-compression-closure (TCC) under muscle relaxation and ventilation is an effective method for exomphalos major.
• This approach facilitates safe, tension-free, and aesthetic midline abdominal wall closure with umbilical preservation.
• TCC represents a valuable strategy for managing EM, optimizing outcomes and patient recovery.