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A strategy for treatment of giant omphalocele
Kaan Sönmez1, Esra Onal, Ramazan Karabulut
1Faculty of Medicine, Department of Pediatric Surgery, Gazi University, 06500 Ankara, Turkey.
Insights
A novel bedside technique using sterile incision drape and polypropylene mesh effectively managed giant omphalocele (GO) in an infant, avoiding anesthesia and complications. Further trials are needed to confirm its efficacy for GO treatment.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Innovation
Background:
- Giant omphalocele (GO) management poses significant challenges for pediatric surgeons.
- Existing treatments for GO can lead to complications like wound infection and abdominal domain loss.
- This study introduces an alternative management strategy for GO requiring delayed closure.
Observation:
- A full-term infant with GO was treated using a custom-created silo constructed from polypropylene mesh and sterile incision drape.
- The silo was secured to the fascial margin, and gradual abdominal reduction was initiated on the 4th day post-birth without anesthesia.
- Progressive constriction using sutures and clamps facilitated eventual skin, subcutaneous, and fascial approximation on the 42nd day.
Findings:
- The described method allowed for delayed closure of giant omphalocele.
- The infant experienced an uneventful postoperative course and was discharged in good health.
- This technique was performed at the bedside without the need for anesthesia.
Implications:
- This innovative approach offers a potentially safer and more accessible method for managing giant omphalocele.
- The technique's feasibility at the bedside and avoidance of anesthesia warrant further investigation.
- Wider adoption of this method could improve outcomes for infants with giant omphalocele.
Background:
The management of giant omphalocele (GO) presents a major challenge to pediatric surgeons. Current treatment modalities may result in wound infection, fascial separation, and abdominal domain loss. We report a GO infant who required a delayed closure and was managed using sterile incision drape and polypropylene mesh.
Methods:
A 3080 g full-term female infant was born with a GO. The skin was dissected from the fascia circumferentially without opening the amniotic sac and the peritoneum. Subsequently, two polypropylene meshes of 10 x 10 cm in diameter were sutured to each other. Inner surface of the mesh silo was covered with sterile incision drape. This texture was sutured to the fascial margin. Then, the skin was sutured to the mesh and the silo was closed from the side and above. On the 4th day the reduction was started using thick sutures without anesthesia. This procedure was repeated on every 3rd day. When it came closer to the skin margins, constriction was performed using right angle clamps, each time placed 2 cm proximally to the previous sutures in a circular manner. Silo was removed easily and the skin, subcutaneous layers, and fascia were then approximated on the 42nd day.
Results:
The postoperative course was uneventful and the infant was well with left inguinal hernia repaired in the 3rd month.
Conclusion:
The method we used can be performed at bedside and without the application of anesthesia, but should be tried on more patients to determine its effect.
