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Staged repair of giant recurrent omphalocele and gastroschesis "camel-litter method"-a new technique
Valiollah Mehrabi1, Arianeb Mehrabi, Maliheh Kadivar
1Department of Pediatric Surgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. prof_mehrabi@yahoo.com
Insights
This study introduces a novel two-stage surgical repair for giant omphalocele and gastroschisis. The technique, utilizing tissue expanders and muscle traction, achieved successful closure in all seven pediatric patients, ensuring survival without complications.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Abdominal Wall Defects
Background:
- Giant omphalocele and gastroschisis present significant surgical challenges, often requiring complex repair strategies.
- Primary repair failures in these conditions necessitate alternative treatment approaches.
Purpose of the Study:
- To present a novel two-stage surgical technique for repairing giant omphalocele and gastroschisis.
- To evaluate the safety and efficacy of this technique in neonatal and later-life cases, including those with failed primary repairs.
Main Methods:
- A series of seven pediatric patients (6 giant omphalocele, 2 gastroschisis) underwent a two-stage surgical repair.
- The technique involved the placement of an intraperitoneal tissue expander followed by abdominal muscle traction to facilitate closure.
Main Results:
- All seven patients survived the procedure with no reported complications during follow-up (1 month to 7 years).
- Mean hospital stay was 38 days, with full enteral feeding achieved by postoperative day 14.
- Final abdominal wall closure was completed within a mean of 21 days after the initial operation.
Conclusions:
- This novel two-stage surgical approach is safe and effective for repairing giant omphalocele and gastroschisis.
- The technique successfully creates necessary abdominal space for closure over several weeks, offering a viable solution for complex cases.
Abstract:
The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been failed. From 1999 to 2006, seven consecutive children (male/female ratio 0.4) with giant omphalocele (n=6) and Gastroschesis (n=2) were underwent this new operation in our center. In this technique, there were two operations. The mean of hospital stay was 38 days (range, 23-42 days), and full enteral feeding was achieved on the 8 to 25 postoperative day (Mean, 14 day). The final closure, in all patients was achieved between the 14 to 32 days after the first operation (Mean, 21 day). Mechanical ventilation was necessary for the mean of 5 days (range, 2-8 days). All patients are alive and have no complication due to the operation (1 month-7 years). Giant omphalocele and Gastroschesis can be safely repaired. The placement of an intraperitoneal tissue expander and traction of abdominal muscles can create the needed space for closure in several weeks in patients with giant omphalocele/ Gastroschesis.
