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Exomphalos Defects : A Review of 15 Cases
1Senior Advisor (Surgery and Paediatric Surgery), Army Hopsital (R & R), New Delhi.
Insights
Monitoring intra-abdominal pressures, specifically urinary bladder pressure, is crucial for successful exomphalos defect repair. This method helps prevent abdominal compartment syndrome, leading to satisfactory outcomes in neonates with omphaloceles.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Exomphalos (omphalocele) repair outcomes have improved due to surgical advancements and multidisciplinary care.
- Monitoring intra-abdominal pressures is key in managing these complex cases.
Purpose of the Study:
- To evaluate the outcomes of exomphalos defect repair.
- To assess the utility of intra-abdominal pressure monitoring in surgical management.
Main Methods:
- Retrospective review of 15 omphalocele cases.
- Measurement of urinary bladder pressure (UBP) to assess intra-abdominal pressure.
- Surgical closure techniques included immediate primary closure, silo repair, Goretex mesh, and conservative management.
Main Results:
- Nine major (defect > 5 cm) and six minor exomphalos defects were identified.
- Primary closure was achieved in 56% of major defects.
- Intraoperative UBP monitoring guided management, preventing closure when pressures exceeded 20 mm Hg.
Conclusions:
- Satisfactory outcomes are achievable for exomphalos defects.
- Intraoperative intravesical pressure assessment is a practical method to exclude abdominal compartment syndrome during repair.
Background:
The outcome after repair of exomphalos defects has improved significantly with refinements in surgical techniques, multidisciplinary management and monitoring of intra-abdominal pressures.
Methods:
A retrospective study of medical records of 15 cases with omphalocele was done.
Results:
Antenatal diagnosis was available in six cases. There were eight females and seven males with a mean birth weight of 2.2 kg. Nine babies had associated anomalies. There were nine major (defect size> 5 cm) and six minor defects. Immediate closure in neonatal period was carried out in 12 cases. Urinary bladder pressure (UBP) was measured to assess intra-abdominal pressure in cases where primary closure was difficult. Primary closure was omitted in the event of intravesical pressures exceeding 20 mm Hg (~ 25 cms of water). Primary surgical closure was possible in five (56%) major cases. Two cases were subjected to silo repair followed by delayed primary closure whereas the other two required a Goretex mesh closure. Three minor defects could be repaired primarily whereas the remaining three were managed conservatively and closed at age of 9 to 12 months. There were no significant anaesthetic complications. Elective postoperative ventilation was required in one baby. There were three deaths at ages five, nine and ten months due to unrelated causes.
Conclusion:
Satisfactory outcome is possible in cases with exomphalos defects with intra-operative intravesical pressure assessment forming a convenient method for excluding abdominal compartment syndrome.
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