Modified sequential sac ligation and staged closure technique for the management of giant omphalocele
Xueqiong Huang1, Huimin Huang1, Yujian Liang1
1Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
Insights
Sac ligation and staged closure effectively manages giant omphalocele (GO). Outcomes depend on comorbidities and pulmonary hypoplasia, not just abdominal wall defects.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Giant omphalocele (GO) is a complex congenital abdominal wall defect requiring specialized management.
- Effective surgical strategies are crucial for improving outcomes in neonates with GO.
Purpose of the Study:
- To describe the sac ligation and sequential closure technique for managing giant omphalocele (GO).
- To analyze the outcomes associated with this management approach in neonates.
Main Methods:
- Retrospective review of 13 neonates with GO treated between 2012 and 2020.
- Application of sac ligation and progressive external compression, followed by staged closure with or without prosthetic patches.
Main Results:
- Sac ligation-traction-compression was performed in 12 cases, with 10 undergoing staged closure.
- Survival rate was 90% among those with staged closure; pneumonia was a common complication.
- Median mechanical ventilation and hospital stay were 22.2 and 44.2 days, respectively.
Conclusions:
- Sac ligation and staged closure is an effective treatment option for giant omphalocele (GO).
- Prognosis is influenced by comorbidities and pulmonary hypoplasia, in addition to the abdominal wall defect.
Purpose:
This study aimed to describe sac ligation and sequential closure for the management of giant omphalocele (GO) and analyze its outcomes.
Methods:
The medical records of 13 neonates with GO treated at a tertiary general hospital between July 2012 and April 2020 were reviewed. Sac ligation and progressive external compression were performed on most cases immediately after birth. Staged closure with or without a prosthetic patch was conducted after a period of sac suspension.
Results:
Sac ligation-traction-compression was performed on 12 cases, of which 10 underwent staged closure, one with delayed closure. One patient with coexistent esophageal atresia was deemed ineligible for surgery. Among those who had undergone staged closure, 9 survived; however, one neonate who complicated with bilateral diaphragmatic eventration and severe ventilator-associated pneumonia died from multiple-organ failure. Pentalogy of Cantrell was excluded. One patient in whom primary closure was performed after birth died aged 29 h. Pneumonia was the most common infection among patients (5/13), with three having ventilator-associated pneumonia. The median durations of mechanical ventilation and hospital stay were 22.2 days (range, 1-151) and 44.2 days (range, 2-152), respectively, and 25.6 days and 46.4 days, respectively, among patients with staged closure. Among five infants who required oxygen support for more than 28 days, four had pulmonary hypoplasia.
Conclusions:
Aside from abdominal wall defects, other major comorbidities and pulmonary hypoplasia influence the prognosis of GO. Sac ligation and staged closure is a effective choice for GO.
Type Of Study:
Retrospective Study Level of Evidence: Level IV.
