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Meeting in the middle: pediatric abdominal wall reconstruction for omphalocele
Katelyn Kondra1, Christian Jimenez1, Eloise Stanton1
1Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA, 90027, USA.
Insights
Pediatric and plastic surgery collaboration improves outcomes for large omphaloceles. Component separation and primary closure without mesh are effective, with minimal complications and ventilation needs.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Congenital Abnormalities
Background:
- Omphalocele is a congenital abdominal wall defect affecting approximately 1 in 4,200 births.
- Repair timing and surgical techniques for omphalocele have evolved over recent decades.
- Establishing optimal surgical and ventilation protocols for omphalocele reconstruction is crucial.
Purpose of the Study:
- To evaluate the effectiveness of collaborative surgical approaches for omphalocele repair.
- To identify improved surgical and ventilation protocols for patients requiring abdominal reconstruction due to omphalocele.
Main Methods:
- Retrospective review of patients with omphalocele requiring abdominal wall reconstruction.
- Data collected included birth history, comorbidities, surgical details, and ventilation parameters.
- Analysis focused on outcomes in patients managed by Plastic and/or Pediatric Surgery.
Main Results:
- Seven out of 129 patients required Plastic Surgery intervention for omphalocele repair.
- Average defect size was 102.9 cm², with five patients undergoing component separation.
- No mesh was used, and zero complications or recurrences were recorded; two patients needed brief postoperative ventilation.
Conclusions:
- Collaborative pediatric and plastic surgery leads to successful primary fascial closure for large omphaloceles without mesh.
- Component separation is a valuable technique in these complex cases.
- Long-term follow-up is needed to assess hernia incidence in adults with omphaloceles repaired by plastic surgery.
Background:
Omphalocele is a congenital abdominal wall defect with an incidence of 1/4,200 births. Repair timing varies from the neonatal period to the first few years of life. Surgical technique has changed over the last two decades. We sought to establish improved surgical/ventilation protocols for patients with omphaloceles requiring abdominal reconstruction.
Methods:
An IRB-approved retrospective review was performed on patients with omphalocele requiring abdominal wall reconstruction by Plastics and/or Pediatric Surgery at a pediatric tertiary-care referral center (January 2006-July 2021). Birth history, comorbidities, surgical details, ventilation data, complications/recurrence were extracted.
Results:
Of 129 patients screened, seven required Plastic Surgery involvement. Defect size was 102.9 cm2 (range: 24-178.5); five patients required component separation; zero patients received mesh; zero complications/recurrences were recorded. Two patients required postoperative ventilation for 2.5 days, based on increased peak inspiratory pressures at surgery stop versus start time.
Conclusion:
Patients with large defects secondary to omphalocele benefit from collaboration between Pediatric and Plastic Surgery for component separation and primary fascial closure without mesh. Future research should follow patients who mature out of pediatric clinics to evaluate the incidence of hernias in adults with Plastic Surgery-repaired omphaloceles.
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