Case Report: Staged surgical repair and negative pressure wound therapy in congenital omphalocele

Omphalocele is a congenital abdominal wall defect that causes the protrusion of the abdominal organs at the base of the umbilical cord, which is covered by a membranous sac composed of the peritoneum and amnion. We report the case of a newborn with a giant omphalocele containing the liver and bowel loops who underwent staged surgical closure followed by negative pressure wound therapy (NPWT) for the management of skin wound dehiscence.

A male Caucasian infant was born at 35 weeks by elective cesarean section due to a prenatal diagnosis of a giant omphalocele. The clinical examination at birth confirmed a giant omphalocele with extensive liver and small bowel content. Cardio-respiratory and neurological examinations were unremarkable. The omphalocele was initially wrapped with hydrocolloid dressings. After bowel content reduction and epithelialization of the membrane, a three-stage surgery was scheduled as follows: first, a silo bag was fashioned (on day 22); then, after complete liver reduction, the wide muscle-fascial defect was temporarily covered by a porcine dermal implant to close the gap (on day 32); finally, the abdominal wall was fully closed without prosthetic material using the component separation method (on day 68). NPWT was performed in two stages for a total of 29 days. The first period, applied between the second and third interventions, began on day 37 and continued for 16 days. Due to partial dehiscence of the surgical wound, NPWT was restarted on day 75 for 13 days, with increasing pressure (from -20 to -40 mmHg). Progressive improvement of the wound was obtained. After NPWT removal, an antimicrobial hydro-balanced dressing was placed on the wound.

This case underlines the lack of a standardized therapeutic approach for complex abdominal wall defects. It also highlights the efficacy of NPWT in complicated surgical wounds in infancy, given the reduction in dressing frequency and related stress. Furthermore, NPWT guarantees a significant reduction in the number of days required for the resolution of the surgical wound.