Early surgical management for giant omphalocele: Results and prognostic factors

Roux, N.; Jakubowicz, D.; Salomon, Laurent; Grangé, G.; Giuseppi, Agnès; Rousseau, Véronique; Khen-Dunlop, Naziha; Beaudoın, Sylvie

doi:10.1016/j.jpedsurg.2018.04.036

Cited by 41 publications

(34 citation statements)

References 21 publications

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“…The longer clinical course in patients with associated malformations is a known fact, as such malformations represent the most important prognostic factor in patients with giant omphaloceles. 2,3 In these patients, several surgical steps may be required to achieve fascial closure, 8,19,20 and very large defects, as well as infection and suture line disruption represent the most frequent aggravating factors. 14,21 Aside from surgical sutures and sterile dressings, GRAVITAS bears the advantage of not requiring additional or costly materials.…”

Section: Discussionmentioning

confidence: 99%

“…1 Cases may be complicated by associated congenital malformations such as congenital heart disease and lung hypoplasia. 2 These comorbidities, if present, require comprehensive multidisciplinary care and often have a severe impact on the outcome and prognosis of the affected patients. 2,3 Optimal management of large omphaloceles not suitable for primary closure remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…2 These comorbidities, if present, require comprehensive multidisciplinary care and often have a severe impact on the outcome and prognosis of the affected patients. 2,3 Optimal management of large omphaloceles not suitable for primary closure remains controversial. The large variety of surgical techniques described in the literature reflects the challenge that these patients continue to represent for pediatric surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Gravitational Autoreposition for Staged Closure of Omphaloceles

et al. 2019

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Introduction Management strategies for large omphaloceles remain controversial. In this study, we discuss the use of GRAVITAS (gravitational autoreposition sutures), the method used at our institution when successful primary closure is deemed questionable. Patient's primary clinical course and long-term outcomes were analyzed. Materials and Methods This is a single-center retrospective analysis of all consecutive patients with omphaloceles treated between 1997 and 2018. Decision for GRAVITAS was made when the defect was estimated too large for primary closure. Traction sutures were placed in the fascia surrounding the defect and then suspended from the top of the incubator to allow gravitational autoreposition of the herniated organs. Ventilation and muscle relaxation were maintained until secondary closure, which was performed after the obtruding viscera had been reduced by repeated adjustment of the suture's tension. Data are presented as mean ± standard deviation. Results Out of 49 patients with omphaloceles, 12 were treated with GRAVITAS, 33 underwent primary closure, and 4 were treated using Schuster's technique. Mean time to secondary closure after GRAVITAS was 7 ± 10 days. In nine of the patients who had isolated omphalocele, secondary closure was achieved after 4 ± 2 days. Ventilation time was 5 ± 2 days, and time to full feeds was 18 ± 16 days. In three patients (one with Fallot's tetralogy, one with Cantrell's pentalogy, and one with lung hypoplasia), abdominal closure was achieved after 17 ± 15 days. Due to cardiorespiratory comorbidity, ventilation time was >30 days. Five patients received initial closure of the skin and secondary fascial closure after 18 ± 15 months. One patient with prior fascial closure underwent later repair of an abdominal wall hernia. During follow-up (30 ± 35 months), one patient with gastrointestinal obstruction due to adhesions required laparotomy, and one patient with gastroesophageal reflux disease underwent fundoplication. Conclusion GRAVITAS is a feasible method for staged closure of large omphaloceles when successful primary closure is deemed questionable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gravitational Autoreposition for Staged Closure of Omphaloceles

et al. 2019

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“…Staged closure Gradual reduction using the amniotic sac itself and sequential ligation would be one of the options for staged closure. Staged closure using a synthetic prosthesis constructed like a silicon chimney is a useful method in giant omphaloceles [50].…”

Section: Primary Closurementioning

confidence: 99%

Major abdominal wall defects in the low- and middle-income setting: current status and priorities

2020

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Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low-and middle-income countries. In many low-and middle-income countries, the reported mortality of these malformations is 30-100%, while in high-income countries, mortality in infants with major abdominal wall reaches less than 5%. This review highlights the challenges faced in the management of newborns with major congenital abdominal wall defects in the resource-limited setting. Current high-income country best practice is assessed and opportunities for appropriate priority setting and collaborations to improve outcomes are discussed.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…When possible, early surgical closure is the most appropriate treatment [8,12]. A coordinated multidisciplinary team including Prenatal Diagnosis, Obstetrics, Neonatology, Pediatric Surgery, and Anesthesiology is essential to achieve success in the management of these patients [13].…”

Section: Introductionmentioning

confidence: 99%

Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management

Cubo

Alcalde

Gastaca

et al. 2020

Case Reports in Medicine

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Omphalocele is a congenital malformation of the abdominal wall consisting of a protrusion of the abdominal contents at the base of the umbilical cord. It has a high association with genetic and structural defects; however, if the latter is ruled out, its prognosis improves significantly. Prenatal diagnosis has a key role in this condition as omphalocele can be diagnosed by ultrasound in the first trimester scan, enabling a coordinated approach strategy to achieve the best perinatal results. We present a case report of a pregnant patient with a fetus having a giant omphalocele in which prenatal diagnosis played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial in the immediate care of the newborn.

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Early surgical management for giant omphalocele: Results and prognostic factors

Cited by 41 publications

References 21 publications

Gravitational Autoreposition for Staged Closure of Omphaloceles

Gravitational Autoreposition for Staged Closure of Omphaloceles

Major abdominal wall defects in the low- and middle-income setting: current status and priorities

Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management

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