Giant omphaloceles: surgical management and perinatal outcomes

Akinkuotu, Adesola C.; Sheikh, Fariha; Olutoye, Oluyinka O.; Lee, Timothy C.; Fernandes, Caraciolo J.; Welty, Stephen E.; Ayres, Nancy A.; Cass, Darrell L.

doi:10.1016/j.jss.2015.03.060

Cited by 62 publications

(73 citation statements)

References 17 publications

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“…We have shown that infants with exomphalos born at lower gestational age and birthweight are at increased risk of mortality. The overall mortality of live‐born infants with exomphalos in the present series was 14%, similar to that reported previously . Importantly, we have also shown that infants with exomphalos minor can have chronic morbidity, as evidenced by the requirement for nasogastric tube feeding at discharge.…”

Section: Discussionsupporting

confidence: 89%

Mortality and short‐term morbidity in infants with exomphalos

Sakonidou

Ali

Farmer

et al. 2018

Pediatrics International

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Section: Discussionsupporting

confidence: 89%

Mortality and short‐term morbidity in infants with exomphalos

Sakonidou

Ali

Farmer

et al. 2018

Pediatrics International

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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%

“…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%

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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“…Poor long-term outcomes for infants with omphalocele are more likely in the presence of associated structural or chromosomal abnormalities that occur in approximately 50-77% of these infants [2,3,4]. Other factors associated with poor outcomes include early respiratory distress [5], presence of liver within the omphalocele sac [6], high in utero omphalocele diameter to abdominal circumference ratio [7], low birth weight, low gestational age, and antenatal rupture of the sac [8].…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele

Hutson

Baerg²,

Deming³

et al. 2017

Neonatology

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Background: Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. Objectives: To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele. Methods: This is a multicenter retrospective chart review of demographic data and clinical characteristics of infants with omphalocele admitted to the neonatal intensive care units of Loma Linda University Children's Hospital and Children's Mercy Hospital between 1994 and 2011. Echocardiogram images were reviewed for pulmonary hypertension, and statistical analyses were performed to identify risk factors associated with the presence of pulmonary hypertension. Results: Pulmonary hypertension was diagnosed in 32/56 (57%) infants with omphalocele. Compared to infants without pulmonary hypertension, infants with pulmonary hypertension were more likely to have a liver-containing defect (16/32 [50%] vs. 5/24 [21%], p = 0.03), require intubation at birth (18/32 [56%] vs. 6/24 [17%], p = 0.03), and die during initial hospitalization (12/32 [38%] vs. 2/24 [8%], p = 0.01). Conclusion: The majority of infants with omphalocele have evidence of pulmonary hypertension which is associated with increased mortality. Echocardiograms to screen for pulmonary hypertension should be obtained at ≥2 days of life in infants with omphalocele, especially in those with liver within the omphalocele sac and/or in those infants who require intubation at birth to screen for pulmonary hypertension.

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Giant omphaloceles: surgical management and perinatal outcomes

Cited by 62 publications

References 17 publications

Mortality and short‐term morbidity in infants with exomphalos

Mortality and short‐term morbidity in infants with exomphalos

Gravitational Autoreposition for Staged Closure of Omphaloceles

High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele

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