New method of surgical delayed closure of giant omphaloceles: Lazaro da Silva’s technique

Pereira, Regina Maria; Tatsuo, Edson Samesima; Silva, Ana Cristina Simões e; Guimaräes, José Teixeira; Paixäo, Ricardo Mattos; Lanna, José Carlos Brandäo Duarte; Miranda, Marcelo Eller

doi:10.1016/j.jpedsurg.2004.03.064

Cited by 32 publications

(35 citation statements)

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“…Some techniques, which are usually considered for at risk patients (e.g. infants with a very low birth rates or respiratory insufficiencies at birth) involve conservative management (7)(8)(9). However, the most common surgical treatments involve the staged closure techniques that have been modified since 1948.…”

Section: Discussionmentioning

confidence: 99%

A New Method of Repairing Giant Omphaloceles with Bilateral Mesh Grafts Lateral to the Rectus Abdominis Muscles

Foroutan¹,

Jahromi²,

Dastgheyb³

et al. 2013

Ann Colorectal Res

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Introduction:In spite of the advances in prenatal and neonatal medicine, giant omphalocele (GO) has remained as a challenge for pediatric surgeons. Although different techniques have been introduced for treating GO, the ideal treatment would be a primary closure without compromising the respiratory system or multiorgan failure. However, reaching this goal is challenging due to the high degree of visceroabdominal disproportion. This present study described the results of primary or secondary closure of five GO cases using the "bilateral mesh graft" technique. Case presentation: Five consecutive GO patients were treated in our department. Two patients underwent a primary closure, while three other patients underwent a secondary closure using the "bilateral mesh graft" technique. When two mesh grafts were bilaterally fixed to the rectus abdominis muscles, the abdominal wall was reconstructed in the midline. All 5 patients were closely monitored for potential complications and a follow-up was also performed for each patient after they were discharged. Discussion: The "bilateral mesh graft" technique was performed on the pediatric patients with a median age of 2.5 months (range 3 days to 6 months). The median diameter of the abdominal wall defect was 9 cm (range 7 -10 cm). Moreover, the median was increased in bladder pressure after closure was 6.4 cm H 2 O (range 3 -10 cm H 2 O). One of the patients who underwent secondary closure was diagnosed with a congenital heart condition and died postoperatively due to heart failure and respiratory insufficiency. The median hospital staying duration of the four surviving cases was 4.5 days with minimal complications. During the follow-up appointments, all four surviving patients exhibited normal weight gain and a soft abdomen with no infections or erosions detected at the site of surgery. The "bilateral mesh graft" technique yielded good clinical outcomes in both the primary and secondary closure cases. However, prior to surgery, particularly in the primary closure cases, the patients must be evaluated for respiratory function and additional congenital anomalies, such as heart conditions, in order to minimize potential complications. Nevertheless, further research is still needed in order to determine the long-term effects of the functional aspects on the abdominal wall muscles and viscera.

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Section: Discussionmentioning

confidence: 99%

A New Method of Repairing Giant Omphaloceles with Bilateral Mesh Grafts Lateral to the Rectus Abdominis Muscles

Foroutan¹,

Jahromi²,

Dastgheyb³

et al. 2013

Ann Colorectal Res

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“…Nuchtern et al [26] demonstrated that sac dressing, followed by delayed surgical closure of EM, has reduced time to enteral feeding and discharge home, with a satisfactory cosmetic outcome being achieved [4,17]. Surgical repair following a period of non-operative treatment has a lower morbidity and infection risk and may allow the infant to achieve a better clinical condition prior to surgery [27]. The major disadvantages of initial non-operative management for EM are constant dressing changes, while epithelialisation occurs and a large ventral hernia requiring surgical correction in later life.…”

Section: Discussionmentioning

confidence: 99%

Exomphalos major: the Northern Ireland experience

2008

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“…Second stage, consisting with repair of the residual abdominal hernia would be carried out after 6-12 months, when the abdominal cavity is big enough to allocate all the viscera without over tension and to be closed by layers, including muscles and fasciae [22]. Modifying his original first stage technique, in 1948 Gross [1] reported three cases of GO treated by mobilization of undermined skin flaps from the border of the sac to be advanced and closed in the midline over an intact sac, adequately cleansed and sterilized by iodine-alcohol solution and left underneath.…”

Section: Staged Closurementioning

confidence: 99%

“…In 2004 Pereira et al [22] reported 11 cases of delayed closure of GO using the surgical technique originally described by Da Silva [46] in 1971 for the treatment of abdominal hernia in adults. This technique uses flaps of rectus sheath and the fibroperitoneal tissue of the hernial sac itself, creating three overlapping layers that approximate the medial edges of the rectus muscles to the midline, with the advantage of reducing the suture line tension by its distribution between the three layers, without necessity of prosthetic materials.…”

Section: Escharotic Agentsmentioning

confidence: 99%

Giant Omphalocele: What's the Way to Go?

Cesare¹

2014

JPNC

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New method of surgical delayed closure of giant omphaloceles: Lazaro da Silva’s technique

Cited by 32 publications

References 10 publications

A New Method of Repairing Giant Omphaloceles with Bilateral Mesh Grafts Lateral to the Rectus Abdominis Muscles

A New Method of Repairing Giant Omphaloceles with Bilateral Mesh Grafts Lateral to the Rectus Abdominis Muscles

Exomphalos major: the Northern Ireland experience

Giant Omphalocele: What's the Way to Go?

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