The Use of Intra-abdominal Tissue Expansion for the Management of Giant Omphaloceles

Adetayo, Oluwaseun A.; Aka, Allison A.; Ray, Andrea O.

doi:10.1097/sap.0b013e31822128f5

Cited by 32 publications

(16 citation statements)

References 33 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%

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%

Gravitational Autoreposition for Staged Closure of Omphaloceles

et al. 2019

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“…A third method involves the prior placement of tissue expanders [11]. While this may create extra room in the intra-abdominal domain, it does little to reduce the risk of Budd-Chiari syndrome from a too rapid rotation of a globular liver from outside to inside the abdomen [12].…”

Section: Discussionmentioning

confidence: 99%

Negative pressure wound therapy facilitates closure of large congenital abdominal wall defects

et al. 2014

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The degree of viscero-abdominal disproportion often makes single-stage reduction difficult in large abdominal wall defects, without risking respiratory or hemodynamic compromise. As a consequence, clinicians have adopted a number of different methods to control these defects. Repair may be in the neonatal period, or later in life. Delayed repairs require epithelialization of the gastroschisis or omphalocele. Definitive repair may be in single or multiple stages. This paper describes four children in whom negative pressure wound therapy (NPWT) was used to facilitate closure of these complex defects.

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“…опыт применения экспандерной техники показал, что расположение экспандеров подкожно или внутримышечно у новорожденных может быть невозможно или может сопрово-ждаться высоким процентом ишемических осложнений [35]. метод внутрибрюшной имплантации является наиболее оптимальным, потому что создает полноценный лоскут, который включает все слои передней брюшной стенки.…”

Section: этапное закрытие дефектаunclassified

Surgical Methods of Treatment of Giant Omphalocele in Children

Zapalianski¹,

Kandratsyeva²,

Svirsky³

2018

Novosti Khirurgii

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Surgical Methods of Treatment of Giant Omphalocele in Children A.V. Zapalianski, O.V. Kandratsyeva, A.A. Svirsky в обзоре описаны различные варианты как классических, так и современных методов хирургической коррекции врожденного порока развития передней брюшной стенки-омфалоцеле больших размеров. приведены основные существующие методики, такие как первичная пластика, этапное и отсроченное закрытие дефекта. особое внимание уделено таким перспективным направлениям этапного хирургического лечения, как вакуум-ассистированное закрытие дефекта, использование тканевых экспандеров и систем наружного вытяжения. указаны достоинства и недостатки каждого метода, а также проведен сравнительный анализ их эффективности. приведены примеры новых хирургических методик коррекции порока, в основе которых лежат достижения современных биоинженерных исследований и инновационных технологий. рассмотрены перспективы применения биодеградабельных биоматериалов, таких как «аллодерм» и подслизистый слой тонкой кишки для пластики передней брюшной стенки и первичного закрытия дефекта. подробно описаны различные подходы к реконструктивному лечению больших дефектов передней брюшной стенки у детей старшего возраста после формирования вентральной грыжи в период новорожденности. проведен анализ опыта применения техники разделения слоев передней брюшной стенки для абдоминопластики в периоде новорожденности и более старшем возрасте, а также намечены пути улучшения косметических и физиологических результатов лечения. Ключевые слова: омфалоцеле больших размеров, новорожденный, дефект передней брюшной стенки, хирургическое лечение, этапное закрытие дефекта, отсроченное закрытие дефекта The review describes various options of classical and modern techniques of surgical treatment of congenital malformation of the anterior abdominal wall-the giant omphalocele. The main existing techniques are presented, such as primary, staged and delayed closure of the defect. Particular attention is paid to such perspective areas of the staged surgical treatment as vacuum-assisted closure, using of tissue expanders and systems with active external traction. The advantages and disadvantages of each technique are indicated and a comparative analysis of their effectiveness is carried out. Examples of new surgical options for correction of the malformation are presented, based on the achievements of modern bioengineering researches and innovative technologies. The prospects of the using the biodegradable biomaterials, such as «Alloderm» and submucosal layer of the small intestine for reconstruction of the abdominal wall and primary closure of the defect are analyzed. The review details various approaches of reconstructive surgical treatment of large abdominal wall defects in older children after the formation of ventral hernia in newborns. The application experience of the component separation technique (CST) for abdominoplasty in the period of newborns and older age is analyzed, and also the ways to improve the cosmetic and physiological results of the treatment are outlined.

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The Use of Intra-abdominal Tissue Expansion for the Management of Giant Omphaloceles

Cited by 32 publications

References 33 publications

Gravitational Autoreposition for Staged Closure of Omphaloceles

Gravitational Autoreposition for Staged Closure of Omphaloceles

Negative pressure wound therapy facilitates closure of large congenital abdominal wall defects

Surgical Methods of Treatment of Giant Omphalocele in Children

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