Abstract
Background
Omphalocele is a congenital abdominal wall defect with an incidence of 1/4,200 births. Repair timing varies from the neonatal period to the first few years of life. Surgical technique has changed over the last two decades. We sought to establish improved surgical/ventilation protocols for patients with omphaloceles requiring abdominal reconstruction.
Methods
An IRB-approved retrospective review was performed on patients with omphalocele requiring abdominal wall reconstruction by Plastics and/or Pediatric Surgery at a pediatric tertiary-care referral center (January 2006-July 2021). Birth history, comorbidities, surgical details, ventilation data, complications/recurrence were extracted.
Results
Of 129 patients screened, seven required Plastic Surgery involvement. Defect size was 102.9 cm2 (range: 24–178.5); five patients required component separation; zero patients received mesh; zero complications/recurrences were recorded. Two patients required postoperative ventilation for 2.5 days, based on increased peak inspiratory pressures at surgery stop versus start time.
Conclusion
Patients with large defects secondary to omphalocele benefit from collaboration between Pediatric and Plastic Surgery for component separation and primary fascial closure without mesh. Future research should follow patients who mature out of pediatric clinics to evaluate the incidence of hernias in adults with Plastic Surgery-repaired omphaloceles.
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References
Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ et al (2019) National population-based estimates for major birth defects, 2010–2014. Birth Defects Res 111(18):1420–1435
Prefumo F, Izzi C (2014) Fetal abdominal wall defects. Best Pract Res Clin Obstet Gynaecol 28(3):391–402
Verla MA, Style CC, Olutoye OO (2019) Prenatal diagnosis and management of omphalocele [Internet]. Sem Pediatric Surg. https://doi.org/10.1053/j.sempedsurg.2019.04.007
Gonzalez KW, Chandler NM (2019) Ruptured omphalocele: Diagnosis and management. Semin Pediatr Surg 28(2):101–105
Logsdon NT, Gallo CM, Favorito LA, Sampaio FJ (2021) Investigation of a connection between abdominal wall defects and severity of the herniation in fetuses with gastroschisis and omphalocele. Sci Rep 11(1):27
Barrios Sanjuanelo A, AbellóMunarriz C, Cardona-Arias JA (2021) Systematic review of mortality associated with neonatal primary staged closure of giant omphalocele. J Pediatr Surg 56(4):678–685
Saxena AK, Raicevic M (2018) Predictors of mortality in neonates with giant omphaloceles. Minerva Pediatr 70(3):289–295
Levy S, Tsao K, Cox CS Jr, Phatak UR, Lally KP, Andrassy RJ (2013) Component separation for complex congenital abdominal wall defects: not just for adults anymore. J Pediatr Surg 48(12):2525–2529
Zmora O, Castle SL, Papillon S, Stein JE (2017) The biological prosthesis is a viable option for abdominal wall reconstruction in pediatric high risk defects. Am J Surg 214(3):479–482
Martin AE, Khan A, Kim DS, Muratore CS, Luks FI (2009) The use of intraabdominal tissue expanders as a primary strategy for closure of giant omphaloceles. J Pediatr Surg 44(1):178–182
Adetayo OA, Aka AA, Ray AO (2012) The use of intra-abdominal tissue expansion for the management of giant omphaloceles: review of literature and a case report. Ann Plast Surg 69(1):104–108
Zhang ZZ, Haddock C, Verchere C, Arneja JS, Skarsgard ED (2019) Management of narrow stalked giant omphalocele using tissue expansion, staged closure, and amnion preservation technique. J Pediatr Surg Case Rep 51:101311
Shah RS, Parelkar SV, Sanghvi BV, Gupta RK, Mudkhedkar KP (2016) Staged repair of giant exomphalos major using tissue expanders. J Pediatr Surg Case Rep 13:13–17
Griscom NT, Driscoll SG (1980) Radiography of stillborn fetuses and infants dying at birth. AJR Am J Roentgenol 134(3):485–489
Tsakayannis DE, Zurakowski D, Lillehei CW (1996) Respiratory insufficiency at birth: a predictor of mortality for infants with omphalocele. J Pediatr Surg 31(8):1088–1090
Baerg JE, Thorpe DL, Sharp NE, Ramlogan SR, Hutson SM, Goff DA et al (2015) Pulmonary hypertension predicts mortality in infants with omphalocele. J Neonatal Perinatal Med 8(4):333–338
Ein SH, Rubin SZ (1980) Gastroschisis: primary closure or Silon pouch [Internet]. J Pediatric Surg. 15:549–552
Duggan E, Puligandla PS (2019) Respiratory disorders in patients with omphalocele. Semin Pediatr Surg 28(2):115–117
Nakayama DK, Motoyama EK, Tagge EM (1991) Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia [Internet]. J Pediatrics. 118:793–799
Dimitriou G, Greenough A, Giffin F, Davenport M, Nicolaides KH (1996) Temporary impairment of lung function in infants with anterior abdominal wall defects who have undergone surgery. J Pediatr Surg 31(5):670–672
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KK: contributed to the majority of manuscript writing, study protocol design, data analysis and acquisition, and figure creation. CJ and ES: contributed to manuscript writing, editing, and figure creation. KC: contributed to project conception, manuscript writing and editing. CES and JAH: contributed to data analysis, manuscript editing, and final approval of the version to be published.
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The following study was conducted with Children’s Hospital Los Angeles Institutional Review Board approval, CHLA-21–00268.
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Kondra, K., Jimenez, C., Stanton, E. et al. Meeting in the middle: pediatric abdominal wall reconstruction for omphalocele. Pediatr Surg Int 38, 1981–1987 (2022). https://doi.org/10.1007/s00383-022-05244-6
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DOI: https://doi.org/10.1007/s00383-022-05244-6