Definitive surgical management of antenatally diagnosed exomphalos.
OBJECTIVE
The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without problems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our institution using a policy of aggressive abdominal wall closure.


METHODS
This is a retrospective review of all infants with exomphalos treated from January 1995 to September 2002.


RESULTS
There were 35 infants, all of whom underwent surgery. These were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos major) underwent primary closure (n = 13), and group C (exomphalos major) underwent staged closure involving a silo (n = 11). Infants in group C had a lower birth weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P < .001), a longer hospital stay (P = .001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97%) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failure) early after the creation of a silo.


CONCLUSIONS
An aggressive surgical approach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly greater resources than other options.
Rijhwani
Ashok
A
Department of Paediatric Surgery, Kings College Hospital, SE5 9RS London, UK.
Davenport
Mark
M
Dawrant
Michael
M
Dimitriou
Gabriel
G
Patel
Shailesh
S
Greenough
Anne
A
Nicolaides
Kypros
K
D034861:Abdominal Wall / Q000601:surgery; D000015:Abnormalities, Multiple / Q000453:epidemiology; D001724:Birth Weight; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric; D062109:Dermatologic Surgical Procedures; D004739:England / Q000453:epidemiology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000196:embryology / Q000453:epidemiology / Q000235:genetics / Q000601:surgery*; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007621:Karyotyping; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011296:Prenatal Diagnosis; D012086:Reoperation / Q000706:statistics & numerical data; D012120:Respiration Disorders / Q000453:epidemiology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome