title: Staged repair of giant omphalocele in the neonatal period.
abstract: OBJECTIVE
  The aim of this study was to analyze the outcome of giant omphalocele repaired in the neonatal period.
  
  
  METHODS
  Twelve consecutive (1997-2004) neonates with giant omphalocele (defect >6 cm with liver herniation) were reviewed. A silo of Prolene mesh (Ethicon) was attached to the fascia and the defect was closed without opening the amniotic sac after sequential reduction. In 2 neonates with ruptured omphalocele a plastic sheet was inserted below the mesh. Data are reported as median and range.
  
  
  RESULTS
  Gestational age was 38 weeks (range, 32-40 weeks) and birth weight was 2.9 kg (range, 1.0-3.1 kg). The final closure was achieved at 26 days (range, 16-62 days). Three neonates (25%) died before final closure (causes: ruptured omphalocele, lung hypoplasia, cardiac anomalies, and intestinal failure). In the 9 surviving neonates, mechanical ventilation was required for 8 days (range, 2-20 days), hospital stay was 42 days (range, 23-73 days), and full enteral feeding was achieved on day 12 (range, 4-53 days). Complications included wound infection in 5 neonates and midgut volvulus in 1. Prophylactic Ladd's procedure was performed laparoscopically at a later stage in 4 children. At laparoscopy, intraperitoneal adhesions were minimal and the central liver did not preclude the operation. The 9 survivors are all well after 46 months (range, 12-67 months).
  
  
  CONCLUSIONS
  Giant omphalocele can be safely repaired in the neonatal period without opening the amniotic sac. Intestinal malrotation should be excluded and Ladd's procedure can be performed laparoscopically at a later stage.
authors.affiliation: Department of Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 1EH London, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pacilli
authors.forename: Lewis
authors.initials: L
authors.lastname: Spitz
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
authors.forename: Joe
authors.initials: J
authors.lastname: Curry
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality; D000650:Amnion; D002585:Cesarean Section; D004750:Enteral Nutrition; D000071938:Fasciotomy; D005260:Female; D005865:Gestational Age; D006554:Hernia, Umbilical / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013526:Surgical Mesh; D016019:Survival Analysis; D016896:Treatment Outcome