Staged repair of giant omphalocele in the neonatal period.
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.
Pacilli
Maurizio
M
Department of Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 1EH London, UK.
Spitz
Lewis
L
Kiely
Edward M
EM
Curry
Joe
J
Pierro
Agostino
A
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