A strategy for treatment of giant omphalocele.
BACKGROUND
The management of giant omphalocele (GO) presents a major challenge to pediatric surgeons. Current treatment modalities may result in wound infection, fascial separation, and abdominal domain loss. We report a GO infant who required a delayed closure and was managed using sterile incision drape and polypropylene mesh.


METHODS
A 3080 g full-term female infant was born with a GO. The skin was dissected from the fascia circumferentially without opening the amniotic sac and the peritoneum. Subsequently, two polypropylene meshes of 10 x 10 cm in diameter were sutured to each other. Inner surface of the mesh silo was covered with sterile incision drape. This texture was sutured to the fascial margin. Then, the skin was sutured to the mesh and the silo was closed from the side and above. On the 4th day the reduction was started using thick sutures without anesthesia. This procedure was repeated on every 3rd day. When it came closer to the skin margins, constriction was performed using right angle clamps, each time placed 2 cm proximally to the previous sutures in a circular manner. Silo was removed easily and the skin, subcutaneous layers, and fascia were then approximated on the 42nd day.


RESULTS
The postoperative course was uneventful and the infant was well with left inguinal hernia repaired in the 3rd month.


CONCLUSIONS
The method we used can be performed at bedside and without the application of anesthesia, but should be tried on more patients to determine its effect.
Sönmez
Kaan
K
Faculty of Medicine, Department of Pediatric Surgery, Gazi University, 06500 Ankara, Turkey.
Onal
Esra
E
Karabulut
Ramazan
R
Turan
Ozden
O
Türkyilmaz
Zafer
Z
Hirfanoğlu
Ibrahim
I
Kapisiz
Alparslan
A
Başaklar
Abdullah C
AC
D000071938:Fasciotomy; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D011126:Polypropylenes; D013526:Surgical Mesh; D013536:Suture Techniques
D011126:Polypropylenes