title: Management of giant omphaloceles: A systematic review of methods of staged surgical vs. nonoperative delayed closure.
abstract: OBJECTIVE
  Despite the numerous methods of closure for giant omphaloceles, uncertainty persists regarding the most effective option. Our purpose was to review the literature to clarify the current methods being used and to determine superiority of either staged surgical procedures or nonoperative delayed closure in order to recommend a standard of care for the management of the giant omphalocele.
  
  
  METHODS
  Our initial database search resulted in 378 articles. After de-duplification and review, we requested 32 articles relevant to our topic that partially met our inclusion criteria. We found that 14 articles met our criteria; these 14 studies were included in our analysis. 10 studies met the inclusion criteria for nonoperative delayed closure, and 4 studies met the inclusion criteria for staged surgical management.
  
  
  RESULTS
  Numerous methods for managing giant omphaloceles have been described. Many studies use topical therapy secondarily to failed surgical management. Primary nonoperative delayed management had a cumulative mortality of 21.8% vs. 23.4% in the staged surgical group. Time to initiation of full enteric feedings was lower in the nonoperative delayed group at 14.6days vs 23.5days.
  
  
  CONCLUSIONS
  Despite advances in medical and surgical therapies, giant omphaloceles are still associated with a high mortality rate and numerous morbidities. In our analysis, we found that nonoperative delayed management with silver therapy was associated with lower mortality and shorter duration to full enteric feeding. We recommend that nonoperative delayed management be utilized as the primary therapy for the newborn with a giant omphalocele.
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Brent
authors: B
authors: Bauman
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Daniel
authors: D
authors: Stephens
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Hannah
authors: H
authors: Gershone
authors: Health Science Libraries, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Connie
authors: C
authors: Bongiorno
authors: Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Erin
authors: E
authors: Osterholm
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Robert
authors: R
authors: Acton
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Donavon
authors: D
authors: Hess
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Daniel
authors: D
authors: Saltzman
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. Electronic address: bjsegura@umn.edu.
authors: Bradley
authors: B
authors: Segura
mesh_terms: D000287:Administration, Topical; D019468:Disease Management; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012834:Silver / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D012834:Silver
keywords: Betadine; Giant omphalocele; Neonatal surgery; Nonoperative delayed closure; Silvadene; Staged surgical closure