Management of Giant Omphalocele: A Case Series

Introduction

Giant omphalocele (GO) is congenital abdominal wall defect measuring >6 cm and/or containing liver.[1] The omphalocele sac consists of amnion and peritoneum, and is prone to rupture either in utero, during delivery or after birth. The surgical management of neonates with GO is challenging. Several operative and nonoperative strategies have been described although a traditional silo chimney with graduated visceral reduction is commonly used. In this case report, we describe four patients with GO in whom postnatal management was highly problematic. We used an acellular biological xenograft called Surgisis Biodesign® (Cook Ltd.) to repair the GO.[2] Surgisis Biodesign is derived from porcine small intestine submucosa and consists of an extracellular matrix containing collagens, glycoproteins glycosaminoglycans, proteoglycans, and growth factors.[2] Once implanted into tissue it provides a scaffold for epithelialization.

• References

• 1 Patel G, Sadiq J, Shenker N, Impey L, Lakhoo K. Neonatal survival of prenatally diagnosed exomphalos. Pediatr Surg Int 2009; 25 (5) 413-416
• 2 Pu LL. Plastic Surgery Educational Foundation DATA Committee. Small intestinal submucosa (Surgisis) as a bioactive prosthetic material for repair of abdominal wall fascial defect. Plast Reconstr Surg 2005; 115 (7) 2127-2131
• 3 Groves R, Sunderajan L, Khan AR, Parikh D, Brain J, Samuel M. Congenital anomalies are commonly associated with exomphalos minor. J Pediatr Surg 2006; 41 (2) 358-361
• 4 Pacilli M, Spitz L, Kiely EM, Curry J, Pierro A. Staged repair of giant omphalocele in the neonatal period. J Pediatr Surg 2005; 40 (5) 785-788
• 5 Bawazir OA, Wong A, Sigalet DL. Absorbable mesh and skin flaps or grafts in the management of ruptured giant omphalocele. J Pediatr Surg 2003; 38 (5) 725-728
• 6 Yamagishi J, Ishimaru Y, Takayasu H , et al. Visceral coverage with absorbable mesh followed by split-thickness skin graft in the treatment of ruptured giant omphalocele. Pediatr Surg Int 2007; 23 (2) 199-201
• 7 Lee SL, Beyer TD, Kim SS , et al. Initial nonoperative management and delayed closure for treatment of giant omphaloceles. J Pediatr Surg 2006; 41 (11) 1846-1849
• 8 Baird R, Gholoum S, Laberge JM, Puligandla P. Management of a giant omphalocele with an external skin closure system. J Pediatr Surg 2010; 45 (7) E17-E20
• 9 Foglia R, Kane A, Becker D, Asz-Sigall J, Mychaliska G. Management of giant omphalocele with rapid creation of abdominal domain. J Pediatr Surg 2006; 41 (4) 704-709 , discussion 704–709
• 10 Nuchtern JG, Baxter R, Hatch Jr EI. Nonoperative initial management versus silon chimney for treatment of giant omphalocele. J Pediatr Surg 1995; 30 (6) 771-776
• 11 Ginting N, Tremblay L, Kortbeek JB. Surgisis® in the management of the complex abdominal wall in trauma: a case series and review of the literature. Injury 2010; 41 (9) 970-973
• 12 Admire AA, Greenfeld JI, Cosentino CM, Ghory MJ, Samimi KJ. Repair of cloacal exstrophy, omphalocele, and gastroschisis using porcine small-intestinal submucosa or cadaveric skin homograft. Plast Reconstr Surg 2003; 112 (4) 1059-1062
• 13 Dasgupta R, Wales PW, Zuker RM, Fisher DM, Langer JC. The use of Surgisis for abdominal wall reconstruction in the separation of omphalopagus conjoined twins. Pediatr Surg Int 2007; 23 (9) 923-926
• 14 Gabriel A, Gollin G. Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy. J Pediatr Surg 2006; 41 (11) 1836-1840
• 15 Grethel EJ, Cortes RA, Wagner AJ , et al. Prosthetic patches for congenital diaphragmatic hernia repair: Surgisis vs Gore-Tex. J Pediatr Surg 2006; 41 (1) 29-33 , discussion 29–33