1/39. Repair of a giant omphalocele by a modified technique.Large omphaloceles that contain centrally herniated liver pose challenges to surgical closure, the most significant being the space limitation of the abdominal cavity. In addition, the "pedicled" nature of the liver on the inferior vena cava creates a predisposition to acute hepatic vascular outflow obstruction as the liver is reduced into the abdominal cavity. In such cases, the alternatives include conservative treatment or staged silo reduction. The worst complication of silastic silo (SS) placement is tension and infection of the fascia with disruption of the suture line. Once infection or premature disruption occurs, closure of the defect is difficult or impossible. This case report details a different management technique for a newborn with a giant omphalocele and presents an interesting variation of the usual SS technique that may be helpful in the management of some cases, especially in an emergency. The thick silk sutures applied in the present case absorbed the tension and the silastic sheet prevented the risks of infection and adhesions.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/39. Silo reduction of giant omphalocele and gastroschisis utilizing continucous controlled pressure.A method is described utilizing continuous controlled pressure to achieve smooth, rapid, and safe silo reduction of an anterior abdominal-wall defect. A metal tube with larger wheels at each end is suspended by runners and counterweights to slowly roll the silo and squeeze the contents into the abdominal cavity.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
3/39. Left-lung-collapse bronchial deformation in giant omphalocele.Five infants with giant omphalocele had persistent collapse of the left lung and required prolonged respiratory support. Narrowing of the left main bronchus, reversible with positive end-expiratory pressure, was identified radiographically in 3 infants, and we postulate that this relates to distortion of the bronchus within the constraints of the elongated, narrow thoracic cavity characteristic of these patients. The lung collapse may be precipitated by manipulation (reduction or attempted reduction) of the omphalocele. J Pediatr Surg 36:846-850.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/39. In utero sonographic diagnosis of a communicating enteric duplication cyst in a giant omphalocele.Enteric duplications are rare lesions, and relatively few cases have been diagnosed prenatally. We present, to our knowledge, the first case of an associated communicating ileal duplication cyst in a huge omphalocele diagnosed prenatally. The prenatal ultrasound findings revealed four features of the cystic lesion including peristaltic movements of the cystic wall, communication between the cyst and normal bowel lumen, intra-cystic echogenic contents, and echogenic mesenteric tissue (fat) close to the cyst. These distinct characteristics helped us to make a firm in utero diagnosis.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
5/39. Management of neglected giant omphalocele with Gore-tex in a child aged 8 years.Omphalocele is a disease of neonatal age and its present management is successful in almost all specialized centers of Pediatric Surgery. A case of an 8-year-old girl who was managed with conservative treatment during her neonatal period with mercurochrome (Grob method) is presented. Due to very serious congenital cardiopathy, a corrective operative procedure of the omphalocele was not feasible during neonatal age. However, following successful heart surgery the child grew up with her initial disorder. The child was first seen in our clinic at the age of 5 years, presenting with a very large omphalocele. Following a staged pressure of the abdomen with a special belt an attempt was made to close the ventral hernia successfully using a Gore-tex sheet.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
6/39. Bipedicled skin flaps for reconstruction of the abdominal wall in newborn omphalocele.Despite technical refinements in surgery and advances in postoperative intensive care, abdominal wall closure in giant omphalocele remains a difficult endeavor. In this respect, bipedicled skin flaps obtained with longitudinal incisions along the margins of the rectus abdominis muscle may represent a good alternative solution to achieve a complete, tension-free midline closure. Incisional areas can subsequently be easily covered with split-thickness thigh grafts. Two neonatal cases were treated with this technique with good results. This has enabled avoidance of palliative coverage as well as complex musculo-cutaneous reconstructions at a later age.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
7/39. Absorbable mesh and skin flaps or grafts in the management of ruptured giant omphalocele.PURPOSE: The authors report the use of absorbable mesh closure with subsequent skin graft or skin flap coverage for giant ruptured omphalocele. methods: Retrospective review of a single surgeon's experience was conducted from 1996 through 2001. RESULTS: Four infants were identified presenting an average of 4 weeks prematurely. All patients had an initial attempt at silo reduction but had either infection or respiratory compromise. The silo was removed, and the defect was covered with polyglycan mesh followed by subsequent skin coverage. In 2 patients, final coverage was obtained using skin flaps, whereas in 2 patients, split-thickness skin grafts were required. All patients were noted to have a distinct narrow chest contour with evidence of pulmonary hypoplasia. Three patients had respiratory failure requiring tracheostomy and prolonged ventilation. Two children were decannulated after one and 2 years, respectively; the third child is booked for decannulation at age 12 months. Although these children have required multiple reoperations, they are all presently doing well with an average of 4 years of follow-up. CONCLUSIONS: patients with giant omphalocele have associated pulmonary hypoplasia, which limits the ability to reduce the abdominal contents. Absorbable mesh coverage followed by split-thickness skin graft or skin flap coverage provides a viable biological coverage and minimizes ongoing pulmonary morbidity. The authors recommend a minimally aggressive attempt at sac reduction in the initial treatment of giant omphalocele and, if necessary, the use of absorbable mesh as a staged coverage with subsequent split-thickness skin grafting to minimize the pulmonary effects of the abdominal operation.- - - - - - - - - - ranking = 1.4keywords = giant (Clic here for more details about this article) |
8/39. Management of giant omphalocele in a premature low-birth-weight neonate utilizing a bedside sequential clamping technique without prosthesis.Management of giant omphalocele in a full-term neonate is a challenging clinical situation. Even more challenging is giant omphalocele in a premature low-birth-weight infant. The authors describe a successful staged noninvasive technique for the management of giant omphalocele in a premature, low-birth-weight neonate without the use of prosthetic material until delayed primary closure could be attempted.- - - - - - - - - - ranking = 1.4keywords = giant (Clic here for more details about this article) |
9/39. The use of tissue expanders in the closure of a giant omphalocele.Giant omphalocele is associated with a high degree of visceroabdominal disproportion, which prohibits safe primary closure. Conventional treatment options include (1) topical therapy with epithelialization followed by secondary ventral hernia repair and (2) staged reduction using a SILASTIC(R) (Dow Corning, Midland, MI) chimney. The authors report a case in which staged reduction of a giant omphalocele was facilitated by the use of crescent-shaped tissue expanders positioned in the potential space between the internal oblique and transversus abdominis layers of the abdominal wall.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/39. Novel use of acellular dermal matrix in the formation of a bioprosthetic silo for giant omphalocele coverage.A case report is presented on the utilization of an acellular dermal matrix in the formation of a biologic silo conducive to early epithelial grafting in the treatment of a giant omphalocele associated with cloacal exstrophy.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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