Year 2018 Vol. 26 No 5




Republican Scientific and Practical Center for Pediatric Surgery, Minsk,
The Republic of Belarus

The review describes various options of classical and modern techniques of surgical treatment of congenital malformation of the anterior abdominal wall the giant omphalocele. The main existing techniques are presented, such as primary, staged and delayed closure of the defect. Particular attention is paid to such perspective areas of the staged surgical treatment as vacuum-assisted closure, using of tissue expanders and systems with active external traction. The advantages and disadvantages of each technique are indicated and a comparative analysis of their effectiveness is carried out. Examples of new surgical options for correction of the malformation are presented, based on the achievements of modern bioengineering researches and innovative technologies. The prospects of the using the biodegradable biomaterials, such as Alloderm and submucosal layer of the small intestine for reconstruction of the abdominal wall and primary closure of the defect are analyzed. The review details various approaches of reconstructive surgical treatment of large abdominal wall defects in older children after the formation of ventral hernia in newborns. The application experience of the component separation technique (CST) for abdominoplasty in the period of newborns and older age is analyzed, and also the ways to improve the cosmetic and physiological results of the treatment are outlined.

Keywords: giant omphalocele, newborn, abdominal wall defect, surgical treatment, staged defect closure, delayed defect closure
p. 594-604 of the original issue
  1. Akinkuotu AC, Sheikh F, Olutoye OO, Lee TC, Fernandes CJ, Welty SE, Ayres NA, Cass DL. Giant omphaloceles: surgical management and perinatal outcomes. J Surg Res. 2015 Oct;198(2):388-92. doi: 10.1016/j.jss.2015.03.060
  2. Buinewicz J, Laub D Jr. Giant omphalocele treated with intramuscular tissue expansion. Eplasty. 2014 Jan 16;14:ic3. eCollection 2014.
  3. Ein SH, Langer JC. Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience. J Pediatr Surg. 2012 Mar;47(3):494-500. doi: 10.1016/j.jpedsurg.2011.08.014
  4. Kumar HR, Jester AL, Ladd AP. Impact of omphalocele size on associated conditions. J Pediatr Surg. 2008 Dec;43(12):2216-19. doi: 10.1016/j.jpedsurg.2008.08.050
  5. Campos BA, Tatsuo ES, Miranda ME. Omphalocele: how big does it have to be a giant one? J Pediatr Surg. 2009 Jul;44(7):1474-75; author reply 1475. doi: 10.1016/j.jpedsurg.2009.02.060
  6. Harjai MM, Bhargava P, Sharma A, Saxena A, Singh Y. Repair of a giant omphalocele by a modified technique. Pediatr Surg Int. 2000;16(7):519-21. doi: 10.1007/s003839900331
  7. van Eijck FC, de Blaauw I, Bleichrodt RP, Rieu PN, van der Staak FH, Wijnen MH, Wijnen RM. Closure of giant omphaloceles by the abdominal wall component separation technique in infants. J Pediatr Surg. 2008 Jan;43(1):246-50. doi: 10.1016/j.jpedsurg.2007.09.051
  8. van Eijck FC, Aronson DA, Hoogeveen YL, Wijnen RM. Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors. J Pediatr Surg. 2011 Mar;46(3):482-88. doi: 10.1016/j.jpedsurg.2010.08.050
  9. Zama M, Gallo S, Santecchia L, Bertozzi E, Zaccara A, Trucchi A, Nahom A, Bagolan P, De Stefano C. Early reconstruction of the abdominal wall in giant omphalocele. Br J Plast Surg. 2004 Dec;57(8):749-53. doi: 10.1016/j.bjps.2004.05.021
  10. Saxena AK, van Tuil C. Delayed three-stage closure of giant omphalocele using pericard patch. Hernia. 2008 Apr;12(2):201-3. doi: 10.1007/s10029-007-0264-x
  11. Zaccara A, Zama M, Trucchi A, Nahom A, De Stefano F, Bagolan P. Bipedicled skin flaps for reconstruction of the abdominal wall in newborn omphalocele. J Pediatr Surg. 2003 Apr;38(4):613-15. doi: 10.1053/jpsu.2003.50133
  12. De Ugarte DA, Asch MJ, Hedrick MH, Atkinson JB. The use of tissue expanders in the closure of a giant omphalocele. J Pediatr Surg. 2004 Apr;39(4):613-15. doi: 10.1016/j.jpedsurg.2003.12.022
  13. Kapfer SA, Keshen TH. The use of human acellular dermis in the operative management of giant omphalocele. J Pediatr Surg. 2006 Jan;41(1):216-20. doi: 10.1016/j.jpedsurg.2005.10.093
  14. Parida L, Pal K, Al Buainain H, Elshafei H. Staged closure of giant omphalocele using synthetic mesh. APSP J Case Rep. 2014 Sep-Dec;5(3):27. eCollection 2014 Sep.
  15. Alaish SM, Strauch ED. The use of Alloderm in the closure of a giant omphalocele. J Pediatr Surg. 2006 Mar;41(3):e37-39. doi: 10.1016/j.jpedsurg.2005.12.067
  16. Jiang W, Zhang J, Lv X, Lu C, Chen H, Xu X, Tang W. Use of small intestinal submucosal and acellular dermal matrix grafts in giant omphaloceles in neonates and a rabbit abdominal wall defect model. J Pediatr Surg. 2016 Mar;51(3):368-73. doi: 10.1016/j.jpedsurg.2015.08.005
  17. Martin AE, Khan A, Kim DS, Muratore CS, Luks FI. The use of intraabdominal tissue expanders as a primary strategy for closure of giant omphaloceles. J Pediatr Surg. 2009 Jan;44(1):178-82. doi: 10.1016/j.jpedsurg.2008.10.031
  18. Sönmez K, Onal E, Karabulut R, Turan O, T ürkyilmaz Z, Hirfanoğlu I, Kapisiz A, Başaklar AC. A strategy for treatment of giant omphalocele. World J Pediatr. 2010 Aug;6(3):274-77. doi: 10.1007/s12519-010-0016-3
  19. Schuster SR. A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet. 1967 Oct;125(4):837-50.
  20. Pacilli M, Spitz L, Kiely EM, Curry J, Pierro A. Staged repair of giant omphalocele in the neonatal period. J Pediatr Surg. 2005 May;40(5):785-88. doi: 10.1016/j.jpedsurg.2005.01.042
  21. Lee SL, Beyer TD, Kim SS, Waldhausen JH, Healey PJ, Sawin RS, Ledbetter DJ. Initial nonoperative management and delayed closure for treatment of giant omphaloceles. J Pediatr Surg. 2006 Nov;41(11):1846-49. doi: 10.1016/j.jpedsurg.2006.06.011
  22. Hong AR, Sigalet DL, Guttman FM, Laberge JM, Croitoru DP. Sequential sac ligation for giant omphalocele. J Pediatr Surg. 1994 Mar;29(3):413-15. doi: 10.1016/0022-3468(94)90581-9
  23. Shinohara T, Tsuda M. Successful sequential sac ligation for an unruptured giant omphalocele: report of a case. Surg Today. 2006 Aug;36(Is 8):707-709. doi: 10.1007/s00595-006-3223-8
  24. Almond SL, Goyal A, Jesudason EC, Graham KE, Richard B, Selby A, Losty PD. Novel use of skin substitute as rescue therapy in complicated giant exomphalos. J Pediatr Surg. 2006 Mar;41(3):e1-2. doi: 10.1016/j.jpedsurg.2005.11.085
  25. Archer LP, Billmire DA, Falcone JrRA, Warner BW. Reconstruction of an acquired abdominal wall defect in a neonate using acellular human dermis. Plast Reconstr Surg. 2006 Dec;118(Is 7):163e-166e. doi: 10.1097/01.prs.0000232215.59089.e8
  26. Gabriel A, Gollin G. Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy. J Pediatr Surg. 2006 Nov;41(11):1836-40. doi: 10.1016/j.jpedsurg.2006.06.050
  27. Reimer MW, Yelle JD, Reitsma B, Doumit G, Allen MA, Bell MS. Management of open abdominal wounds with a dynamic fascial closure system. Can J Surg. 2008 Jun;51(3):209-14.
  28. Baird R, Gholoum S, Laberge JM, Puligandla P. Management of a giant omphalocele with an external skin closure system. J Pediatr Surg. 2010 Jul;45(7):E17-20. doi: 10.1016/j.jpedsurg.2010.05.004
  29. DeLuca FG, Gilchrist BF, Paquette E, Wesselhoeft CW, Luks FI. External compression as initial management of giant omphaloceles. J Pediatr Surg. 1996 Jul;31(7):965-67. doi: 10.1016/S0022-3468(96)90423-6
  30. Patkowski D, Czernik J, Baglaj SM. Active enlargement of the abdominal cavitya new method for earlier closure of giant omphalocele and gastroschisis. Eur J Pediatr Surg. 2005 Feb;15(1):22-25. doi: 10.1055/s-2004-830542
  31. Morabito A, Owen A, Bianchi A. Traction-compression-closure for exomphalos major. J Pediatr Surg. 2006 Nov;41(11):1850-53. doi: 10.1016/j.jpedsurg.2006.06.044
  32. Kilbride KE, Cooney DR, Custer MD. Vacuum-assisted closure: a new method for treating patients with giant omphalocele. J Pediatr Surg. 2006 Jan;41(1):212-15. doi: 10.1016/j.jpedsurg.2005.10.003
  33. Binet A, Gelas T, Jochault-Ritz S, Noizet O, Bory JP, Lefebvre F, Belouadah M, James-Robert I, Aubert D, Bouche-Pillon Persyn MA, Poli-Merol ML, François-Fiquet C. VAC therapy a therapeutic alternative in giant omphalocele treatment: a multicenter study. J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):e373-75. doi: 10.1016/j.bjps.2013.05.010
  34. Verlende P, Zoltie N. A new surgical approach to exomphalos. Br J Plast Surg. 1990 Mar;43(2):241-43. doi: 10.1016/0007-1226(90)90169-Z
  35. Adetayo OA, Aka AA, Ray AO. The use of intra-abdominal tissue expansion for the management of giant omphaloceles: review of literature and a case report. Ann Plast Surg. 2012 Jul;69(1):104-8. doi: 10.1097/SAP.0b013e31822128f5
  36. 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 Apr;41(4):704-9; discussion 704-9. doi: 10.1016/j.jpedsurg.2005.12.013
  37. Mehrabi V, Mehrabi A, Kadivar M, Soleimani M, Fallahi A, Khalilzadeh N. Staged repair of giant recurrent omphalocele and gastroschesis camel-litter method-a new technique. Acta Med Iran. 2012;50(6):388-94.
  38. Gross RE. A new method for surgical treatment of large omphaloceles. Surgery. 1948 Aug;24(2):277-92.
  39. Grob M. Conservative Treatment of Exomphalos. Arch Dis Child. 1963 Apr;38(198):148-50.
  40. Oquendo M, Agrawal V, Reyna R, Patel HI, Emran MA, Almond PS. Silver-impregnated hydrofiber dressing followed by delayed surgical closure for management of infants born with giant omphaloceles. J Pediatr Surg. 2015 Oct;50(10):1668-72. doi: 10.1016/j.jpedsurg.2015.06.011
  41. Kouame BD, Odehouri Koudou TH, Yaokreh JB, Sounkere M, Tembely S, Yapo KG, Boka R, Koffi M, Dieth AG, Ouattara O, da Silva A, Dick R. Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years experience. Afr J Paediatr Surg. 2014 Apr-Jun;11(2):170-73. doi: 10.4103/0189-6725.132825
  42. Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP, Kumar V. Non-operative management of giant omphalocele with topical povidone-iodine and powdered antibiotic combination: early experience from a tertiary centre. Pediatr Surg Int. 2014 Apr;30(4):407-11. doi: 10.1007/s00383-014-3479-9
  43. Sakellaris G, Petrakis I, Vlazakis S, Kakavelakis K, Vasiliou M, Antipas S, Ntolatzas T. Management of neglected giant omphalocele with Gore-tex in a child aged 8 years. Minerva Pediatr. 2002 Oct;54(5):455-58.
  44. Mali VP, Prabhakaran K, Patankar JZ. Management of ventral hernia after giant exomphalos with external pressure compression using helmet device. J Pediatr Surg. 2004 Aug;39(8):e1-4. doi: 10.1016/j.jpedsurg.2004.04.041
  45. Ramirez OM, Ruas E, Dellon AL. Components separation method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519-26.
  46. Wijnen RM, van Eijck F, van der Staak FH, Bleichrodt RP. Secondary closure of a giant omphalocele by translation of the muscular layers: a new method. Pediatr Surg Int. 2005 May;21(5):373-76. doi: 10.1007/s00383-005-1387-8
  47. van Eijck FC, van Vlimmeren LA, Wijnen RM, Klein W, Kruijen I, Pillen S, Nijhuis-van der Sanden MW. Functional, motor developmental and long-term outcome after the component separation technique in children with giant omphalocele: a case control study. J Pediatr Surg. 2013 Mar;48(3):525-32. doi: 10.1016/j.jpedsurg.2012.08.010
  48. Levy S, Tsao K, Cox CS Jr, Phatak UR, Lally KP, Andrassy RJ. Component separation for complex congenital abdominal wall defects: not just for adults anymore. J Pediatr Surg. 2013 Dec;48(12):2525-29. doi: 10.1016/j.jpedsurg.2013.05.067
  49. Pereira RM, Tatsuo ES, Simoes e Silva AC, Guimarães JT, Paixão RM, Lanna JC, Miranda ME. New method of surgical delayed closure of giant omphaloceles: Lazaro da Silvas technique. J Pediatr Surg. 2004 Jul;39(7):1111-15. doi: 10.1016/j.jpedsurg.2004.03.064
  50. Kruit AS, Al-Ani SA, Jester I, Jester A. Multilayered flap technique: a method for delayed closure of giant omphalocele. Ann Plast Surg. 2016 Jun;76(6):680-83. doi: 10.1097/SAP.0000000000000589
Address for correspondence:
220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Scientific and Practical
Center for Pediatric Surgery,
Pediatric Surgery Unit,
Tel. mobile: +375 29 141 91 29,
Andrei V. Zapalianski
Information about the authors:
Zapalianski Andrei V., PhD, Pediatric Surgeon, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
Kandratsyeva Volha V., PhD, Pediatric Surgeon, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
Svirsky Aliaksandr A., PhD, Associate Professor, Head of the Pediatric Surgery Unit, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
Contacts | ©Vitebsk State Medical University, 2007-2023