Brent Bauman1, Daniel Stephens1, Hannah Gershone1, Connie Bongiorno2, Erin Osterholm3, Robert Acton1, Donavon Hess1, Daniel Saltzman1, Bradley Segura4. 1. Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. 2. Health Science Libraries, University of Minnesota, Minneapolis, MN 55455, USA. 3. Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA. 4. Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. Electronic address: bjsegura@umn.edu.
Abstract
PURPOSE: 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. CONCLUSION: 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.
PURPOSE: 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. CONCLUSION: 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: Teresa Victoria; Savvas Andronikou; Diana Bowen; Pablo Laje; Dana A Weiss; Ann M Johnson; William H Peranteau; Douglas A Canning; N Scott Adzick Journal: Pediatr Radiol Date: 2018-03-17
Authors: Nina C J Peters; Annelieke Hijkoop; Rosan L Lechner; Alex J Eggink; Joost van Rosmalen; Dick Tibboel; René M H Wijnen; Hanneke IJsselstijn; Titia E Cohen-Overbeek Journal: Prenat Diagn Date: 2019-08-29 Impact factor: 3.050
Authors: Marcelo C Rombaldi; Caroline G Barreto; Carlos A Peterson; Leandro Totti Cavazzola; Paola M B Santis-Isolan; José Carlos Fraga Journal: Int J Surg Case Rep Date: 2021-03-23