DELAYED PRIMARY CLOSURE OF GIANT OMPHALOCELE: GRADUAL CLOSED-REDUCTION FOLLOWED BY OPEN FASCIAL CLOSURE
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Abstract
Objectives: To introduce the new technique of gradual closed-reduction followed by open fascial closure and to
assess its clinical outcome in our setup.
Material and Methods: It was a prospective and descriptive study. It was conducted at the Department of Pediatric
Surgery, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from January 2003 to December 2007.
All patients with giant omphalocele (base-diameter more than 5 cm in width) including ruptured ones were first
managed with conservative treatment using mercurochrome (0.5-1%) solution and were then admitted to the hospital
after the age of 06 months. Small omphaloceles were excluded from the study. A thorough clinical examination and
relevant investigations were performed in all patients.
Results: A total of 18 children with giant omphalocele were treated with this technique. There were 10 (55.55%)
female and 8 (44.44%) male patients. Age ranged from 6-24 months. Hospital stay was from 12-15 days. No mortality
was observed and no major complications (abdominal wound dehiscence, compromised venous return, respiratory
discomfort or cyanosis) were seen. Mild wound infection (local erythema and / or purulent discharge) was seen in
3 (16.66%) patients, fever up to 102F0 in 9(50.00%) patients and mild respiratory embarrassment in 5 (27.77%)
patients.
Conclusion: Delayed primary closure of giant omphalocele by this technique is a safe and effective way of treatment
particularly in places where neonatal and pediatric ICU facilities are not available.
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