Delayed Primary Closure of Omphaloceles: A Minimal-Invasive Treatment Strategy

For omphaloceles, specially giant ones, different approaches of abdominal wall repair exist. Serious complications can follow staged repair as well as primary closure. We performed a delayed direct closure under stable conditions. Eight patients (gestational age: 26-37 weeks, birth weight: 710-3240 g) with omphalo-celes of different sizes were treated prospectively. The hernial sac was protected by a sterile dressing and gentle upward traction was performed without sedation or anaesthesia. This allowed spontaneous reduction of herniated viscera and liver, before the defect was closed. Seven defects were closed on day 2-14. No serious complications were observed. At follow-up 15-34 months cosmetic results were excellent without ventral hernia. One re-laparotomy for ileus due to adhesions was necessary. The preterm infant with 730 g birth weight died of severe intracranial haemorrhage before the defect could be closed. Present treatment proved to be safe and reliable, even in two giant omphaloceles. Multiple operative procedures as well as prosthetic material were avoided. No infection or abdominal-compartment syndrome occurred. Cosmetic results were very good, no secondary ventral hernia or other long-term complications developed.