Management of giant omphaloceles: A systematic review of methods of staged surgical vs. nonoperative delayed closure

Brent Bauman, Daniel Stephens, Hannah Gershone, Connie Bongiorno, Erin Osterholm, Robert Acton, Donavon Hess, Daniel Saltzman, Bradley Segura

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations

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 14.6 days vs 23.5 days. 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.

Original languageEnglish (US)
Pages (from-to)1725-1730
Number of pages6
JournalJournal of Pediatric Surgery
Volume51
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • Betadine
  • Giant omphalocele
  • Neonatal surgery
  • Nonoperative delayed closure
  • Silvadene
  • Staged surgical closure

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