Neonatal & Pediatric Minimally Invasive Surgery

Giant omphalocele (≥5 cm or liver in sac) carries significant morbidity: prolonged time to full feeds, increased TPN dependence, higher rates of chromosomal anomalies and respiratory insufficiency compared to routine omphalocele . Pulmonary hypertension affects the majority (56/97 survivors), typically diagnosed within the first week, though delayed onset after sepsis is well-documented and can be fatal [e2996-c2, e2996-c3, e2996-c4, e13507-c3, e13507-c4]. The sac-preserving active reduction technique using hydrocolloid dressing achieves closure in 97% within 30 days (92% within 15 days) when applied in the first 24 hours; patients remain intubated and paralyzed during reduction [e2996-c5, e2996-c6, e2996-c7, e2996-c8, e13507-c6]. Ruptured sacs can be sutured prior to dressing application [e2996-c9, e13507-c9]. Omphalocele patients have non-rotation/malrotation with higher midgut volvulus risk than gastroschisis; Ladd procedure is indicated if intestines are exposed, though not necessary with sac-preserving techniques [e2996-c11, e2996-c12, e2996-c13, e13507-c10, e13507-c11]. For massive defects unsuitable for hydrocolloid, prolene mesh with plastic bag protection achieves 80% closure within 2–3 months; component separation provides fascial closure in most cases [e2996-c17, e2996-c20, e2996-c22, e13507-c12, e13507-c15, e13507-c16]. Lung hypoplasia may preclude primary closure despite optimal reduction [e13651-c40, e13651-c41].