A multi-institutional comparison of management techniques for infants with giant omphalocele

Infographic · Jan 2026 · 1 min read

In brief

This multi-institutional study compared four management approaches for giant omphaloceles in 117 infants. DuoDerm silo placement achieved the highest primary fascial closure rate (82%), while operative silo had the shortest time to closure. Findings suggest management strategy should be tailored to individual patient characteristics.

DuoDerm silo achieved highest primary fascial closure rate (82%) compared to paint-and-wait (78%), operative silo (40%), and compression (20%)
Operative silo placement resulted in fastest time to closure (0.6 months) but lowest primary closure rate, often requiring patch
Half of giant omphalocele patients required ≥6 months to achieve fascial closure regardless of initial management strategy
Complication rates were equivalent (37%) across all four management approaches for giant omphalocele
Ruptured sac was primary indication for operative silo; DuoDerm silo offers non-operative alternative for intact giant omphaloceles

Written by the GCMD Library team from the infographic.

The infographic uses a teal and yellow color scheme with simple illustrations including a hospital building and a swaddled infant. Data is presented in hierarchical sections with bullet points and percentages. The layout flows from study design at top, through management strategies in the middle, to outcomes and conclusion at bottom.

Alyssa Stetson, Samantha Leonard, Katherine Flynn-O'Brien, Seth Goldstein, Tiffany Wright, Cynthia Downard, Kyle J Van Arendonk, Charles M Leyes, Linda Cherney-Stafford, Karen Speck, Peter C Minneci, Troy A Markel, Shawn D St Peter, Dave Lal, Michael Sobolic, Matthew P Landman, Beth Rymeski; Midwest Pediatric Surgery Consortium

Purpose: Giant omphaloceles (GO) are uncommon with no consensus on treatment strategy. Placement of a DuoDerm® silo (DDS) is a novel management technique. We sought to identify optimal approach by comparing outcomes of patients who underwent DDS placement, paint and wait (P&W), operative silo placement (OSP), or alternative compression techniques (ACT).

Methods: A multi-institutional retrospective review between 7/1/2012-5/31/2023 of patients with GO (fascial defect >5 cm). Patients were identified via ICD codes and chart review.

Results: There were 117 children with GO from nine centers. Twelve children (10 %) were managed with DDS, 83 (71 %) with P&W, 11 (9 %) with OSP, and 11 (9 %) with ACT. Patients in the OSP group were more likely to have a torn or ruptured sac (p < 0.001) but there was no difference in number of organs present in the sac (p = 0.22). There was no difference in percentage of patients with fascial closure between groups (p = 0.16). Age at fascial closure was lowest in the OSP group (0.6 months) followed by the DDS group (1.5 months) (p = 0.003). Patients in the DDS group had the highest rate of primary fascial closure (9, 82 %), followed by the P&W (49, 78 %), OSP (4, 40 %), and ACT (2, 20 %) (p < 0.001). Forty-three patients (37 %) experienced a complication, equal between groups (p = 0.71).

Conclusions: Half the infants in our cohort did not achieve fascial closure until ≥6 months. While median time to fascial closure was lowest for OSP, patients with DDS placement achieved the highest rate of primary fascial closure. Further research could help optimize patient selection for GO closure strategy.

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