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

Space: StayCurrentMD Author: Lizzy Lee,PA-C Published: 2026-02-04

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Lizzy Lee,PA-C

General Surgery

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Introduction to Giantombalocele Management

This chapter introduces the management of giantombalocele, discussing the study of 117 infants and the comparison of four treatment approaches, highlighting the effectiveness of the Duoderm silo.

Topic overview

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.

Intended audience: Healthcare professionals and clinicians.

Categories

Specialty

General Surgery Pediatric Surgery

Care Context

Operating Room

Population

Pediatric

Topic Format

In-depth Reviews Technique Videos/OP Notes Work-up and Treatment

Clinical Task

Management

Keywords

giantombalocele infants treatment approaches Duoderm silo operative silos compression techniques abdominal closure surgical outcomes complications neonatal care pediatric surgery clinical study surgical techniques postoperative care abdominal wall defects infant surgery healthcare medical research surgical management patient outcomes

Hashtags

#Giantombalocele #PediatricSurgery #NeonatalCare #DuodermSilo #SurgicalTechniques #InfantHealth #AbdominalClosure #ClinicalStudy #Healthcare #SurgicalOutcomes #PostoperativeCare #MedicalResearch #AbdominalWallDefects #InfantSurgery #Complications #TreatmentApproaches #SurgicalManagement #PatientOutcomes #CompressionTechniques #OperativeSilos

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Speaker: Lizzy Lee,PA-C

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