# A multi-institutional comparison of management techniques for infants with giant omphalocele — GCMD Library

<i>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</i><div><i><br></i></div><div><b>Purpose: </b>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).</div><div><br></div><div><b>Methods:</b> 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.</div><div><br></div><div><b>Results:</b> 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).</div><div><b><br></b></div><div><b>Conclusions: </b>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.</div>

Type: video · 0 min · posted 2026-02-04
Canonical: https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457

## Chapters
- [0:00](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=0) Comparison of Giant Omphalocele Management Techniques

## Statements
- "The study examined 117 infants with giant omphalocele" — Lizzie Lee (epidemiological) [0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Four treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo" — Lizzie Lee (clinical) [0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Babies treated with Duoderm silo were most likely to have their abdomen closed in one surgery" — Lizzie Lee (clinical) [0:19](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=19)
- "Approximately 80% of infants treated with Duoderm silo achieved single-surgery abdominal closure" — Lizzie Lee (clinical) [0:24](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=24)
- "Some babies treated with operative silos achieved closure sooner than other methods" — Lizzie Lee (clinical) [0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Complication rates were similar across all four management methods" — Lizzie Lee (clinical) [0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Almost half of infants required 6 months or more before complete abdominal closure could be achieved" — Lizzie Lee (clinical) [0:32](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=32)
- "There is no universal best treatment approach for giant omphalocele" — Lizzie Lee (opinion) [0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)
- "Duoderm silos may be particularly beneficial when the goal is single-stage abdominal closure" — Lizzie Lee (opinion) [0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)

## Transcript
What's the best way to manage a giantombalocele? I'm Lizzie Lee from Cincinnati Children's, and this is an article you should know about. This study looked at 117 infants and compared 4 different treatment approaches, paint and weight, operative silos, compression techniques, and a newer option, the Duoderm silo. Here's the big take. Babies treated with the duoderm silo were most likely to have their abdomen closed in one surgery. About 8 out of 10 did. Some babies who had operative silos were closed sooner, but overall, the chance of complications was about the same, no matter which method was used. Almost half of the babies needed 6 months or more before the abdomen could be fully closed. So what does this mean? There's no one size fits all treatment, but Duoderm silos may be a really good option for certain babies, especially when the goal is closing the abdomen in one step. Let us know what you think in the comments below and stay tuned for more articles that you should know about.

---
Not medical advice · citation policy: https://library.globalcastmd.com/ai