Definitive surgical management of antenatally diagnosed exomphalos |
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Authors: | Rijhwani Ashok Davenport Mark Dawrant Michael Dimitriou Gabriel Patel Shailesh Greenough Anne Nicolaides Kypros |
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Institution: | a Department of Paediatric Surgery, Kings College Hospital, SE5 9RS London, UK b Department of Neonatology, Kings College Hospital, SE5 9RS London, UK c Harris Birthright Centre for Fetal Medicine, Kings College Hospital, SE5 9RS London, UK |
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Abstract: | Background/PurposeThe management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without problems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our institution using a policy of aggressive abdominal wall closure.MethodsThis is a retrospective review of all infants with exomphalos treated from January 1995 to September 2002.ResultsThere were 35 infants, all of whom underwent surgery. These were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos major) underwent primary closure (n = 13), and group C (exomphalos major) underwent staged closure involving a silo (n = 11). Infants in group C had a lower birth weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P < .001), a longer hospital stay (P = .001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97%) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failure) early after the creation of a silo.ConclusionsAn aggressive surgical approach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly greater resources than other options. |
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Keywords: | Exomphalos Omphalocele Antenatal diagnosis Silo |
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