Work-up for associated anomalies must still be performed. This should include a
cardiac echocardiogram, renal ultrasound, and chromosomal studies.
Operative Considerations
If the defect is small (3cm or less), primary closure can be achieved easily.
Consider getting an Upper GI study to define whether the baby’s mesentery is narrow
and therefore whether volvulus is likely.
Giant omphalocoeles cannot be closed primarily in the newborn period. Keeping
the omphalocoele itact creates a biologic dressing much better than artificial dressings
such as PTFE. The omphalocoele membrane is ‘scarified” by application of ¼ strength
betadine paint (mixed with saline) here in CHW. Other hospitals may use silavadene.
The dressing is changed daily. The membrahe hardens and epithelializes. Closure is
done in one or several stage(s) when the baby is one year of age. A Ladd’s procedure
is done at this time, if the baby has no feeding problems. The baby with giant
omphalocoele is often able to breathe without support and eat without any problems.
REMEMBER that omphalocoele babies all have malrotation, so feeding problems
should be seriously considered –ie. Upper GI to rule out volvulus.
If an omphalocele is closed in the early newborn period, specific attention should
be paid when the globular liver is placed in the abdomen. The hepatic veins are longer
than normal in these patients and replacement of the liver in the abdomen can kink
these veins causing hemodynamic compromise. This can occur in the operating room or
hours after the operation. In addition, replacing all the viscera in the abdomen (with or
without a patch) can cause an abdominal compartment syndrome to develop. This