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Definition Return to top
Omphalocele repair corrects a birth defect in which all or parts of the small intestine, liver, and large intestine are on the outside of the abdomen and enclosed in a membranous sac at birth. This procedure is similar to gastroschisis repair.
Omphalocele is frequently associated with other birth defects, such as heart defects, imperforate anus, urinary problems, and some genetic conditions. Omphalocele is similar to gastroschisis, except that the protruding organs are enclosed in a sac.
Gastroschisis and omphalocele are frequently diagnosed before birth by ultrasound examinations.
Description Return to top
Surgical repair of abdominal wall defects involves placing the abdominal organs back into the abdomen through the defect and repairing the defect if possible. If immediate replacement is not possible, a sterile pouch is created to protect the intestines while they are gradually pushed back into the abdomen over a period of time.
Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A nasogastric tube (NG tube) is inserted through the baby's nose or mouth into the stomach to keep the stomach empty. This prevents choking on or breathing stomach contents into the lungs (aspiration). The surgery is done as soon as the infant is stable.
While the baby is under general anesthesia, an incision is made to remove the sac membrane. The intestine is examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges are stitched together.
A tube may be inserted into the stomach (gastrostomy tube) and out through the skin.
If possible, the organs are replaced into the abdominal cavity and the incision closed. If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch will be made from a sheet of plastic (silo) to cover and protect the organs. Complete closure may be done over a few weeks.
Surgery may be necessary to repair the abdominal muscles at a later time.
The baby's abdominal cavity may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties. The infant may require the use of a ventilator for a few days or weeks until the swelling of the organs has decreased and the size of the abdomen has increased.
Indications Return to top
Omphalocele is a life-threatening event requiring immediate intervention. The infant may be born underweight (small for gestational age) due to stress from this condition before birth.Risks Return to top
Risks for any anesthesia include the following:Expectations after surgery Return to top
This defect can be corrected with surgery in most cases. The outcome depends on the amount of damage to or loss of intestine. Omphalocele is often associated with other congenital (present from before birth) defects that may influence the patient's prognosis.Convalescence Return to top
The infant will be cared for postoperatively in a neonatal intensive care unit (NICU). The patient is placed in an isolette (incubator) to provide warmth and prevent infection. Oxygen is given and mechanical ventilation is often required. Intravenous fluids, antibiotics, and pain medications will be given as needed.
A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly, and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement.
Update Date: 2/10/2003 Updated by: James P. Dolan, M.D., Department of Surgery, University of California, San Francisco, San Francisco, CA. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |