Omphalocele: clinical review and surgical experience using dura patch grafts

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 6; no. 2; pp. 73 - 78
• Main Authors: SAXENA, A. K, WILLITAL, G. H
• Format: Journal Article
• Language: English
• Published: Paris Springer 2002; Springer Nature B.V
• Subjects: Abdomen; Biological and medical sciences; Birth Weight; Dura Mater - transplantation; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gestational Age; Hernia, Umbilical - complications; Hernia, Umbilical - mortality; Hernia, Umbilical - surgery; Humans; Infant, Newborn; Male; Malformations; Medical sciences; Treatment Outcome; Human; Prognosis; Plastic surgery; Review; Surgical closure; Newborn; Malformation; Abdominal disease; Abdominal wall; Dura mater; Graft; Omphalocele; Patch; Bibliographic review
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-002-0058-0

Over a period of 15 years we surgically treated 50 cases of omphaloceles. The pathology occurred more frequently in boys (n = 30) than in girls (n = 20). The mean birth weight was 2995 g and mean gestational age was 38 weeks. Four infants (8%) were delivered vaginally and the rest (92%) by cesarian section. Eleven infants (22%) underwent primary closure, but in 20 infants (40%) with larger defects a primary closure of the skin was possible; however, a single solvent-dried dura graft implant was employed for the fascia enlargement. The remaining 19 infants (38%) had extremely large defects, and optimal closure of the defect required a two layered graft implantation. Twenty-five infants (50%) had associated anomalies, the majority being congenital cardiac anomalies. Five patients (10%) required secondary laparotomies due to bowel associated complications. Four patients (8%) experienced non-bowel-associated complications. The average postoperative mechanical ventilation required was for a period of 3.2 days and the average hospital stay was 45.7 days. The overall mortality rate was 8% (n = 4) and was largely due to severe congenital heart anomalies. Solvent-dried dura was successfully employed in the management of the larger defects with no major complications; only one patient (2%) had a local abscess around the area of the implant and was managed conservatively. Our experience favors the employment of solvent-dried dura graft implants for the repair of large omphaloceles. The solvent-dried dura grafts are biomaterials that promote rapid scar formation and integration with the adjacent skin tissue and do not produce any foreign body reactions at the site of implantation.