American Association of Plastic Surgeons
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Pediatric Omphalocele Repair: A 26-Year Single Surgeon Consecutive Case Series.
Sameer Shakir, MD1, Mychajlo Kosyk, BA2, Sammy Othman, MD1, Said Azoury, MD1, Holly Hedrick, MD2, David Low, MD2.
1University of Pennsylvania, Philadelphia, PA, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PURPOSE: The purpose of this study was to analyze long-term outcomes following pediatric omphalocele repair.
METHODS: A retrospective review was performed of all consecutive subjects undergoing pediatric omphalocele repair between 1994 and 2019. The standardized treatment plan involved neonatal mesh repair for smaller defects (<5 cm) and staged reconstruction with tissue expansion and mesh reinforced fascial repair for larger defects (>5 cm).
RESULTS: Forty-one subjects were included. Nearly half (46.3%) presented with cardiac anomalies. Fascial defect size was >5 cm in 73.3% of subjects with a median defect area of 114.5 cm2 [interquartile range: 60, 200]. Median age at expander placement was 4.1 years [0.7, 7.5] with median time from placement to fascial repair of 249 days [149, 3,902]. An average of 2 expanders were utilized with total fill volume of 305 mL [250, 500]. Anterior component separation was utilized in 27.8% of subjects while 83.8% underwent primary fascial closure. Length of ICU and hospital stay averaged 3 days [0, 9.5] and 19 days [12, 40], respectively. Median follow-up was 3.6 years (range: 0.1, 17.9). There were 5 subjects who developed expander-related complications including infection/extrusion. Complications following fascial repair included cardiac arrest (n=1), abdominal compartment syndrome (n=2), delayed healing (n=2), mesh exposure (n=2), and mortality (n=1). The recurrence and re-operative rates were 4.9% (n=2) and 12.8%, respectively.
CONCLUSION: Reconstruction of large omphalocele defects using tissue expansion and mesh implantation offers a durable solution, with low recurrence. Although rare, families should be counseled regarding potential devastating complications in this high-risk group.


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