Immediate Transumbilical Repair and Umbilical Plasty for Omphalocele Minor

Background/Purpose: Omphalocele is a congenital midline abdominal wall defect that results in herniation of intraabdominal contents. Omphaloceles are classified into minor if the diameter of the umbilical defect is less than 5cm or major if more. The objective of this study was to present our experience in treatment of omphalocele minor and to review the literature. Material and Methods: Over an 8 years period, 38 patients, 20 males and 18 females, with omphalocele minor were treated at pediatric surgery unit, Assiut children university hospital. 26 patients presented the same day of birth and 12 cases presented the following days Diagnosis was done on clinical basis, antenatal diagnosis Proved only in 13. The sac was intact in 33 cases and ruptured sac in 5 cases, one of them had a faecal discharge through a patent vitellointestinal duct.All patients except 4 were passing meconium preoperatively. All patients were prepared for emergency surgery the day of presentation. Results: 38 patients were operated upon. 3 patients had associated anomalies, one patient had polydactyl, and distal penile hypospadius, one patient had patent vitellointestinal duct and one patient had ileal atresia type 2. There was no associated anomalies that could contraindicate surgery or anaesthesia. The mean operative time was 65 minutes. Most patients passed stool and started oral feeding within 24 hours and discharged within 24-48 hours. Minor complications have occurred in 3 patients. Conclusion: •Prenatal diagnosis of omphalocele is recommended to detect associated foetalanomalies for and to preparefor post natal management. •Babies with omphaloceles must be examined thoroughly for other congenital anomalies. •Careful inspection of the base of umbilical cord should be done prior to clamping of the cord because of the possible association of exomphalos minor and a patent vitellointestinal duct. •Immediate repair of omphalocele minor is the recommrnded treatment, especially for patients who have irreducible contents, ruptured sac and associated other intestinal anomalies. •A purse string repair and umbilical plasty is recommended for treatment of omphalocele minor. •Omphalocele minor has a good prognosis even in delayed presented cases or associated anomalies.