Omphalocele repair
Definition
Omphalocele repair is surgery to repair a birth defect in which all or parts of the small intestine, liver, and large intestine stick outside of the abdomen.
This procedure is similar to gastroschisis repair.
Description
Omphalocele is frequently associated with other birth defects, such as heart defects, imperforate anus, urinary problems, and some genetic conditions. It is frequently diagnosed before birth by ultrasound examinations.
The goal of surgery is to place the abdominal organs back into the body and to repair the defect, if possible. If this can not be done immediately, a sac is created to hold and protect the intestines, which are slowly pushed back into the abdomen over a few weeks.
Immediately after delivery, the baby's exposed organs are covered with warm, moist, sterile dressings. A nasogastric (NG) tube is inserted through the baby's nose or mouth into the stomach to keep the stomach empty. This prevents choking and breathing stomach contents into the lungs (aspiration).
The procedure is done under general anesthesia, which means the baby is asleep and feels no pain during surgery. The surgeon makes a cut to remove the sac surrounding the organs. The intestine is examined closely for signs of damage or additional birth defects. Damaged or defective parts are removed and the healthy edges are stitched together.
A tube may be inserted into the stomach (gastrostomy tube) and out through the skin.
Surgery may be necessary to repair the abdominal muscles at a later time.
Placing the organs back into position increases the pressure within the abdominal cavity and can cause breathing difficulties. Breathing help (ventilator) may be needed until swelling of the organs has decreased and the size of the abdominal area has increased.
Why the Procedure is Performed
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
Risks for any anesthesia include:
- Reactions to medications or the anesthetic
- Problems breathing due to anesthesia
Risks for any surgery include:
Additional risks of omphalocele repair include:
If the baby has breathing difficulties, a breathing machine may be needed. If a large part of the small bowel is damaged, there may be problems with digestion and absorption of nutrients.
Outlook (Prognosis)
This defect can be corrected with surgery in most cases. The outcome depends on the amount of damage to or loss of intestine, and whether there are additional birth defects. Omphalocele is frequently associated with other birth defects, such as heart defects, imperforate anus, urinary problems, and some genetic conditions.
Recovery
After surgery, the infant will be cared for in a hospital's neonatal intensive care unit (NICU). The infant will be placed in a machine called an isolette (incubator) to provide warmth and prevent infection.
Additional treatments after surgery usually include:
A tube placed through the nose into the stomach will keep the stomach empty. Feedings are started through this tube as soon as bowel function starts again. Feedings are started very slowly, and often infants are slow to feed. The baby may need feeding therapy and lots of encouragement.
Review Date:
10/16/2006
Reviewed By:
J.A. Lee, M.D., Assistant Professor of Surgery, Columbia University Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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