A Multi-Institutional Comparison of Management Techniques for Infants with Giant Omphalocele

PURPOSE: Giant omphaloceles (GO) are uncommon with no consensus on treatment strategy. Placement of a DuoDerm® silo (DDS) is a novel management technique. We sought to identify optimal approach by comparing outcomes of patients who underwent DDS placement, paint and wait (P&W), operative silo placement (OSP), or alternative compression techniques (ACT).

METHODS: A multi-institutional retrospective review between 7/1/2012-5/31/2023 of patients with GO (fascial defect > 5 cm). Patients were identified via ICD codes and chart review.

RESULTS: There were 117 children with GO from nine centers. Twelve children (10%) were managed with DDS, 83 (71%) with P&W, 11 (9%) with OSP, and 11 (9%) with ACT. Patients in the OSP group were more likely to have a torn or ruptured sac (p < 0.001) but there was no difference in number of organs present in the sac (p = 0.22). There was no difference in percentage of patients with fascial closure between groups (p = 0.16). Age at fascial closure was lowest in the OSP group (0.6 months) followed by the DDS group (1.5 months) (p = 0.003). Patients in the DDS group had the highest rate of primary fascial closure (9, 82%), followed by the P&W (49, 78%), OSP (4, 40%), and ACT (2, 20%) (p < 0.001). Forty-three patients (37%) experienced a complication, equal between groups (p = 0.71).

CONCLUSIONS: Half the infants in our cohort did not achieve fascial closure until ≥6 months. While median time to fascial closure was lowest for OSP, patients with DDS placement achieved the highest rate of primary fascial closure. Further research could help optimize patient selection for GO closure strategy.

STUDY TYPE: retrospective observational cohort LEVEL OF EVIDENCE: Level 4.