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Giant omphalocele repair using external abdominal wall traction: A step-by-step surgical video.
Till-Martin Theilen, Yannick Braun, Florian Friedmacher, Henning Fiegel, Udo Rolle
Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
Purpose: Treatment strategies for giant omphalocele include primary closure, delayed primary closure using Schuster plasty, or delayed closure after scarring of the omphalos sac. The approach depends on the degree of viscero-abdominal disproportion, available medical resources, and surgeon preference. This report demonstrates the technical application of fasciotens®Pediatric, an external traction device designed to accelerate abdominal wall closure in cases of delayed primary closure.
Video Method: An intraoperative video illustrates the use of the fasciotens®Pediatric device. The patient was a one-day-old male newborn, delivered by cesarean section at 37+1 weeks of gestation (birth weight 3740 g). A prenatal diagnosis of omphalocele had been made, with no associated genetic, cardiac, or pulmonary anomalies. The abdominal wall defect measured 5.8 cm in width and contained over 75% of the liver.
Results: Surgery was performed under general anesthesia two hours after birth. Following sterile preparation, the omphalocele sac was completely excised at skin level, exposing the fascia circumferentially. A silicone sheet was sutured to the fascia to create a temporary silo. The fasciotens®Pediatric device applied a continuous traction force of 750 g (approximately 20% of body weight) for five days, during which the patient remained sedated and mechanically ventilated. On day five, the patient returned to the operating room for successful, tension-free abdominal wall closure.
Conclusion: External traction using fasciotens®Pediatric is a viable technique for newborns with giant omphalocele. Key procedural steps include full circumferential exposure of the fascia and direct application of traction to both fascia and skin to achieve safe and effective closure.