WOFAPS 2025 8th World Congress of Pediatric Surgery

Lucas Moratilla-Lapeña, Jose Luis Encinas, María del Carmen Sarmiento, Miriam Miguel-Ferrero, Mercedes Diaz, Juan Carlos Lopez Gutierrez, M. Mar Rodrigo Hierro, Ester Sánchez Muñoz, Francisco Hernandez-Oliveros

Hospital Universitario La Paz

Introduction:
The management of giant omphalocele (GO) remains challenging. While recent techniques have improved fascial closure rates, it is not always feasible. We present the first cases using absorbable biosynthetic meshes (ABMs) as a therapeutic alternative.

Case presentation:
In the first case, a patient with GO and pulmonary hypoplasia required delayed closure at 18 months after two sessions of botulinum toxin. The initial fascial defect measured 25 × 20 cm and was reduced to 15 × 15 cm during the first procedure, when an ABM was placed. A second surgery with progressive traction reduced the defect to 6 × 10 cm without intestinal adhesions. Complete closure remained unfeasible, so ABM was again used, achieving satisfactory aesthetic and functional results.
In the second case, early closure was attempted using a non-surgical silo, which had to be converted to a conventional silo after amniotic rupture. Fascial closure was not achieved following visceral reduction, and an ABM was used. However, the patient developed compartment syndrome eight days after closure, requiring abdominal decompression. Subsequently, a high-output enteroatmospheric fistula and complete thrombosis of the superior cava vein developed, leading to a limitation of therapeutic efforts due to the case’s complexity.

Conclusions:
ABMs have shown effectiveness in complex abdominal wall management in adults and may offer a promising alternative in GO cases where fascial closure is not possible.