WOFAPS 2025 8th World Congress of Pediatric Surgery

Cristobal Abello ¹, Miguel Parra ², Jezid Miranda ², Amiel Pérez ³

¹ Chief of Pediatric Surgery, North Clinic Organization, Barranquilla, Colombia
² Caribbean Institute for Fetal Surgery and Therapy, Barranquilla, Colombia
³ Fetal and Neonatal Surgery Research Group (GICIFEN), Barranquilla, Colombia

Purpose

Giant omphalocele (GO) is defined as a defect exceeding 5 cm or containing more than 50% of the liver. Only 10% of cases are hepato-omphaloceles, which increase morbidity and mortality by up to 30-80%. Traditionally, treatment has involved staged or delayed surgical closure. Myorelaxation using type A botulinum toxin (TxBtA) has been suggested as an additional treatment for complex abdominal wall defects. Its use during pregnancy has been linked to an increase in abdominal capacity of up to 30%. This study aims to describe the clinical evolution of prenatal therapeutic intervention and neonatal and surgical outcomes.

Method

A retrospective cohort analysis was conducted on fetuses diagnosed with a major omphalocele that underwent prenatal administration of TxBtA between 28 and 36 weeks of gestation between 2023 and 2025. The study was conducted following institutional protocols approved by the local ethics committee.

Results

Seven patients were included. The mean time to silo reduction was 1.5 days (1–3) and to amnion inversion was 5 days. Primary closure was achieved at 7 ± 2 days of life. Component separation was performed using the Ramírez technique in 42% of cases. Atelectasis was reported in one instance, no complications related to closure. The mean hospital stay was 12 days (12–32), of which an average of eight days required mechanical ventilation, and one day required systemic relaxation. All patients began enteral nutrition within 15 days (3–14).

Conclusion

The collected data suggest that the prenatal administration of TxBtA is a safe and effective method of improving abdominal capacity in cases of abdominal wall defects such as giant omphalocele. This facilitates primary closure and reduces the time required for silo, with favourable results reflected in length of stay, postnatal complications, and the need for invasive mechanical ventilation and parenteral nutrition.