WOFAPS 2025 8th World Congress of Pediatric Surgery

Furkan Torala ¹, Ali Ekber Hakalmaz ¹, Pınar Kendigelen ², Anıl Demiröz Uslu ³, Rahşan Özcan ¹

¹ Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery
² Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Anesthesiology
³ Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery

INTRODUCTION:The management of giant omphaloceles with viscero-abdominal disproportion remains challenging and controversial. This article presents the effectiveness of a hybrid technique—combining silo placement, synthetic mesh, and vacuum-assisted closure (VAC)—in a case where standard treatments were insufficient.

CASE PRESENTATION: A male infant was delivered by cesarean section at 37 weeks’ gestation, weighing 3150 grams, with a prenatal diagnosis of a giant omphalocele. The abdominal wall defect measured 5 cm, and the omphalocele sac (8×8×8 cm) contained the entire liver, bowel, stomach, and spleen. Initial management involved compressive moist dressings for 10 days, but these failed to achieve sufficient reduction due to the narrow neck of the defect and liver adhesions.

During surgery, the stomach and spleen were successfully reduced into the abdomen, but the enlarged liver and significant bowel segments could not be accommodated, necessitating silo placement. Despite this, reduction remained incomplete. On postoperative day 24, in collaboration with plastic surgery, fascial repair was performed using a composite dual mesh. However, much of the mesh could not be covered with skin, so VAC therapy was applied to the exposed areas.

By the third postoperative month, there was satisfactory development of the abdominal wall and intraabdominal space. Most of the mesh was removed, allowing for primary repair and skin reconstruction. Thirteen months after birth, the patient is asymptomatic, with normal growth, development, and neurological status.

Conclusion: When conventional silo techniques fail in giant omphaloceles, temporary fascial repair using synthetic mesh combined with VAC wound management can be an effective salvage strategy. This hybrid approach promotes physiologic development of the abdominal wall and cavity, minimizes infection risk when skin coverage is lacking, and enables safe wound healing, facilitating successful delayed primary repair.