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Omphalocele repair is a surgical procedure to close a gap in the abdominal wall. The gap is caused by a birth defect.
Reasons for Procedure
With an omphalocele, the muscles and skin around the belly button do not close completely before the baby is born. As a result, abdominal tissue and organs, like the intestine, may be outside of the abdominal cavity. The misplaced abdominal tissue and organs are enclosed in a sac.
The omphalocele may be small with just a section of intestines or can be large and involve several abdominal organs, including the liver.
Surgery may be done soon after birth or when the baby is strong enough, depending on the size of the defect. The eventual goal of surgery is to put the abdominal tissue back in place, and repair the defect in the abdominal wall. There may be multiple, progressive steps needed to complete this process.
Normal Anatomy of the Abdominal Organs
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Problems from the procedure depend on the size of the defect. Complications may include:
What to Expect
If the gastroschisis is found before birth, a birth plan will be made to decrease the risk of further damage.
After birth, supportive steps before the surgery may include:
- The sac will be protected in a sterile dressing
- If the sac ruptures, the exposed tissue will be wrapped in a plastic device to protect the organs
- IV fluids and nutrition
- Nasogastric tube to help reduce the size of the exposed tissue by removing air from the stomach and intestines
- Watching for complications, such as shock, heat loss, dehydration, or bowel obstruction
The extent of the surgery depends on the size of the omphalocele. When possible, organs and other exposed tissue are placed back into their proper place. The abdominal wall is repaired and stitched.
Intestines may be swollen and difficult to place back into the abdominal cavity or there may not be enough room to fit them all initially. The sac will be covered in a mesh device that will support the structures. Slow tightening of the device will allow the intestines to be gradually pushed back into the abdomen as the abdominal skin grows enough to cover the area. Later surgeries will complete the repairs and close the skin.
The baby will be taken to a recovery room and monitored.
It depends on how much repair is needed.
Anesthesia prevents pain during surgery. Additional medication will be given to relieve pain or soreness during recovery.
The length of stay depends on the extent of the repair needed. Proper feeding, weight gain, and bowel function are needed before the baby can go home. This may take several days or weeks.
At the Hospital
A neonatal intensive care unit will monitor blood pressure, pulse, and breathing. Recovery may also include:
- Pain medications
- Antibiotics to prevent infection
- IV fluids and nutritional support
- Oxygen therapy
- Mechanical ventilation
The hospital staff will take steps to reduce the chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your baby’s incisions covered
There are also steps you can take to reduce your baby’s chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding their healthcare providers to wear gloves or masks
- Not allowing others to touch your baby’s incisions
Recovery may take some time and require a special diet. The doctor will monitor the baby’s growth and overall health to make sure the baby is getting adequate nutrition.
Call Your Doctor
It is important to monitor your baby's recovery after they leave the hospital. Alert your baby's doctor to any problems. If any of the following occur, call your baby's doctor:
- Signs of infection, including fever or chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- New or worsening symptoms
Call for emergency medical service right away if your baby has:
- Difficulty breathing
- Signs of bowel obstruction, such as:
- High fever
- Localized abdominal tenderness
- Abdominal swelling or hardness
- Green or yellow vomit
If you think your baby has an emergency, call for emergency medical services right away.
About Omphalocele. The Children’s Hospital of Philadelphia website. Available as: http://www.chop.edu/conditions-diseases/omphalocele/about#.VPubv46j99k.Updated March 2013. Accessed May 3, 2016.
Facts About Omphalocele. Center for Disease Control and Prevention website. Available as: http://www.cdc.gov/ncbddd/birthdefects/Omphalocele.html. Updated November 17, 2015. Accessed May 3, 2016.
Omphalocele. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 7, 2015. Accessed May 3, 2016.
Last reviewed June 2016 by Michael Woods, MD
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