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Omphalocele repair
Definition Omphalocele repair is surgery to repair a birth defect in which all or parts of the small intestine, liver, and large intestine stick outside of the abdomen. For information on the condition itself, see: Omphalocele Description The procedure is similar to gastroschisis repair. The goal of surgery is to place the abdominal organs back into the body and to repair the defect, if possible. If this can not be done immediately, a sac is created to hold and protect the intestines, which are slowly pushed back into the abdomen over a few weeks. Immediately after delivery, the baby's exposed organs are covered with warm, moist, sterile dressings. A nasogastric (NG) tube is inserted through the baby's nose or mouth into the stomach to keep the stomach empty. This prevents choking and breathing stomach contents into the lungs. While the baby is under general anesthesia (asleep, no pain), the surgeon makes a cut to remove the sac surrounding the organs. The intestine is examined closely for signs of damage or additional birth defects. Damaged or defective parts are removed and the healthy edges are stitched together. A tube may be inserted into the stomach and out through the skin. Additional surgery may be needed to repair the abdominal muscles at a later time. Indications This surgery is done when a baby is born with an omphalocele. Omphalocele is a life-threatening condition that requires immediate treatment. Risks Risks for any anesthesia include: - Reactions to medications
- Breathing problems
Risks for any surgery include: Additional risks of omphalocele repair include: - Breathing difficulties
- Inflammation of the tissue that lines the wall of the abdomen and covers the abdominal organs
- Organ injury
- Temporary paralysis of the small bowel (if a large part of the small bowel is damaged, there may be problems with digestion and absorption of nutrients)
Expectations after surgery In most cases, surgery can correct the defect. How well the baby does depends on the amount of damage to or loss of intestine, and whether there are additional birth defects. Convalescence After surgery, the infant will be cared for in a hospital's neonatal intensive care unit (NICU). The infant will be placed in a machine called an isolette (incubator) to provide warmth and prevent infection. Placing the organs back into position increases the pressure within the belly area and can cause breathing difficulties. The baby may need to be on a breathing machine until organ swelling has decreased and the size of the belly area has increased. Additional treatments after surgery usually include: - Antibiotics as needed
- Fluids given through a vein
- Oxygen
- Pain medicines as needed
A tube placed through the nose into the stomach will keep the stomach empty. Feedings are started through this tube as soon as bowel function starts again. Feedings are started very slowly, and often infants are slow to feed. The baby may need feeding therapy and lots of encouragement. Review date: 11/2/2007 Reviewed By: Deirdre O'Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children's Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts. Previously reviewed by J.A. Lee, M.D., Assistant Professor of Surgery, Columbia University Medical Center, New York, NY. Reviews provided by VeriMed Healthcare Network. (10/16/2006)
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