Giant omphalocele repair using external abdominal wall traction: A case report

Viscero-abdominal disproportion is a major limiting factor for primary abdominal wall closure in patients with giant omphalocele. The application of fascial traction has been shown to be an effective strategy to overcome this disproportion, thereby facilitating delayed primary closure in these patients. We report a male newborn with a prenatal diagnosis of omphalocele and no other anomalies. He was delivered by cesarean section at 37+1 weeks of gestation with a birth weight of 3740 g. The abdominal wall defect measured 5.8 cm and contained more than 75% of the liver. Surgery was performed under general anesthesia two hours after birth. After sterile preparation, the omphalocele sac was excised at skin level, and the fascia was circumferentially exposed. Primary closure was not feasible due to viscero-abdominal disproportion; therefore, a Shuster plasty combined with abdominal wall traction was performed. A silicone sheet was sutured to the fascia and skin to create a temporary silo. Continuous traction was applied using fasciotens®Pediatric, a novel fascial traction device. The traction force was set at 750 g (20% of body weight) and maintained for four days while the patient remained sedated and mechanically ventilated. On day four, tension-less abdominal wall closure was successfully achieved. The patient has completed one year of follow-up without any significant adverse events. All key operative steps are illustrated in an intraoperative video. The application of external abdominal traction as described in this case appears to be a safe and effective adjunct for the closure of omphaloceles.