What is giant omphalocele? Omphalocele is a central congenital abdominal wall defect of variable size that allows various abdominal contents to herniate outside the abdominal cavity. A large defect with herniated liver is referred to as a giant omphalocele. There are many diverse approaches to the management of giant omphalocele, influenced by co-morbidities, gestational age, surgical techniques, available resources, and institutional practice patterns. However, closure of giant omphalocele remains a challenge for pediatric surgeons around the world.
Learning Objective
Around The World in 90 Minutes: Contemporary Approaches to Management of Giant Omphalocele from Six Continents is an international webinar that addressed the challenge of closure of giant omphalocele in an international context by hosting one surgeon from each continent to describe their contemporary approach to treatment of giant omphalocele. Attendees gained knowledge that may enable them to improve the management of giant omphalocele in their own practice.
Faculty will address three areas:
- Describe their practice environment.
- Describe their approach to management of giant omphalocele.
- Present the outcomes of their management approach.
Video Presentations & Faculty
Sherif Emil, MD, CM, FRCSC, FACS, FAAP
McGill University Health Centre, Montreal, Canada
Moderator and Senior Editor of The Hendren Project and Abdominal Wall Defects Section
Dr. Emil is the Mirella and Lino Saputo Foundation Chair in Pediatric Surgical Education and Patient and Family-Centered Care, Associate Chair for Education, and Professor of Pediatric Surgery, Surgery, and Pediatrics at the McGill University Faculty of Medicine and Health Sciences. He is also the Director of the Harvey E. Beardmore Division of Pediatric Surgery at The Montreal Children’s Hospital of The McGill University Health Centre.
An Approach from Las Vegas, NV USA: Early Fascial Closure After Nonoperative Management
Kelly Kogut, MD, FACS
Sunrise Children's Hospital, Las Vegas, NV USA
Dr. Kogut will describe a method that aims to gently reduce the omphalocele while maintaining and recruiting abdominal domain. It is low-tech and gentle, and it maintains normal physiology and feeding, with an ultimate goal of early closure of the abdomen without excessive intra-abdominal pressure.
Dr. Kogut is a member of Pediatric Surgery Associates, a busy group private practice in Las Vegas. She is currently chief of staff of her hospital. She completed medical school at Columbia University, surgery residency at the University of Rochester, and pediatric surgery fellowship at Le Bonheur Children’s Hospital in Memphis, Tennessee.
An Approach from Santiago, Chile: Management with a Simple and Efficient Nonsurgical Silo
Miguel Guelfand, MD, FACS
Infant and Neonatal Surgeon, University of Chile, Santiago, Chile
Dr. Guelfand will demonstrate a very simple nonsurgical silo technique for the management and anatomical closure of giant omphalocele with a single procedure.
Dr. Guelfand trained in pediatric surgery in Santiago Chile. Following his training, he completed a neonatal surgery fellowship at Great Ormond Street Hospital in England under Professor Lewis Spitz, a laparoscopic fellowship in Adelaide, Australia, under Professor Hock Tan, and minimally invasive surgery training in Denver under Professor Steve Rothenberg. His main interests in pediatric surgery are in the fields of minimally invasive and neonatal surgery. He is an Editor at JLAST and JPS and past president of IPEG.
An Approach from Melbourne, Australia: Management with Intra-abdominal Expansion
William Alexander, MB, BS, FRACS
Royal Children's Hospital, Melbourne, Australia
Dr. Alexander will describe a plastic surgical approach to giant omphalocele, consisting of a series of intra-abdominal tissue expanders to increase intra-abdominal domain and volume, allowing for reduction and closure.
Dr. Alexander is a plastic surgeon with subspecialist training in pediatric microsurgery and hand surgery. He is involved in complex reconstructions with other surgical teams, particularly after sarcoma resection or treatment of congenital defects. He is on the plastic surgery faculty at Royal Children’s Hospital and has a private practice in Melbourne, Australia.
An Approach from Abuja, Nigeria: Safe and Effective Management in Low Resource Settings
Emmanuel Ameh, MB, BS, FWACS, FACS, FAS
National Hospital, Abuja, Nigeria
Dr. Ameh will focus on an approach to treatment of giant omphalocele in low-resource settings, where advanced intensive care resources are not readily available. This approach avoids complications of abdominal compartment syndrome and disastrous surgical site infection.
Dr. Ameh is Professor & Chief Consultant Pediatric Surgeon at the National Hospital, Abuja, Nigeria. His clinical research focuses on neonatal surgery and surgical infections, while his global health work focuses on access to children’s surgical care in low-resource settings. He is the lead editor of Comprehensive Paediatric Surgery Textbook for Africa. He is the immediate past Chair for the Global Initiative for Children’s Surgery and current President of the Pan African Paediatric Surgical Association.
Suren Arul, MD, FRCS
Birmingham Women's and Children's Hospital, Birmingham, England
Mr. Arul will present a standardized approach using manuka honey to dress the exomphalos, discharging the baby home with plans for delayed closure at 1 year. Home care is provided by outreach nurses. The major benefits of this approach are the “normalization” of the infant period by obviating the need to transfer to a tertiary center, early feeding, and early discharge.
Mr. Arul is a pediatric surgeon at Birmingham Children’s Hospital in the United Kingdom. His major interests include surgical oncology, laparoscopy, congenital anomalies, vascular access, and trauma. He has also served 3 tours of duty as a military general surgeon, an experience that has strongly impacted his practice.
An Approach from Bandung, Indonesia: Conservative Management Using Silver Sulfadiazine
Emiliana Lia, MD, SpBA, MKes
Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Dr. Lia will present an extensive experience using silver sulfadiazine ointment for skin epithelialization, with delayed abdominoplasty.
Dr. Lia is an attending staff pediatric surgeon in Hasan Sadikin Hospital in Bandung, West Java, Indonesia. She also teaches pediatric surgery residents in Hasan Sadikin Hospital and medical students in Padjadjaran University. She currently serves as Chief of Continuous Professional Development for the Indonesian Pediatric Surgical Association.
Patient Case Presentations
Patient Case 1. Female Patient with Giant Omphalocele in Benin
Stijn Heyman, MD
Ziekenhuis Netwerk Antwerpen, Antwerpen, Belgium
Vivek Gharpure, MD,
Children's Surgical Hospital, Aurangabad Area, India
Verónica Pólit, MD
Universidade Católica de Santiago de Guayaquil
In-depth Discussion with Faculty and Webinar Attendees
Sherif Emil, MD, CM, FRCSC, FACS, FAAP
McGill University Health Centre, Montreal, Canada
Moderator and Senior Editor of The Hendren Project and Abdominal Wall Defects Section
Dr. Emil is the Mirella and Lino Saputo Foundation Chair in Pediatric Surgical Education and Patient and Family-Centered Care, Associate Chair for Education, and Professor of Pediatric Surgery, Surgery, and Pediatrics at the McGill University Faculty of Medicine and Health Sciences. He is also the Director of the Harvey E. Beardmore Division of Pediatric Surgery at The Montreal Children’s Hospital of The McGill University Health Centre.