Initial Treatment After Birth
Initial treatment for your baby’s omphalocele depends on how severe the condition is and whether there are any other associated conditions that take priority. If your child also has a cardiac defect or poor lung development, these conditions may be addressed before the omphalocele. Your child will likely need a ventilator to breathe if he has underdeveloped lungs. An intact omphalocele, one in which the outer sac covering the organs is not ruptured, poses minimal risk to your baby’s health in the short term. Your child’s heart and lungs will need to be stabilized before any surgical treatment for the omphalocele can be attempted. If your child has no additional conditions in play, however, treatment for the omphalocele may begin right away.
Omphalocele Treatment Options
Omphalocele treatment consists of two main options:
- Reducing the organs
- “Paint and Wait” (P&W)
Source: Seattle Children’s Hospital
Omphalocele Reduction Treatment
The ultimate goal of any treatment for an omphalocele is reduction of the internal organs and closure of the abdomen. This can be accomplished in several different ways. If your child has a mild omphalocele and an abdominal cavity that is large enough to accommodate his organs, one surgery may be enough to replace the organs in the abdomen and close the muscle and skin of the abdominal wall. If your child’s omphalocele is significant, however, this reduction process will likely be done in a staged approach. The most common type of staged approach involves placing a silo, a sterile covering, over the abdominal organs. Gradually, the organs are squeezed through the silo into the abdominal cavity over a period of 3 to 10 days, with the help of gravity. When the organs are returned to the abdominal cavity, the silo is removed.
When the organs are back in the abdominal cavity, the next step in your child’s treatment is closing the abdominal wall. This involves closing both skin and muscle. In some cases, the muscle cannot be closed, and only the skin is closed, leaving behind a hernia. Your child will require an additional surgery to repair the hernia at a later date if that is the case. Alternatively, a synthetic material like Gore-Tex may be used to close the hole in the muscle. Your child’s doctor will determine the appropriate treatment, depending on how much space is in your child’s abdominal cavity and other factors. A pediatric plastic surgeon will likely be called in for the final closure of the skin in order to minimize scarring and fabricate a belly button for your child.
Paint and Wait – Non-Operative Treatment
Surgery can be delayed until the baby is doing well if the omphalocele sac is intact. Small omphaloceles are repaired immediately to prevent infection or tissue damage. Larger omphaloceles may require gradual reduction by enlarging the abdominal cavity to accommodate the intestinal contents. A Silastic (plastic) pouch is placed over the abdominal contents to contain the bowel and aid in reduction until surgical closure is possible. When the abdominal contents have returned to the abdominal cavity with the aid of gravity, the opening is surgically closed. Returning the abdominal contents into the abdominal cavity can take up to ten days. The baby is usually on a breathing machine (or ventilator) during the time it takes for this return.
Sometimes the omphalocele is so large (termed ‘giant’) that it cannot be placed back inside the infant’s abdomen right away. The skin around the omphalocele is allowed to grow and eventually covers the omphalocele. The abdominal muscles and skin can be repaired when the child is older to achieve a better cosmetic outcome. This process requires daily or weekly dressing changes using a non-operative method of covering the omphalocele with cream and wrapping it with gauze.
This non-operative treatment or Paint and Wait involves the application of Silvadene cream or Flamazine cream to toughen the sac. Surgery is postponed in these cases for 6-12 months to allow the skin to grow and the abdominal cavity to enlarge as the baby grows. If the omphalocele ruptures, this is a medical emergency and surgery would be performed immediately.