Surgery

Specific treatment for an omphalocele will be determined by your baby’s physician based on the following:

  • your baby’s gestational age, overall health, and medical history
  • the extent of the condition
  • your baby’s tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion and preference

For a “small” omphalocele (only a portion of the intestine protruding outside the abdominal cavity), shortly after birth, an operation is done to return the organs to the abdomen and close the opening in the abdominal wall.

For a “large” omphalocele (most of the abdominal organs, including intestine, liver, and spleen are present outside the abdominal cavity), the repair is done in “stages” and may include the following:

  • Initially, sterile, protective sheeting is placed over the abdominal organs.
  • Because the abdomen may be small and underdeveloped, it may not be able to hold all of the organs at once. Therefore, the exposed organs are gradually moved back into the abdomen over several days or weeks.
  • The abdominal wall is closed surgically once the organs have been returned to the abdominal cavity.

Because the abdominal cavity may be small and underdeveloped, and the organs may be swollen, a baby with an omphalocele may have breathing difficulties as the organs are returned to the abdomen. Your baby may need help from a breathing machine called a mechanical ventilator while the swelling is decreasing and the size of the abdominal cavity is increasing.

 The surgical repair may be performed in stages. If the omphalocele is very small, it may be possible to return all of the contents to the inside, and surgically close the opening. If the omphalocele is too large to do this all at once, some contents will remain on the outside while a sterile pouch is created to protect the tissue that remains on the outside. To be sure that the tissue does not dry out, it will be covered with warm and moist sterile dressings. The infant can lose considerable body heat through the large amount of exposed surface area, so keeping him or her warm, and closely monitoring body temperature is a high priority. An antibacterial solution may be used to decrease the risk of infection. The infant will have a tube that goes in through the nose or mouth and down into the stomach, called a nasogastric tube. Suction is used to keep the stomach empty, avoiding the chance of vomiting, or of the fluid moving from the stomach up into the lungs. The contents of the sac will be carefully examined to make sure that none of the tissue is damaged or dead, and to check for signs of intestinal birth defects before being inserted into the body.

The omphalocele repair is a surgical procedure performed under general anesthesia. The infant will receive medication to relax his or her muscles, and to help the surgery move forward without causing any pain. A large omphalocele repair may be done in stages over several weeks. The contents of the sac are often swollen, which makes it impossible to return them into the small cavity all at once. The return of the sac contents into the abdominal cavity creates intra-abdominal pressure, which may cause the infant to have difficulty breathing. To help the infant breathe, a special breathing tube may be inserted. The tube is attached to a machine that regulates the length and frequency of the breaths. When the necessary surgeries have been completed, the suturing will be done in such a way as to leave, if possible, a somewhat normal-looking belly button. A large omphalocele repair can leave a large, unsightly scar. For cosmetic purposes, the scar may be operated on at a later date to make it less noticeable. Gastroesophageal reflux, which may require additional surgery, is common in patients with a repaired omphalocele.

Complete recovery is expected after surgery for an omphalocele. However, omphaloceles may often occur with other birth defects. How well a child does depends on which other conditions the child also has.

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