A New Method of Repairing Giant Omphaloceles with Bilateral Mesh Grafts Lateral to the Rectus Abdominis Muscles

Introduction: in spite of the advances in prenatal and neonatal medicine, giant omphalocele (go) has remained as a challenge forpediatric surgeons. although different techniques have been introduced for treating go, the ideal treatment would be a primary closurewithout compromising the respiratory system or multiorgan failure. however, reaching this goal is challenging due to the high degree ofvisceroabdominal disproportion. this present study described the results of primary or secondary closure of five go cases using the “bilateralmesh graft” technique. case presentation: five consecutive go patients were treated in our department. two patients underwent a primary closure, while threeother patients underwent a secondary closure using the “bilateral mesh graft” technique. when two mesh grafts were bilaterally fixed tothe rectus abdominis muscles, the abdominal wall was reconstructed in the midline. all 5 patients were closely monitored for potentialcomplications and a follow-up was also performed for each patient after they were discharged. discussion: the “bilateral mesh graft” technique was performed on the pediatric patients with a median age of 2.5 months (range 3 days to6 months). the median diameter of the abdominal wall defect was 9 cm (range 7 - 10 cm). moreover, the median was increased in bladderpressure after closure was 6.4 cm h2o (range 3 - 10 cm h2o). one of the patients who underwent secondary closure was diagnosed with acongenital heart condition and died postoperatively due to heart failure and respiratory insufficiency. the median hospital staying durationof the four surviving cases was 4.5 days with minimal complications. during the follow-up appointments, all four surviving patients exhibitednormal weight gain and a soft abdomen with no infections or erosions detected at the site of surgery. the “bilateral mesh graft” techniqueyielded good clinical outcomes in both the primary and secondary closure cases. however, prior to surgery, particularly in the primary closurecases, the patients must be evaluated for respiratory function and additional congenital anomalies, such as heart conditions, in order tominimize potential complications. nevertheless, further research is still needed in order to determine the long-term effects of the functionalaspects on the abdominal wall muscles and viscera.