Delayed primary closure of giant omphalocele: Gradual closed-reduction followed by open fascial closure

Objectives: to introduce the new technique of gradual closed-reduction followed by open fascial closure and to assess its clinical outcome in our setup. material and methods: it was a prospective and descriptive study. it was conducted at the department of pediatric surgery,post graduate medical institute,lady reading hospital,peshawar from january 2003 to december 2007. all patients with giant omphalocele (base-diameter more than 5 cm in width) including ruptured ones were first managed with conservative treatment using mercurochrome (0.5-1%) solution and were then admitted to the hospital after the age of 06 months. small omphaloceles were excluded from the study. a thorough clinical examination and relevant investigations were performed in all patients. results: a total of 18 children with giant omphalocele were treated with this technique. there were 10 (55.55%) female and 8 (44.44%) male patients. age ranged from 6-24 months. hospital stay was from 12-15 days. no mortality was observed and no major complications (abdominal wound dehiscence,compromised venous return,respiratory discomfort or cyanosis) were seen. mild wound infection (local erythema and / or purulent discharge) was seen in 3 (16.66%) patients,fever up to 102f0 in 9(50.00%) patients and mild respiratory embarrassment in 5 (27.77%) patients. conclusion: delayed primary closure of giant omphalocele by this technique is a safe and effective way of treatment particularly in places where neonatal and pediatric icu facilities are not available.