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 Omphalocele repairDescription:Surgical repair of abdominal wall defects involves replacing the abdominal organs back into the abdomen through the abdominal wall defect, repairing the defect if possible, or creating a sterile pouch to protect the intestines while they are gradually pushed back into the abdomen. Immediately after delivery, the exposed organs are covered with warm, moist, sterile dressings. A tube is inserted into the stomach (nasogastric tube, also called NG tube) to keep the stomach empty to prevent choking on or breathing in ( aspiration ) stomach contents into the lungs. The surgery is done as soon as the infant is stable. While the baby is deep asleep and pain-free (under general anesthesia) an incision is made to remove the sac membrane. The bowel is examined closely for signs of damage or additional birth defects. Damaged or defective portions are removed and the healthy edges stitched together. A tube is inserted into the stomach ( gastrostomy tube ) and out through the skin. The organs are replaced into the abdominal cavity and the incision closed, if possible. If the abdominal cavity is too small or the protruding organs are too swollen to allow the skin to be closed, a pouch will be made from a sheet of plastic to cover and protect the organs. Complete closure may be done over a few weeks. Surgery may be necessary to repair the abdominal muscles at a later time. The infant's abdomen may be smaller than normal. Placing the abdominal organs into the abdomen increases the pressure within the abdominal cavity and can cause breathing difficulties . The infant may require the use of a breathing tube and machine (ventilator) for a few days or weeks until the swelling of the abdominal organs has decreased and the size of the abdomen has increased. Indications: Omphalocele is a life-threatening event requiring immediate intervention. The infant may be born underweight ( small for gestational age ) due to stress from this condition before birth. What to Expect After: This defect can be corrected with surgery in most cases. The outcome depends on the amount of damage to or loss of intestine. Omphalocele is often associated with other congenital defects which may influence the patient's prognosis. Convalescence: The infant is cared for post-operatively in a neonatal intensive care unit. The baby is placed in an isolette (incubator) to keep warm and prevent infection. Oxygen is given and mechanical ventilation is often required. Intravenous fluids, antibiotics, and pain medications will be given. A nasogastric tube will be in place to keep the stomach emptied of gastric secretions. Feedings are started by nasogastric tube as soon as bowel function resumes. Feedings are started very slowly and often infants are reluctant to feed. These babies may need feeding therapy and lots of encouragement. Risks: Risks for any anesthesia are:
Risks for any surgery are:
Additional risks include:
If a large portion of the small bowel is damaged, the infant may have problems digesting and absorbing feedings. |