Kifayat Khan, Muhammad Yunas Khan, Muhammad Jehangir Khan, Syed Asad Maroof, Muhammad Ayub, Muhammad Uzair, Saddar Rahim, Arshad Kamal, Muhammad Tariq.
Delayed primary closure of giant omphalocele: gradual closed-reduction followed by open fascial closure.
J Med Sci Jan ;18(1):4-7.

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.

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