J. Huang1, C. Eason1,2, P. Moody1, J. Gien1,3, R. Reynolds1,3, S. Derderian1,2,3 1University of Colorado Anschutz, School Of Medicine, Aurora, CO, USA 2Children’s Hospital Colorado, Department Of Surgery, Division Of Pediatric Surgery, Aurora, CO, USA 3Children’s Hospital Colorado, Department Of Pediatrics, Division Of Neonatology, Aurora, CO, USA
Introduction: Giant omphaloceles are congenital anomalies where intra-abdominal organs protrude through the abdominal wall, typically involving the liver and measuring larger than 5 cm. They present significant surgical challenges, with two main management approaches being the “paint-and-wait” delayed closure and the Schuster staged closure. The "paint-and-wait" method involves applying a topical agent to promote skin epithelization over the protruding sac, followed by a delayed defect closure after one to two years. The Schuster procedure, an alternative approach for more stable patients, aims for early defect closure through staged reduction over 5-10 days in the first week of life. There are concerns about the rapid internalization of abdominal contents with the Schuster procedure despite the advantage of early closure to simplify home care, and limited data exist to counsel families on choosing between these approaches. Survival outcomes of these methods are similar in the literature, though no studies have compared the rates of abdominal hernias in these two techniques. We hypothesize that the early rise in intra-abdominal pressure using the Schuster procedure predisposes patients to higher rates of abdominal hernias than the “paint-and-wait” approach.
Methods: This single-institution, retrospective cohort study compared abdominal hernia rates in pediatric patients undergoing the Schuster procedure versus those managed with the “paint-and-wait” approach between 2012 and 2022. Data were analyzed using Fisher's exact test or unpaired t-test, with a p-value <0.05 considered statistically significant.
Results: Among the 21 patients, 9 were managed with the “paint-and-wait” approach, and 12 underwent the Schuster procedure. Demographics were similar between groups; however, birthweight and prenatal lung volumes were greater in the Schuster group. Abdominal Hernias were more common among those who underwent the Schuster procedure n=10 (83%) compared to those who underwent a “paint-and-wait” approach n=2 (22%, p=0.03). Bilateral inguinal hernias were the most common type, followed by unilateral (Table).
Conclusion: Our findings suggest a higher incidence of abdominal hernias in infants undergoing the Schuster procedure compared to the “paint-and-wait” approach for giant omphaloceles. These results highlight the importance of considering long-term outcomes when counseling families of patients and creating a surgical management plan. Further prospective studies are needed to validate these findings and optimize surgical management protocols.