Non-surgical Silo for the management of giant omphalocele

Cecilia Gigena Heitsman¹, Cristobal Abello², Constanza Harding³, Alejandra Rios³, Miguel Guelfand¹

¹Cleveland Clinic
²International pediatric MIS clinic, Barranquilla, Colombia
³Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile

Introduction:
Giant omphaloceles are rare congenital anomalies with no standardized treatment protocols, complicating their management. This study evaluates outcomes of a staged, initially non-surgical approach to neonatal closure of giant omphaloceles.

Materials and Methods:
We performed a retrospective, multicenter cohort analysis of patients treated between 1994 and 2024. Giant omphalocele was defined as an abdominal wall defect >5 cm in diameter and/or containing more than 50% of the liver within the sac. All patients underwent a staged reduction using a nonsurgical silo technique. Collected data included demographics, gestational age, associated anomalies, timeframes for amnion inversion and final closure, mesh use, complications, mortality, and follow-up duration.

The reduction technique involved creating a silo using an adhesive hydrocolloid dressing (Duoderm®), allowing gradual reintegration of abdominal contents and controlled expansion of the abdominal cavity. Simulated closures were performed to assess patient tolerance before definitive closure.

Results:
Fifty neonates were treated using this method. Mean birth weight was 2900 g (range: 890–3900 g), with a median gestational age of 38 weeks (range: 28–40 weeks). Associated anomalies were observed in 37.5% of cases. The average duration for silo reduction was 7.3 days (range: 0–35), with amnion inversion completed in 5 days (range: 2–9), and final closure achieved in 14.6 days on average (range: 6–38). Anatomical closure was successful in 95% of patients. Absorbable mesh was used in 4 cases; 2 required permanent mesh (Dualmesh®). There were no deaths related to the technique. Follow-up averaged 60 months (range: 6–288).

Conclusion:
This nonsurgical, staged silo approach offers a safe and effective alternative for managing giant omphaloceles in neonates, achieving high rates of anatomical closure with low morbidity and no associated mortality.

Keywords: Omphalocele, abdominal wall defect, non-surgical silo, neonatal surgery, giant omphalocele

Cecilia Gigena Heitsman¹, Cristobal Abello², Constanza Harding³, Alejandra Rios³, Miguel Guelfand¹

¹Cleveland Clinic
²International pediatric MIS clinic, Barranquilla, Colombia
³Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile

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