A multi-institutional comparison of management techniques for infants with giant omphalocele.

Creator(s)

• Alyssa Stetson
• Samantha Leonard
• Katherine Flynn-O'Brien
• Seth Goldstein
• Tiffany Wright
• Cynthia Downard
• Kyle J. Van Arendonk
• Charles M. Leyes
• Linda Cherney-Stafford
• Karen Speck
• Peter C. Minneci
• Troy A. Markel
• Shawn D. St Peter, Children's Mercy HospitalFollow
• Dave Lal
• Michael Sobolic
• Matthew P. Landman
• Beth Rymeski
• Midwest Pediatric Surgery Consortium

Document Type

Article

Publication Date

8-2026

Identifier

DOI: 10.1016/j.jpedsurg.2025.162822

Abstract

PURPOSE: Giant omphaloceles (GO) are uncommon with no consensus on treatment strategy. Placement of a DuoDerm® silo (DDS) is a novel management technique. We sought to identify optimal approach by comparing outcomes of patients who underwent DDS placement, paint and wait (P&W), operative silo placement (OSP), or alternative compression techniques (ACT).

METHODS: A multi-institutional retrospective review between 7/1/2012-5/31/2023 of patients with GO (fascial defect >5 cm). Patients were identified via ICD codes and chart review.

RESULTS: There were 117 children with GO from nine centers. Twelve children (10 %) were managed with DDS, 83 (71 %) with P&W, 11 (9 %) with OSP, and 11 (9 %) with ACT. Patients in the OSP group were more likely to have a torn or ruptured sac (p < 0.001) but there was no difference in number of organs present in the sac (p = 0.22). There was no difference in percentage of patients with fascial closure between groups (p = 0.16). Age at fascial closure was lowest in the OSP group (0.6 months) followed by the DDS group (1.5 months) (p = 0.003). Patients in the DDS group had the highest rate of primary fascial closure (9, 82 %), followed by the P&W (49, 78 %), OSP (4, 40 %), and ACT (2, 20 %) (p < 0.001). Forty-three patients (37 %) experienced a complication, equal between groups (p = 0.71).

CONCLUSIONS: Half the infants in our cohort did not achieve fascial closure until ≥6 months. While median time to fascial closure was lowest for OSP, patients with DDS placement achieved the highest rate of primary fascial closure. Further research could help optimize patient selection for GO closure strategy.

STUDY TYPE: retrospective observational cohort.

LEVEL OF EVIDENCE: Level 4.

Journal Title

Journal of pediatric surgery

Volume

61

Issue

8

First Page

162822

Last Page

162822

MeSH Keywords

Humans; Omphalocele; Retrospective Studies; Female; Male; Infant; Treatment Outcome; Infant, Newborn; Abdominal Wound Closure Techniques; Hernia, Umbilical; Watchful Waiting; Fasciotomy

PubMed ID

41260508

Keywords

Abdominal wall condition; Clinical outcomes; DuoDERM silo; Giant omphalocele

Recommended Citation

Stetson A, Leonard S, Flynn-O'Brien K, et al. A multi-institutional comparison of management techniques for infants with giant omphalocele. J Pediatr Surg. 2026;61(8):162822. doi:10.1016/j.jpedsurg.2025.162822