Repair of a giant omphalocele by a modified technique

Large omphaloceles that contain centrally herniated liver pose challenges t o surgical closure, the most significant being the space limitation of the abdominal cavity. In addition, the "pedicled" nature of the liver on the in ferior vena cava creates a predisposition to acute hepatic vascular outflow obstruction as the liver is reduced into the abdominal cavity. In such cas es, the alternatives include conservative treatment or staged silo reductio n. The worst complication of silastic silo (SS) placement is tension and in fection of the fascia with disruption of the suture line. Once infection or premature disruption occurs, closure of the defect is difficult or impossi ble. This case report details a different management technique for a newborn wit h a giant omphalocele and presents an interesting variation of the usual SS technique that may be helpful in the management of some cases, especially in an emergency. The thick silk sutures applied in the present case absorbe d the tension and the silastic sheet prevented the risks of infection and a dhesions.