El Ezzi Oumama, Bossou Raymond, Reinberg Olivier, Vasseur Maurer Sabine, Roessingh Anthony de Buys
Department of Pediatric Surgery, CURCP, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Departement du zou et collines - Pediatry, Abomey, Benin.
European J Pediatr Surg Rep. 2017 Jan;5(1):e4-e8. doi: 10.1055/s-0037-1599796.
Giant omphalocele (GO) management is controversial and not easy. Conservative management at birth and delayed surgical closure is usually mandatory. Postponed surgery may be challenging and carry the risk of intensive care treatment. We report on five children who were treated in our department for GO between 2000 and 2010. Initially, the patients were managed conservatively in West Africa. Delayed closure of the ventral hernia was performed in Switzerland after patient transfer through a nongovernmental organization. Fascial closure was performed at the median age of 23 months. Median diameter of the hernias was 10 × 10 cm ranging from 10 × 8 cm to 24 × 15 cm. Four (80%) patients had associated anomalies. Three children needed mechanical ventilation in the intensive care unit after surgery. Median hospitalization was 19 days. Complications were seen in two patients. The follow-up showed no recurrence of ventral hernia. There was no mortality. This report shows that conservative management of a GO at birth with delayed closure of the ventral hernia after transferring the patients to a European center is a safe approach for West African children and avoids life-threatening procedures. Delayed closure of a GO may be nevertheless challenging everywhere.
巨大脐膨出（GO）的治疗存在争议且并不容易。出生时采用保守治疗并延迟手术闭合通常是必要的。延迟手术可能具有挑战性，且有重症监护治疗的风险。我们报告了2000年至2010年间在我们科室接受治疗的5例GO患儿。最初，这些患者在西非接受保守治疗。通过一个非政府组织将患者转运至瑞士后，进行了腹疝的延迟闭合。在中位年龄23个月时进行了筋膜闭合。疝的中位直径为10×10厘米，范围从10×8厘米至24×15厘米。4例（80%）患者伴有其他异常。3名患儿术后在重症监护病房需要机械通气。中位住院时间为19天。2例患者出现并发症。随访显示腹疝无复发。无死亡病例。本报告表明，对于西非儿童，出生时对GO进行保守治疗并在将患者转运至欧洲中心后延迟腹疝闭合是一种安全的方法，可避免危及生命的手术。然而，无论在何处，GO的延迟闭合都可能具有挑战性。
