Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina.
Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Buenos Aires. Argentina.
J Pediatr Surg. 2021 Jun;56(6):1247-1251. doi: 10.1016/j.jpedsurg.2021.01.016. Epub 2021 Jan 15.
The management of patients with congenital anterior abdominal wall defects remains challenging, particularly in cases of giant omphalocele. In 1948, San Martín described a surgical technique for the repair of large midline incisional hernias in adults without the need for a mesh. The purpose of this report is to describe our experience with this technique for the delayed closure of giant omphaloceles.
We retrospectively reviewed the outcomes of all patients with giant omphalocele managed with the San Martin technique between September 2013 and March 2019. Data collected included birth weight, gestational age, associated malformations, neonatal hospital stay, age at the time of the abdominal wall closure, days on mechanical ventilation (MV) after the closure, time to initiation of enteral feedings, intra- and postoperative complications, and postoperative hospital stay.
A total of 8 patients were included in the study. The median birth weight was 3.190 (2.150 to 3.400) grams. The median gestational age was 35 (32 to 38) weeks. The median age at surgery was 6 (5 to 13) years. The median postoperative days on MV was 3 (3 to 11) days. Enteral feeding were initiated postoperatively at a median of 4 (2 to 4) days. There was one intraoperative complication (minor vascular injury). There were no short-term or long-term complications directly related to the surgical technique. The median postoperative hospital stay was 10 (6 to 16) days. The follow-up was 18 months to 8 years.
We believe that the San Martín technique is a valid alternative for the delayed closure of giant omphaloceles.
According to the Journal of Pediatric Surgery this research corresponds to type of study level IV for case series with no comparison group.
先天性腹壁前壁缺陷患者的管理仍然具有挑战性，特别是在巨大脐膨出的情况下。1948 年，San Martín 描述了一种用于修复成人中线切口疝的手术技术，无需使用网片。本报告的目的是描述我们使用该技术延迟闭合巨大脐膨出的经验。
我们回顾性分析了 2013 年 9 月至 2019 年 3 月间采用 San Martin 技术治疗巨大脐膨出的所有患者的结果。收集的数据包括出生体重、胎龄、伴发畸形、新生儿住院时间、腹壁闭合时的年龄、闭合后机械通气（MV）的天数、开始肠内喂养的时间、围手术期并发症和术后住院时间。
共有 8 例患者纳入研究。中位出生体重为 3.190（2.150 至 3.400）克。中位胎龄为 35（32 至 38）周。中位手术年龄为 6（5 至 13）岁。中位 MV 术后天数为 3（3 至 11）天。术后中位肠内喂养开始时间为 4（2 至 4）天。术中出现 1 例并发症（轻微血管损伤）。无与手术技术直接相关的短期或长期并发症。中位术后住院时间为 10（6 至 16）天。随访时间为 18 个月至 8 年。
我们认为 San Martín 技术是延迟闭合巨大脐膨出的有效选择。
根据《小儿外科学杂志》，本研究属于无对照组病例系列的 IV 级研究类型。
