Omphaloceles in combination with a self-made hemispherical cushion: a report of 12 cases

The aim of this study was to discuss the curative effect of applying "capsule-reserved normal saline bag and self-made hemi-spherical cushion oppression" for treating giant omphaloceles. Twelve patients with giant omphaloceles who were admitted to our hospital between January 2008 and June 2016 were selected for treatment as follows: a capsule-reserved normal saline bag was used to promote the gradual return of the abdominal contents into the abdominal cavity in phase I, and a self-made hemi-spherical cushion was used for compression combined with a local dressing change in phase II to treat the giant omphaloceles without surgical treatment. All 12 patients in this group were cured, and after follow-up visits for >10 months, they had no abdominal infections, wound disruption, intestinal obstruction, or other complications, and their growth was normal. Two patients had abdominal hernias, and they recovered after herniorrhaphies. Giant omphaloceles in newborns were treated in stages, and in phase II, non-surgical treatment was applied, which was easily performed with a smaller wound, low cost, an obvious curative effect, and higher safety and effectiveness.

Hernia umbilical en pacientes cirróticos con ascitis: ¿tratamiento conservador o quirúrgico? / Umbilical hernia in liver cirrhosis with ascites: conservative or surgical treatment?

Resumen La ascitis es la complicación más común en los pacientes con cirrosis hepática. Las hernias umbilicales (HU) ocurren en 20% de estos pacientes y 40% en aquellos con ascitis severa. La HU ocurre debido al aumento de presión intraabdominal, al debilitamiento de la fascia abdominal y la pérdida de masa muscular. Además, tienen tendencia a aumentar rápidamente y presentar alto riesgo de complicaciones que amenazan la vida del paciente. El tratamiento de la HU no complicada es controversial, tanto el manejo quirúrgico (herniorrafia) como el manejo conservador (control de ascitis) presentan alta tasa de complicaciones, en consecuencia incrementa la morbimortalidad. Actualmente, se recomienda herniorrafia umbilical con previo control de la ascitis en el manejo de HU no complicada, reduce el riesgo de infección de herida operatoria, evisceración, drenaje de ascitis, peritonitis y reduce hasta 41% la recidiva de HU. El éxito de este enfoque también depende del grado de disfunción hepática. El tratamiento de la HU complicada es quirúrgico (herniorrafia sin malla), con menor tasa de mortalidad respecto al manejo conservador. Estudios revelan ventajas de la herniorrafia umbilical laparoscópica (mínimamente invasiva y sin tensión) en comparación a la cirugía abierta, sin embargo, aún no hay evidencia al respecto.

Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient's life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.

Hernia Umbilical Asintomática en la Cirrosis Hepática / ASYMPTOMATIC UMBILICAL HERNIA IN LIVER CIRRHOSIS

La hernia umbilical es una complicación que puede constituirse en una amenaza para la vida en la cirrosis hepática. Aquí, demostramos dos interesantes casos de cirrosis hepática que se presentaron con hernia umbilical asintomática, pero que no fueron sometidos a ningún tipo de cirugía

Umbilical hernia is a life-threatening complication of liver cirrhosis. Herein, we demonstrated two interesting cases with liver cirrhosis that presented with asymptomatic umbilical hernia, but did not undergo any surgery.

Neo-onfaloplastia com enxerto cutâneo / Neoomphaloplasty with cutaneous graft

Introdução: A cicatriz umbilical é decorrente da queda do coto umbilical, que ocorre alguns dias após o nascimento. Sua presença, formato e localização na parede abdominal fornecem ao indivíduo uma conotação estética e sensual. Métodos: Estudo primário, prospectivo, de intervenção. A casuística foi de conveniência, no período de fevereiro de 2006 a junho de 2016, incluindo pacientes de ambos os gêneros, alocados do ambulatório do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE) e clínica privada. Os critérios de inclusão foram pacientes com indicação de abdominoplastia e que apresentavam um comprometimento da irrigação da pele da região umbilical e periumbilical devido a defeitos herniários da região. O estudo seguiu os critérios de Helsinki e os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Foram operados 28 pacientes, sendo observada uma boa integração da pele enxertada, resultando em uma cicatriz umbilical de aparência natural e sem complicações. Conclusões: A neo-onfaloplastia com enxerto cutâneo é de fácil execução e que, a longo prazo, tem demonstrado um bom resultado estético, principalmente nos retalhos abdominais espessos, demonstrando ser mais uma opção técnica na realização de neo-onfaloplastias.

Introduction: The umbilical scar is due to the fall of the umbilical stump that occurs a few days after birth. Its presence, shape, and location on the abdominal wall provide the individual with an aesthetic and sensual connotation. Methods: A primary prospective interventional study. The sample was of convenience, from February 2006 to June 2016, and included patients of both sexes attending the outpatient clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), a private clinic . The inclusion criteria were patients with abdominoplasty indications presenting with compromised circulation to the skin of the umbilical and periumbilical region caused by hernia defects in this area. The study followed the criteria of Helsinki and the patients signed an Informed Consent Form. Results: Twenty-eight patients underwent surgery and good integration of the grafted skin was observed. This resulted in an umbilical scar with a natural appearance and without complications. Conclusions: Neoomphaloplasty with a cutaneous graft is easy to perform and, in the long term, has shown to provide good aesthetic results, especially in thick abdominal flaps, thus proving to be an additional technical option for neoomphaloplasty procedures.

Traitement des omphaloceles dans les services de chirurgie generale et pediatrique du CHU Gabriel Toure

Introduction : l'omphalocele; est l'absence de l'evolution du coelome extra embryonnaire entre le 32eme et le 72 eme jour de la grossesse. Le traitement depend de son volume et des malformations associees .Au Mali; peu de travaux ont ete publies sur l'omphalocele et son traitement. Materiels et methodes : Nous avons mene une etude retrospective de 8 ans avec les objectifs de determiner les facteurs epidemiologiques; de decrire les aspects cliniques et evaluer les resultats therapeutiques. Resultats : 111 malades ont ete enregistre : 62 garcons et 49 filles. L'age moyen a ete de 4;2 jours et le poids moyen de 2500 - 3500 G .Le diametre du collet etait superieur a 8 cm chez 29(26;13) qui ont beneficie du traitement conservateur selon Grobb. 13 patients presentaient une rupture du sac .Le foie a ete retrouve 29 fois(26;13) dans le sac et 35 fois (31;53) une malformation etait associee. Vingt (18) deces ont ete observes. L'omphalocele a ete objectivee 9 (10) fois en echographie antenatale. Aucune mere n'avait un antecedent de prise de medicaments a effet teratogene et 67(60;36) etaient multipares Conclusion : Les omphaloceles sont des urgences chirurgicales .La prise en charge multidisciplinaire; necessite une echographie en antenatale

Una modalidad para el tratamiento quirúrgico de hernia umbilical

Se presenta una técnica quirúrgica para el tratamiento de la hernia umbilical que sistematiza los tiempos quirúrgicos que deben seguirse para la ejecución de la misma, de tal suerte que es aplicable a cualquier modalidad utilizada en este tipo de afección. Se analizan 56 casos, relacionándolos con: raza, sexo, gestaciones, edad, caracteres de la hernia, tipos de hernia (reducible, estrangulada), tamaño del saco, contenido, material de sutura y otras variables. Además de la sistematización de los tiempos operatorios, la técnica propuesta no reseca el saco herniario, no sutura individualmente el peritoneo, realiza un refuerzo aponeurótico en doble plano de sutura y conserva el ombligo. En ninguno de los pacientes se ha presentado recidivas ni complicaciones en un lapso de seguimiento comprendido entre los 10 y los 2 años.

Specific problems in the treatment of omphalocele and gastroschisis: management strategies most suited in our set-up

Omphalocele and gastroschisis can be managed conservatively as well as surgically. The mode management is influenced by the extent of anatomical defect and associated congenital abnormalities. Forty-five patients with gastroschisis and omphalocele managed at Children's Hospital PIMS were reviewed, and survival rates of surgical and conservative managements were compared. The mortality rate of much managed surgically was found to be these higher [42.8%] as compared to those managed conservatively [29.4%]. We advocate canservative treatment for these patients in our community due to lack of adequate resource

Los grandes defectos de la pared abdominal en el niño / The main defects of the abdominal wall in the children

Se describen algunas características sobresalientes de los 2 defectos congénitos de mayor magnitud de la pared abdominal (gastrosquisis y onfalocele). Adicionalmente, se propone una ruta crítica a manejo médico-quirúrgico dividida en 3 etapas: preoperatoria, transoperatoria y postoperatoria. No es aconsejable como parte del tratamiento, dejar un defecto herniano para cierre ulterior.