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

Infographic · Jan 2026 · 1 min read

In brief

Multi-institutional study comparing four management approaches for giant omphaloceles (>5cm defect) in 117 infants. DuoDerm silo placement achieved highest primary fascial closure rate (82%) while operative silo had shortest time to closure. Findings suggest treatment selection should be individualized based on patient characteristics.

Written by the GCMD Library team from the infographic.

A four-panel educational diagram arranged horizontally, each panel containing a stylized illustration of developing lung tissue in teal/blue tones against a light background. The illustrations progress from simple branching structures to increasingly complex airway networks. Each panel includes a title banner and descriptive text below the anatomical drawing.

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, Dave Lal, Michael Sobolic, Matthew P Landman, Beth Rymeski; Midwest Pediatric Surgery Consortium

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.

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