2.1. Case 1
A baby girl was born on the 37th week of gestation with a birth weight of 3,380 g. She had a 10 cm defect with a sac containing both the large and small intestines and the entire liver. However, no other congenital abnormalities and defects were detected after the infant was stabilized. Prior to the operation, the intra-abdominal pressure was measured at 10 cm H
2O via a Foley catheter. With the infant in a supine position, an incision was made on the skin just lateral to the omphalocele sac, opening a way into the abdominal cavity. In order to access the lateral margin of the rectus abdominis muscles on both sides, the liver and the intestines were dissected from the skin and the ventral abdominal wall. The next step included making an 8 cm longitudinal incision lateral to the rectus abdominis muscles, which dissected them from the peritoneum. The lateral incisions typically create a space of 5×8 cm, which provide sufficient room for the insertion of a mesh graft. The mesh graft is placed beneath intact and healthy skin, which prevents the erosion of the viscera. The mesh grafts are sutured to the muscles with an absorbable suture material (vicryl 3.0). After the reduction of the viscera in the abdominal cavity, the rectus abdomins muscles are shifted midline. However, after measuring the intra-abdominal pressure at 15 cm H 2O, the abdominal wall was closed by suturing the muscles midline with vicryl 2.0. After irrigation of the mesh grafts with keflin, the subcutaneous and skin were closed and a dressing applied to the site. Due to hyperbilirubinemia, the infant was hospitalized for 7 days after the operation and discharged afterwards with normal food toleration and no signs of infection. 2.2. Case 2
A 6-month-old baby girl born prematurely on the 35th week of gestation with GO had undergone primary closure on the third day after birth, which disrupted after her discharge. She returned with a large abdominal mass containing small and large bowel loops and a part of the liver. The bladder pressure was measured with a Foley catheter (2 cm H
2O) before two longitudinal incisions were made on both sides of the mass. On both sides, two 7×5 cm mesh grafts were sutured with prolene 3.0 to the adjacent muscles. The abdominal wall was then closed by bringing the two abdominis muscles to the midline. The subsequent measurement of the bladder pressure showed that it had been increased to 11 cm H 2O. The patient was then discharged 3 days after the surgery with normal food toleration and an uneventful postoperative period. In a follow-up approximately 30 days later, she was found to be feeding normally, gaining weight, and exhibiting a soft abdomen. Most importantly, no erosions or signs of infections were detected at the site of surgery ( Figure 1).
Figure 1. Ventral herniation of the viscera at the site of the abdominal defect (A), Bilateral incision on both sides of the mass (B) Part of the bowel herniating from the abdominal wall defect (C), On both sides, two mesh grafts are sutured to the adjacent muscles and the muscles are approximated in the midline (D).
2.3. Case 3
A 6-month-old baby girl with GO since birth was initially treated with the primary closure of the defect when she was 1 day old. During the physical examination, she exhibited a 10x10 cm abdominal mass (10×10 cm) containing large and small bowel loops and a part of the liver. The bladder pressure was measured at 12 cm H
2O before the surgery. After an elliptical incision was made around the mass, the skin was dissected from the fascia and the omphalocele attachment. By using the above-mentioned technique, two mesh grafts measuring 8×5 cm were fixed to the adjacent muscles. Then, the muscles were separated from the external oblique muscles and approximated to the midline. In addition, the bladder pressure had increased to 15 cm H 2O. After the abdominal wall was closed with an absorbable suture material, a dressing was applied.
Because the baby was stable in the postoperative course with minor complications and normal food tolerance, she was discharged three days after the surgery. In a follow-up approximately 30 days later, she was found to be gaining weight and exhibiting a soft abdomen. Most importantly, no erosions or signs of infections were detected at the site of the surgery.
2.4. Case 4
A 3-day-old baby girl born prematurely on the 36th week of gestation with a birth weight of 3,200 g exhibited an 8 cm GO containing the small and large bowel and (A PART OF ALL OF THE LIVER? This was specifically specified in Cases 1-3, so for consistency purposes, it should also be mentioned here in Case 4) liver. In her workup, she was also diagnosed as having midgut malrotation. After measuring her bladder pressure at 10 cm H
2O via a Foley catheter (10 cm H 2O), the skin was dissected from the fascia and omphalocele attachment. To correct the malrotation, Ladd’s procedure was used and the large bowel was brought to the left side. In the next step, the lateral longitudinal transections were made and the mesh grafts were fixed to the muscles, in this case with a prolene 4.0 suture. Then, the muscles were approximated to the midline. After the bladder pressure was measured at 15 cm H 2O, the abdominal wall was closed with nylon 4.0. Because the baby did not experience any major complications and exhibited normal food toleration, she was discharged 5 days after the surgery. In a follow-up approximately 30 days later, she was found to be feeding normally, experiencing normal bowel movement, and exhibiting a soft abdomen. Most importantly, no erosions or signs of infections were detected at the site of surgery. 2.5. Case 5
A 17-day-old baby boy was born through a caesarean operation at the 38th week of gestation with a birth weight of 2,050 g. He was diagnosed with a giant omphalocele measuring 7×7 cm and congenital heart conditions (i.e. sub aortic ventral septal defect, pulmonary stenosis, and overriding aorta). He had undergone primary reconstruction of the ompholecele with a mesh graft at the site of the defect on the 7th day of birth. However, he was re-admitted on the 17th day due to the disruption of the defect. Prior to the operation, because the bladder pressure was measured at 10 cm H
2O, the original mesh was removed. Accessing the lateral margin of the rectus abdomins muscles, two longitudinal incisions were made and the muscles were dissected from the peritoneum. The fascia was then released from the omphalocele sac, and after the reduction of the viscera, the fascia and muscles from both sides were approximated to the midline. The bladder pressure was measured again and found to have increased to 22 cm H 2O. After measuring the vitals, two 7x4.5 cm mesh grafts were laterally fixed to the muscles with an absorbable suture material. After irrigating the mesh grafts with keflin, the abdominal wall was closed in the midline with a non-absorbable suture material. Again, the bladder pressure was measured to be 20 cm H 2O. Unfortunately, the patient died a day after the operation due to the heart failure and the respiratory acidosis resulting from respiratory insufficiency.