Managing giant omphalocele: A systematic review of surgical techniques and outcomes.

Aim: We analysed closure techniques in the treatment of giant omphalocele. A challenging pathology where there lacks consensus. Methods: Cochrane, MEDLINE and EMBASE were searched between 1 January 1992 and 31 December 2022 using terms and variations: omphalocele, exomphalos, giant, closure and outcome. Papers were selected using Preferred Reporting Items for Systematic review and Meta‐Analyses 2020 criteria. Data collected included demographics, timing and technique of surgical repair, morbidity and mortality. Results: We identified 342 papers; 34 met inclusion criteria with a total 356 neonates. Initial non‐operative management was described in 26 papers (14 dressings, eight silo, four serial sac‐ligation). Operative techniques by paper were as follows: Early closure: nine primary suture closure without patch, two primary closure with patch and four mixed methods. Delayed closure: five simple, four‐component separation technique, four tissue expanders, one Botox/pneumoperitoneum and two with patch. Median number of procedures was two (1–6) in the early group versus three (1–4) in the delayed. The most favourable was early primary closure with biological patch. The most unfavourable was delayed closure with patch. Cumulative reported mortality remained high, mostly due to non‐surgical causes. Conclusion: Definitions of giant omphalocele in the literature were heterogeneous with a variety of management approaches described. [ABSTRACT FROM AUTHOR]