Ahmed Salah Arafa *, Ahmed yehia , Alaa fiad
1Magdy Salah El-Din Hussain, 1Hisham Wefky Anwar, 2Mostafa Mahmoud El Nakib, 1Amr Essam Mosaad*
Doaa Ahmed Mansour M.D., FRCS Eng
Moutaz Ragab1,Mohamed Hamed Abouelfadl1, Mahmoud M. Marei 1
Moutaz Ragab, Mahmoud M. Marei ,Mohamed Hamed Abouelfadl
Wadie Boshra MD, MRCS, Mohammed Attia Elsayed MD, Ahmed S. M. Omar MD.
Mahmoud Alhussinia, M. Ashraf Balbaab, Ahmed Tarek Awada, Tamer Abdelbakia
Ahmed El-Gendi1, Mohamed El-Shafei2, Essam Bedewy3
Elsobky A, MD
Ahmed Sawaby1, Islam Atta2, Amr El Abd3,Mohsen Ahmed Abdelmohsen4
Ayman M. A. Osman1 MD, MRCS (Eng); Hytham H. Mohey1 M.Sc.; Ahmed M. Ghobashy1 MD
Nezar A. Abo Halawa1*, Ahmed El-Abd Ahmed2, Sawsan A. Elkhateeb3, Galal H. Galal3
Nezar A. Abo Halawa1*, Mohamed Yousef Batikhe2
Wadie Boshra MD, MRCS, Abdallah Hamed Ibrahim Khalil MD, Fawzy Salah Fawzy MD, MRCS
Hussein Ali Mustafa Abdel-Motaleb, Mohammed Ahmed Mohammed Ismail, Islam Mohamed Nabil Atta & Ahmed Mohammed Ahmed Abdel-Rahim*
Reem Mohamed Ali Abd El Reheem El Masry1, Sameh Abd Allah Maaty2, Anwar A. El Shenawy3, Fawzy Salah Fawzy2
Delayed Primary Closure of Exomphalos Major in a Limited Resource Area
Background: An omphalocele is a congenital abdominal wall defect consisting of eviscerated abdominal
contents within sac composed of a three-layered. However the objective of treatment is tissue closure, there
is no agreement exists on the ideal treatment of giant omphalocele. The most popular two strategies now
are staged surgical closure and delayed primary closure. Delayed primary closure is associated with
more early full feeding, shorter hospital stay and a lower occurrence of sepsis. Objective: evaluate
outcomes of delayed primary closure of exomphalos major in limited resource area using topical
povidone-iodine. Methods: A prospective study was conducted in the pediatric surgery unit, South Valley
university hospital and Sohag university hospital between Jun 2015 to December. A total of 17 neonates
with omphalocele were managed by delayed non-operative by painting the sac with betadine and saline.
Results: 70.1 % were diagnosed with associated anomalies mostly pulmonary hypoplasia, followed by
cardiac anomalies,. There are two cases with prolonged hospital stay 89 & 125 days as they developed
sepsis and persistent pneumonia. In addition, two patients were treated for line sepsis.. At present,7
patients have undergone delayed repair (primary fascial closure) at a median age of 12 months (range, 5-
18 months), 4 remain with their original ventral hernia( one of them had progressively diminished in size
and 2 has been lost to follow-up . Mean period for epithelization is 2.9 months (2.4- 4.1 months). We had
seven cases (41.2%) were diagnosed prenatally. In two cases the sac burst, one during delivery and the
other during the transport. Conclusions: Delayed primary closure of exomphalos major after repeated
dressing by povidone-iodine is a safe and good option especially in our limited resource locality with
restricted availability of silo and poor bad compliance patient. It enhances rapid epithelization with the
advantage of twice then once weekly dressing. It decreases the handling of babies with diminished doctor
and nursing asset usage. Also, it can be used even by unskilled parents without the nursing direction
Key words: omphalocele, delayed primary closure, topical povidone-iodine.