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    Nezar A. Abo Halawa1*, Mohamed Yousef Batikhe2
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  • Delayed Primary Closure of Exomphalos Major in a Limited Resource Area

    Nezar A. Abo Halawa1*, Mohamed Yousef Batikhe2
    1Pediatric Surgery Unit, General Surgery Department, Qena Faculty of Medicine, South Valley University; 2Pediatric Surgery Unit, General Surgery Department, Sohag Faculty of Medicine, Sohag University

    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.