Definition
Correction of defect of the umbilicus occurring during fetal development, resulting in the protrusion of the abdominal viscera outside the abdominal cavity.
Discussion
- The size and extent of the omphalocele can vary from one containing the greater portion of the abdominal viscera, including the spleen and liver, to one containing only a small loop of bowel or intestines. The condition results from a herniation through a midline defect in the abdominal wall around the area of the umbilicus.
- Usually there is no skin covering the defect, which greatly increases the incidence of a life-threatening infection for the already compromised infant.
- In most cases, additional congenital anomalies are usually present in these patients and, depending on the capability of the abdominal cavity to contain the contents of the omphalocele, a one or two-stage procedure may be performed.
Positioning
- Supine, with arms restrained at the side.
Packs/ Drapes
- Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation
- Pediatric laparotomy tray
- Hemoclips/ surgiclip
Supplies/ Equipment
- Thermal blanket
- Head covering
- Extremity wrap
- Handheld cautery
- Suction
- Basin set
- Blades
- Needle counter
- Dissector sponges
- Solutions
- Sutures
- Silastic/ silicon mesh
- Gastrostomy tube or catheter
Procedure Overview
Single-Stage Repair
- The ophalocele is covered with a warm saline laparotomy sponge.
- An incision is made separating the skin from the peripheral borders of the sac.
- The umbilical vessels are ligated and the sac and rim of the defect are excised.
- A gastrostomy may be performed, creating an artificial opening into the stomach with insertion of a gastrostomy tube or catheter, permitting the process.
- The abdominal contents are reduced within the abdomen, and the abdomen is closed in a routine manner.
Double (Two-Stage) Repair
- When the defect cannot be closed and/ or the abdominal cavity cannot safely accommodate the contents of the omphalocele, an attempt is made to mobilize the surrounding skin to cover the protruding viscera.
- A synthetic material is used to cover the defect by suturing it around and over the viscera.
- As growth permits (6-24 months), a complete repair procedure may be achieved, requiring one or two additional procedures.
Perioperative Nursing Considerations
- Do not begin skin preparation without specific instructions from the surgeon.
- The perioperative nurse should be aware of several crucial factors affecting the outcome of the surgical event including metabolism, fluid and electrolyte balance, temperature regulation, cardiovascular and pulmonary responses, infection, safety, and pain management during the preoperative and postoperative phases.
image by: nlm.nih.gov
