Omphalocele:  Secondary Repair With the Aid of Pneumoperitoneum

Mark M. Ravitch, MD
Arch Surg. 1969;99(2):166-170. doi:10.1001/archsurg.1969.01340140038006.
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The publication by Gross in 19481 suddenly and radically altered the prognosis in children born with massive omphaloceles. Until that time all attempts essentially had been to replace the viscera forcefully and draw the abdominal wall together over the returned viscera. In the very large omphaloceles, particularly those in which the liver as well as the intestine had been out of the true coelom, the result was to produce an enormous increase in inferior vena cava pressure—producing an intolerable decrease in return to the right heart at the same time that the diaphragm was elevated, drastically decreasing respiratory function. The over-all mortality for the repair of omphaloceles was then in the neighborhood of 50% and most of the deaths were in these very large omphaloceles. Gross pointed out the fallacy of attempting to force the viscera back into the abdominal cavity. There is, of course, no muscular defect but


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