Improvement in Modified Allen-Wrenn Method Using Wound Retractor for Whole-Liver-Prolapsed Giant Omphalocele

Abstract

Purpose: The medical management of whole-liver-prolapsed giant omphalocele (WLPGO) remains challenging. We herein investigated whether the Allen-Wrenn Method using a Wound Retractor^® without forcing prolapsed organs into the abdominal cavity (modified AWM) is effective for WLPGO.

Methods: Five patients with WLPGO (group A) and 5 with abdominal wall malformation without liver prolapse (group B), admitted during the 2010 to 2015 period, were compared. Modified AWM was applied to all patients considering essential points, including pulling a silo in the abdominal cavity up until sufficient skin elevation without forcing prolapsed organs into the abdominal cavity.

Results: In group A (2 males, 3 females), the average gestation was 37w3d, the average birth weight was 2,182 g, and the average abdominal wall defect size was 6.5 cm. In group B (4 males, 1 female), the corresponding averages were 34w6d, 2,140 g, and 2.6 cm. In group A, a silo was attached on the day of birth in 4 patients, and 2 days after birth in one with poor general condition. Silo attachment was carried out on the day of birth in all the 5 group B patients. The average silo attachment periods were 6.8 days (5–8) in group A and 6.0 days (3–10) in group B. The difference was not statistically significant.

Conclusions: In all patients, the abdominal wall was safely closed in a short period. Modified AWM is a minimally invasive and very effective treatment strategy for WLPGO, as it is for abdominal wall malformation without liver prolapse. Moreover, WLPGO can be simply carried out at any hospital.