Abstract 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 References 1. Gross, R.E.: A New Method for Surgical Treatment of Large Omphaloceles . Surgery 24:277-292 ( (Aug) ) 1948. 2. Grob, M.: Lehrbuch der Kinderchirurgie , Stuttgart: George Thieme Verlag, 1957, p 314. 3. Wollenweber, E.J., and Coe, H.E.: Conservative Management of Eventration in the Newborn, with Survival , Amer J Surg 97:769-771 ( (June) ) 1959.Crossref 4. Goñi Moreno, Ivan: Chronic Eventrations and Large Hernias: Preoperative Treatment by Progressive Pneumoperitoneum—Original Procedure , Surgery 22:945-953 ( (Dec) ) 1947. 5. Ravitch, M.M.: in Harkins, H.N. et al (Eds.): Surgery , Principles and Practice, ed 2, Philadelphia: J. B. Lippincott Co., 1961, p 1290. 6. Ravitch, M.M.: Giant Omphalocele: Second Stage Repair with the Aid of Pneumoperitoneum , JAMA 185:42-44 ( (July 6) ) 1963.Crossref 7. Whelan, T.J., Jr., and Eaker, A.B.: Pneumoperitoneum in Preparation for Second Stage Omphalocele Repair , Surgery 51:263-269 ( (Feb) ) 1962. 8. Schuster, S.R.: A New Method for the Staged Repair of Large Omphaloceles , Surg Gynec Obstet 125:837-850 ( (Oct) ) 1967. 9. Ahlfeld, F.: Der Alkohol bei der Behandlung inoperabeler Bauchbruche , Mschr Geburtshulfe 10:124-125, 1899. 10. Steichen, F.M.: A Simple Method for Establishing, Maintaining and Regulating Surgically Induced Pneumoperitoneum in Preparation for Large Hernia Repairs , Surgery 58:1031-1032 ( (Dec) ) 1965.
Archives of Surgery – American Medical Association
Published: Aug 1, 1969