Clinical application and systematic review of waiting treatment for giant omphaloceles.

objectiveThis study aims to evaluate the safety and efficacy of delayed treatment for giant omphaloceles through a retrospective analysis of four clinical cases and a systematic review of the relevant literature, offering a theoretical foundation for clinical practice.

methodsWe reviewed and analyzed the clinical data of four patients with giant omphaloceles who received delayed therapy at our center. Following the PRISMA guidelines, we conducted a search of the PubMed, Embase, Web of Science, Ovid Medline, and Scopus databases using the keywords “giant omphaloceles” and “delayed” or “waiting treatment” or “wait.” A qualitative synthesis of the primary outcomes was performed.

resultsAt our center, the membranous sacs of all four patients with giant omphaloceles remained intact at birth, with no complications such as infection, rupture, or intestinal obstruction during the waiting period. The median time for the sac membrane to reach the desiccation phase was 4.5 days (range: 4–6 days), while epithelialization occurred at a median of 56.5 days (range: 52–60 days). The median time to begin enteral nutrition was 2.5 days (range: 2–3 days), and the median time to achieve full feeding was 5.5 days (range: 4–6 days). The median duration of NICU stay was 1 day (range: 0–4 days), and the median length of the first hospitalization was 13 days (range: 11–19 days). All four patients survived and underwent surgery at a median age of 11.25 months (range: 10–21 months). No patches were required during surgery, and postoperative ventilator support was not necessary. The median length of hospital stay after surgery was 7 days (range: 6–8 days), with no complications such as poor wound healing or incisional hernia observed. The literature review included 13 studies, comprising 2 case-control studies (63 patients) and 11 cohort studies (334 patients). They suggested that delayed therapy for giant omphaloceles was associated with lower mortality, a shorter time to full feeding, and reduced ventilator use.

conclusionUnder suitable conditions, delayed therapy is a safe and effective approach for managing giant omphaloceles, potentially reducing mortality, promoting enteral feeding, and significantly shortening the time to full feeding. This approach contributes positively to long-term developmental outcomes and the overall prognosis of patients with giant omphaloceles. However, clinical decisions should be individualized, with careful risk-benefit assessment and vigilant monitoring to adjust therapeutic strategies as necessary.