Pediatric surgery abdomonal wall defects

Abdominal Wall Defects

Definition

In babies with congenital umbilical wall defect gastroschisis and ruptured omphalocele.

Objectives

•   To reduce the bowel inside the abdominal cavity

•   To close the defect primarily if feasible

•   To increase the abdominal cavity by a pouch, if required.

Position

Supine.

Anesthesia

General with endotracheal intubation.

Procedure

1.  Enlarge the defect transversely in the case of gastroschisis.

2.  Excise the remaining sac in the case of ruptured omphalocele and enter the abdominal cavity.

3.  Stretch the anterior abdominal wall. Try to close the defect in layers, if feasible.

4.  Create a pouch of marlex or prolene mesh.

5.  Suture the pouch all around the defect in 2 layers.

6.  Clamp the excess of pouch to force reduce the bowel into the abdominal cavity in stages.

Instruments

General pediatric set.

Sutures

•   Catgut                   4/0

•   Nylon                                 3/0

•   Marlex mesh.

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