Repair of large omphalocele or gastroschisis; with or without prosthesis
CPT4 code
Name of the Procedure:
Repair of Large Omphalocele or Gastroschisis; with or without Prosthesis
Summary
In layman's terms, this is a surgical procedure to repair a large omphalocele or gastroschisis, which are conditions where the baby's abdominal organs protrude outside the body through the navel. The surgery aims to return these organs to the abdominal cavity and close the opening, sometimes using a prosthetic material to support the repair.
Purpose
This procedure addresses congenital defects where abdominal organs remain outside the body. The goal is to reposition the organs inside the abdomen and close the defect, ensuring proper organ function and growth.
Indications
This procedure is indicated for newborn infants diagnosed with a large omphalocele or gastroschisis, usually identified through prenatal ultrasound or at birth. Criteria include:
- Presence of externalized abdominal organs
- Risk of infection or damage to exposed organs
Preparation
Preparation includes:
- Fasting for a specified period before surgery
- Blood tests and imaging studies to plan the procedure
- Stabilizing the infant with fluids and temperature control
Procedure Description
The surgery typically involves:
- Administering general anesthesia to the infant.
- Carefully placing the externalized organs back inside the abdomen.
- Closing the opening, which may involve using a prosthetic patch if the abdominal wall cannot be closed directly.
- Monitoring the infant for any immediate post-operative complications.
Duration
The surgery typically takes between 2 to 4 hours, depending on the complexity and the need for a prosthesis.
Setting
The procedure takes place in a hospital operating room, often in a specialized pediatric surgical center.
Personnel
The healthcare team includes:
- Pediatric surgeons
- Anesthesiologists
- Surgical nurses
- Pediatric intensivists for post-operative care
Risks and Complications
Common risks include:
- Infection
- Bleeding
- Damage to abdominal organs
- Anesthesia-related complications
Rare complications could involve:
- Long-term bowel dysfunction
- Need for additional surgeries
- Issues with prosthesis, if used
Benefits
The primary benefits are:
- Prevention of infection and injury to the exposed organs
- Improved long-term organ function
- Enhanced overall growth and development
Recovery
Post-procedure care includes:
- Monitoring in a neonatal intensive care unit (NICU)
- Pain management and infection prevention
- Gradual introduction of feeding
- Recovery time varies; hospital stay may range from several weeks to months, depending on the infant's condition and size of the defect.
Alternatives
Alternative treatments might include:
- Conservative management with gradual reduction techniques, for smaller defects
- Delayed surgical closure in stages for very large defects
Pros and cons of each alternative depend on the specific case and severity of the condition.
Patient Experience
During the procedure, the infant will be under general anesthesia and will not feel any pain. Post-surgery, pain management includes medications and supportive care. Parents can expect a gradual recovery process and will receive guidance on wound care, feeding, and follow-up appointments to monitor development and healing.