Repair of omphalocele (Gross type operation); first stage
CPT4 code
Name of the Procedure:
Repair of Omphalocele (Gross type operation); First Stage
Summary
The first stage of the Gross type operation to repair an omphalocele involves surgically closing the abdominal wall defect in newborns. This defect causes some of the baby's abdominal organs to protrude outside the body through the belly button area. The initial stage focuses on reducing the omphalocele safely and securing the abdominal organs within the abdomen.
Purpose
The operation addresses congenital omphalocele, a condition present at birth in which the infant’s intestines, liver, or other organs stick outside of the belly through the belly button in a translucent sac. The goal is to protect organs, prevent infections, and eventually contain them within the abdomen to promote normal development and function.
Indications
- Diagnosis of congenital omphalocele via prenatal imaging or physical examination at birth.
- Protruding abdominal organs covered by a thin membrane.
- Breathing difficulties due to the pressure of the organs on the diaphragm.
- Risk of infections due to exposed organs.
Preparation
- Fasting several hours before the procedure to reduce risks related to anesthesia.
- Parental consent and discussion of the procedure details.
- Diagnostic imaging (e.g., ultrasound, MRI) to assess the size and content of the omphalocele.
- Preoperative antibiotics to prevent infections.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the baby is unconscious and pain-free.
- Incision: A careful incision is made around the omphalocele sac.
- Reduction: The protruding organs are gently maneuvered back into the abdominal cavity.
- Closure: If possible, the abdominal wall is closed with stitches or a temporary mesh is placed if there is insufficient space inside the abdomen to accommodate the organs at once.
- Dressing: The surgical site is covered with sterile dressings.
Duration
Typically, the procedure lasts between 2 to 4 hours, depending on the complexity and size of the omphalocele.
Setting
The procedure is performed in a specialized surgical center or hospital operating room with neonatal care facilities.
Personnel
- Pediatric surgeon
- Anesthesiologist
- Surgical nurses
- Neonatologist or pediatrician
Risks and Complications
- Infection
- Bleeding
- Compartment syndrome due to increased intra-abdominal pressure
- Respiratory difficulties
- Recurrence of the omphalocele
Benefits
- Protection of abdominal organs from injury and infection.
- Improved ability of the baby to breathe and feed.
- Gradual development of a normal abdominal wall structure.
Recovery
- Close monitoring in a neonatal intensive care unit (NICU).
- Pain management with medications.
- Gradual introduction to feedings.
- Follow-up appointments to monitor progress and plan for additional necessary surgeries.
- Care instructions for the surgical site and avoidance of pressure on the abdomen.
Alternatives
- Non-surgical management with silo placement to gradually reduce the omphalocele over time before surgical closure.
- Delayed surgery allowing the baby to grow before undergoing surgical repair.
- While less invasive, these alternatives may prolong hospital stay and potentially increase risks of complications.
Patient Experience
- The baby will be under general anesthesia and not feel pain during the procedure.
- Postoperatively, the infant might experience some discomfort managed with pain relief measures.
- Parents may need to assist in postoperative care and attend regular follow-up visits for the baby's recovery and assessment.