Giant Omphalocele: What’s the Way to Go?

Omphalocele is a known congenital anomaly consisting with a periumbilical abdominal wall defect determining the herniation of viscera into a sac made up of peritoneum, Wharton’s jelly and amnios. When the defect is larger than 5-6 cm with herniation of most of the liver and bowel into the sac, the condition is commonly referred to as giant omphalocele (GO). The latter represents a challenging situation to manage because of the disproportion between the volume of herniated viscera and the intra-abdominal capacity, that Gross [1] suitably described as the abdominal viscera having lost its “right of domicile” in the peritoneal cavity. This makes very difficult to reduce all viscera and close the abdominal wall defect without risking an excessive intra-abdominal pressure.