046 PRIMARY vs STAGED CLOSURE OF GIANT EXOMPHALOS - CARDIAC ANOMALIES DO NOT AFFECT OUTCOME 1 1 1 ,2 1 1 Clare Rees , Lucinda Tullie , Agostino Pierro , Edward Kiely , Ignatius Joseph Curry , Kate 1 2 1 ,2 Cross , Simon Eaton , Paolo De Coppi 1 2 Great Ormond Street Hospital for Children, London, UK, Institute of Child Health, UCL, London, UK Aim: to describe management of giant exomphalos and investigate the effect of congenital cardiac anomalies on outcomes Methods: single centre retrospective case note review (with audit approval) was performed of neonates presenting with giant exomphalos (fascial defect ≥5cm ± liver herniation) over 10 years (2004-2014). Demographic and operative data were collected and outcomes compared between infants who had primary or staged closure. Congenital cardiac anomalies were considered significant if requiring surgery or long-term follow up. Data, median (range) were analysed with Mann Whitney-U test, t test and Fishers exact test as appropriate. Results: 22 patients were included, 20 with liver herniation and 1 Pentalogy of Cantrell. Gestational age was 38 weeks (30-40), birth weight 2.7kg (1.4-4.6); 13 (60%) were male. Two were managed conservatively due to severe co-morbidities, 5 underwent primary closure TM and 15 had application of prolene mesh silo and serial reduction. Five (23%) died, including 2 managed conservatively (1 adenovirus, 1 CDH), 1 renal failure, 2 pulmonary hypertension. None died primarily because of exomphalos. Survivors were followed up for 38 months (271). Of patients managed with a staged approach, 13 (87%) had fascial closure, 2 were closed with a patch. Five had other operations before definitive closure (laparotomy [2], exploration of bowel in silo [1], silo reapplication [2]). 1/5 primary and 11/15 staged closure patients developed ventral herniae (p=1). Cardiac anomalies were present in 19 (86%), 7 had minor and 12 major anomalies. Twelve (55%) had other anomalies, including 1 chromosomal anomaly. Outcomes are shown in Table. Conclusions: Infants with giant exomphalos whose defect can be closed primarily without tension have a shorter length of stay but other outcomes are similar. Infants with more significant abdomino-visceral disproportion can be managed with a silo and staged closure the presence of significant cardiac anomalies does not affect surgical outcome.
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