Giant Omphalocele Research Articles

The Analysis Study of Diagnosis and Management of Giant Omphaloceles: A Comprehensive Systematic Review

Background: Giant omphalocele (GO) is a severe form of omphalocele, characterized by a defect larger than 5 cm, often including the liver. Management strategies include staged surgical closure and non-operative delayed closure, with the latter focusing on neo-epithelialization and secondary operations. This study aims to explore diagnosis and management during neonatal care. Methods: This systematic review exclusively examined full-text articles published in English between 2014 and 2024, adhering to the PRISMA 2020 guidelines. Result: The study conducted a thorough review of more than 300 publications that were obtained from reputable databases, such as ScienceDirect, SagePub, and PubMed. Eight publications were identified as necessitating a more comprehensive examination subsequent to an initial screening. As a result, a comprehensive review of these selected studies was conducted to guarantee an exhaustive and rigorous assessment. Conclusion: Giant omphaloceles management involves a multifaceted approach, including primary closure, staged surgical closure, and nonoperative delayed closure. Synthetic materials and biological meshes promote granulation tissue formation and gradual closure, but further research is needed to reduce morbidity and mortality.

GIANT OMPHALOCELE ABOUT A CASE

We report the case of a giant omphalocele 10 cm in diameter diagnosed by ultrasound in the obstetric emergency department in a patient with a full-term pregnancy in labor, in whom an emergency cesarean section was indicated with fetal extraction, performance of emergency neonatal care, coverage of the omphalocele with non-adherent wet compresses and management by the pediatric surgeon with the result of uncomplicated operative sequelae without complications.

Forgotten and Found: Neglected Omphalocele - Vital Role of Imaging

Abstract Background Omphalocele is a congenital abnormality of the abdominal wall consisting of protrusion of the abdominal contents at the base of the umbilical cord. It is associated with genetic and structural defects, which significantly affect its prognosis and survival outcomes. Case Presentation Prenatal diagnosis of this condition is crucial for apt management; however, we present two cases of neglected and giant omphaloceles in early childhood. It is usually a disease of neonatal age, and presentation at such a late age is quite rare. The management of such cases is quite challenging, and multiple strategies have been described. In our case, the giant omphalocele was managed with an external surgical skin closure system as a component of a staged closure strategy. Conclusion The expert surgical technique played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial for optimal management.

Single institution review of operative management of giant omphalocele

PurposeOperative management of giant omphalocele that cannot be closed primarily varies based on several factors, and there is little data to guide choice of operative approach and how this impacts long-term outcomes. We aimed to characterize whether surgical approach – staged closure during the neonatal period, or delayed closure – affects outcomes. MethodsWe conducted a retrospective review of children treated for giant omphalocele who did not undergo primary closure at Children's Hospital Colorado from 2010–2022. We included patients with giant omphalocele who underwent treatment at the study site. Data collected included patient characteristics, clinical course, and outcomes. Comparisons were made based on type of closure, delayed versus staged. ResultsWe identified 24 patients; 6 delayed and 16 staged. 2 patients died prior to closure. Delayed and staged groups did not differ regarding demographics. Infants undergoing staged repair tended to have more total hospital and total ventilator days, and more post-closure ventral hernia requiring repair; short-term outcomes were otherwise comparable. There was no difference between groups in long-term outcomes, including neurodevelopmental milestones and mortality. ConclusionsLong term outcomes are equivalent between staged repair and delayed repair of giant omphalocele. However, staged repair may be associated with more ventilator days, total hospital days and higher risk of ventral hernia.

Morbidity in giant omphaloceles: Predictive factors and management strategies.

To identify predictors of morbidity in GO through an analysis of associated anomalies, defect characteristics and management strategies. PubMed and Ovid EMBASE databases were searched from 2013 to 2023. Primary end points assessed correlation of morbidity with gestational age (GA), birth weight (BW), eviscerated organs, defect size, associated anomalies and management strategy. Twenty articles were included for analysis with a total of 1009 GO. Median GA was 37 weeks (27-41), with a median BW of 2700 g (900-6000). 143 cardiovascular anomalies, 238 pulmonary anomalies, 98 musculoskeletal anomalies, 53 urogenital anomalies, 94 gastrointestinal anomalies, 11 neurological anomalies and 43 chromosomal anomalies were identified. 82 had unspecified additional anomalies, of which 20 and 17 were defined as major and minor, respectively. 123 neonates were managed with primary closure, 206 neonates with staged closure and 312 neonates with conservative treatment. Complications included sepsis, respiratory compromise, feeding dysfunction and closure-related adverse events. Long-term morbidity included home ventilation (n = 72), long-term parental nutrition (n = 36), and delayed motor neurodevelopment (n = 21). Main predictors of morbidity were pulmonary hypertension/hypoplasia, major congenital anomalies, greater defect size and liver herniation. Key predictors of poor outcomes include the presence of additional congenital anomalies, defect size, liver herniation and pulmonary hypertension/hypoplasia.

Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients

PurposeAbdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns.MethodsFour tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation.ResultsTen patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4–22) in GOC and 5 days (range 4–11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4–22).ConclusionTraction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

Perinatal Management of Pregnancies with Fetal Congenital Anomalies: A Guide to Obstetricians and Pediatricians.

Congenital anomalies are responsible for approximately 20% of all neonatal deaths worldwide. Improvements in antenatal screening and diagnosis have significantly improved the prenatal detection of birth defects; however, these improvements have not translated into the improved neonatal prognosis of babies born with congenital anomalies. An attempt has been made to summarise the prenatal interventions, if available, the optimal route, mode and time of delivery and discuss the minimum delivery room preparations that should be made if expecting to deliver a fetus with a congenital anomaly. The recent literature related to the perinatal management of the fetus with prenatally detected common congenital anomalies was searched in English peer-reviewed journals from the PubMed database to work out an evidence-based approach for their management. Fetuses with prenatally detected congenital anomalies should be delivered at a tertiary care centre with facilities for neonatal surgery and paediatric intensive care if needed. There is no indication for preterm delivery in the majority of cases. Only a few congenital malformations, like highrisk sacrococcygeal teratoma, congenital lung masses with significant fetal compromise, fetal cerebral lesions or neural tube defects with Head circumference >40 cm or the biparietal diameter is ≥12 cm, gastroschisis with extracorporeal liver, or giant omphaloceles in the fetus warrant caesarean section as the primary mode of delivery. The prognosis of a fetus with congenital anomalies can be significantly improved if planning for delivery, including the place and time of delivery, is done optimally. A multidisciplinary team should be available for the fetus to optimize conditions right from when it is born.

Total Hepatic Herniation Associated with Giant Omphalocele: Case Report

Omphalocele is a congenital defect of the abdominal wall. The current knowledge of its etiology suggests that this defect is not due to the failure of closure or migration of the body wall. Rather, since the umbilical cord is inserted into the sac, it is considered that the omphalocele appears due to the lack of return of the viscera to the abdominal cavity. Consequently, the abdominal contents are herniated with an incidence of 1.5 to 3 per 10,000 births and are associated with multiple congenital and chromosomal malformations. We present an atypical and rare case of a 37-year-old mother; As a result of his fourth pregnancy, with an ultrasound diagnosis at 21 weeks of omphalocele with herniated fetal liver, with birth without complications by scheduled caesarean section, whose defect was considered a giant omphalocele (> 6cm), and which was treated with the placement of silo since the introduction of the herniated contents (liver) into the abdominal cavity was not achieved. The purpose of this paper is to try to explain the complexity of the management of this type of patient, and the complications related to its management, since, being of rare presentation, it becomes a complex challenge for the multidisciplinary team that must face this type of pathology.

Reconstruction of the abdominal wall with component separation technique in patients with giant omphalocele

BackgroundSeveral techniques have been described to repair giant omphaloceles. Component Separation Technique (CST) is a surgical technique first reported in adults to repair large abdominal wall defects. The purpose of this study is to describe our experience using this technique in repairing large ventral hernias secondary to giant omphaloceles in children. MethodsNine patients with giant omphalocele were treated. The abdominal wall was reconstructed using CST, based on the enlargement of the abdominal wall by separate mobilization of the muscular layers. Patients were monitored for complications during admission, postoperative complications, and all patients were seen for follow-up. ResultsComponent separation technique was performed at a median age of 7.2 years. The median diameter of the hernia was 109.8 cm2. There was no mortality. Minor complications were seen (infection, skin necrosis, and hematoma). There were no recurrences after an average follow-up of 3.3 years (2 - 4 years). ConclusionsComponent separation technique is a valuable method for repairing large ventral hernias as a consequence of giant omphaloceles in children. Our series supports the use of CST in children, in a wide age range, from newborns for primary closure to adolescence in cases of giant ventral hernias secondary to omphaloceles with multiple previous surgeries. Level of EvidenceII

Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants

Background: Chyloperitoneum (CP) and chylothorax (CT) are rare conditions that have a high mortality rate and unclear treatment options. Their incidence in neonates ranges from 1 in 20000 to 1 in 187000 live births. This study aims to evaluate the effectiveness of synthetic somatostatin analog (octreotide) and sirolimus therapy in treating chylous pleural and peritoneal collections in newborns and infants. Methods: We conducted a retrospective analysis of 10 children with either chylothorax or chyloperitoneum, treated in our department between 2018 and 2023. The study was approved by the Local Independent Ethics Committee of The National Medical Research Center of Children's Health, under Protocol №7, dated 11 May 2023. The parents voluntarily signed an informed consent form for the off-label use of the drug. We reviewed the medical records for demographic information, clinical presentation, management, and outcome. Results: Our study looked at patients aged between 0 and 5.5 months, with seven cases of chyloperitoneum and three cases of chylothorax. We initially used octreotide, which was then switched to sirolimus if there was no improvement. Octreotide was effective in five children after 10-18 days of treatment, while the effect of sirolimus was observed 8-14 days after starting treatment. One patient, who had a history of a giant omphalocele with primary closure, experienced complications after 8 weeks of sirolimus therapy, including bilateral knee arthritis, leukopenia, and lymphopenia. Fortunately, there were no fatal outcomes. Conclusion: Sirolimus therapy is effective in treating newborns with chylothorax or chyloperitoneum, with a low risk of complications even in those cases not responding to octreotide therapy. It is recommended that octreotide therapy should not exceed 10 days, after which sirolimus can be prescribed.

Optimizing Surgical vs. Non-Surgical Management of Omphalocele in Newborns: Challenges in Resource-Poor Settings vs. American and Canadian Guidelines: A Systematic Review

Omphalocele represents a significant surgical challenge in developing nations with poor resource settings and has been reported to have higher morbidity and mortality rates. This systematic review’s objective is to evaluate the challenges of surgical versus non-surgical management of omphalocele in newborns in resource-poor settings (developing nations) in comparison to developed nations, particularly the United States and Canada. For this study, a methodology comprising a literature search and review has been utilized. The review entails the search for pertinent literature that focuses on the management of omphalocele in poor resource settings and developing nations. In this review, giant omphalocele has been defined as >5 cm with 50% of the liver being the content of the omphalocele sac. Further, in resource-poor environments, including developing nations, higher rates of neonatal mortality and morbidity due to omphalocele in newborns have been linked to the existence of various related anomalies. However, in developed nations, including the United States and Canada, the development of effective guidelines and advancements in omphalocele management have resulted in improved survival rates and a reduction in mortality and morbidity rates among neonates with omphalocele. However, despite the improvements made in antenatal diagnosis and postnatal management of omphalocele, the general survival rates have remained stagnant at 47.5%. As such, more efforts are necessary to determine the best treatment approaches to improve survival rates and eliminate the various risk factors for mortality.

Fetal lung volumes measured by MRI predict pulmonary morbidity among infants with giant omphaloceles.

Giant omphaloceles (GO) have associated pulmonary hypoplasia and respiratory complications. Total lung volumes (TLV) on fetal MRI can prognosticate congenital diaphragmatic hernia outcomes; however, its applicability to GO is unknown. We hypothesize that late gestation TLV and observed-to-expected TLV (O/E TLV) on fetal MRI correlate with postnatal pulmonary morbidity in GO. A single-institution retrospective review of GO evaluated between 2012 and 2022 was performed. Fetal MRI TLV between 32 and 36weeks' gestation and O/E TLV throughout gestation were calculated and correlated with postnatal outcomes. 86 fetuses with omphaloceles were evaluated; however, only 26 met strict inclusion criteria. MRIs occurred between 18 and 36weeks' gestation. Those requiring delivery room intubation had significantly lower late gestation TLV and O/E TLV. O/E TLV predicted tracheostomy placement and survival. Neither TLV nor O/E TLV predicted the length of hospitalization or supplemental oxygen after discharge. Three fetuses had a TLV less than 35mL: one died of respiratory failure, and the other two required tracheostomy. Fetal MRI TLV measured between 32 and 36weeks' gestation and O/E TLV predict the need for delivery room intubation and tracheostomy. O/E TLV correlated with survival. These data support fetal MRI as a prognostic tool to predict GO associated pulmonary morbidity.

Complex ventral hernia secondary to giant omphalocele managed by preoperative pneumoperitoneum and botulinum toxin: A case report

Complex ventral hernia secondary to giant omphalocele managed by preoperative pneumoperitoneum and botulinum toxin: A case report

Giant Omphaloceles—Morbidity, Mortality, and Financial Impact of Early Versus Delayed Repair

IntroductionWe compared strategy outcomes and financial impact over the first two years of life (F2YOL) for patients with giant omphaloceles undergoing early repair (ER) (primary or staged) versus delayed repair (DR). MethodsA retrospective review of giant omphaloceles (fascial defect > 5 cm/> 50% liver herniation) at a tertiary children's hospital between 1/1/2010 and 12/31/2019 was performed. Survival, length of stay, age at repair, ventilation days (VD), time to full enteral feeds, readmissions during the F2YOL, incidence of major associated anomalies, and total hospitalization charges during the F2YOL were compared. A subanalysis removing potential confounders and only including patients who underwent fascial closure within the F2YOL was also conducted. ResultsThirty four giant omphaloceles (23DR and 11ER) were identified. The median age (days) at repair was 289 [148, 399] DR versus 10 [5, 21] ER, P < 0.001. Total cohort two-year survival was significantly higher in the DR group (95.7% versus 63.6%, P = 0.03). Including patients with a tracheostomy there was no significant difference in VD during the index hospitalization. Excluding tracheostomy patients, the DR group had significantly fewer VD during the index hospitalization, 15 [0, 15] versus 18 [10, 54], P = 0.02 and over the F2YOL 6.5 [ 0, 21] versus 18 [14, 43], P = 0.03. There were no significant differences in the incidence/type of major associated anomalies, time to full enteral feeds, index length of stay, total hospital days, total admissions, or associated hospital charges. On subanalysis, there was no significant difference in VD or survival at any time. ConclusionsDelayed and early repair strategies for giant omphaloceles have equivalent outcomes in the index hospitalization and over the course of the first two years of life. These findings are useful for family counseling and expectation setting.

Abdominal wall defect repair with component separation technique for giant omphalocele with previous relaxing incisions on the abdominal skin

BackgroundThe repair of large abdominal wall defects that cannot be closed primarily is quite challenging. The component separation technique (CST) is a surgical approach using autologous tissue to close large abdominal wall defects. The CST requires extensive dissection between the abdominal skin and the anterior sheath of the rectus abdominis muscle. Subsequently, incisions are made at both sides of the external oblique aponeurosis, releasing the external oblique muscle from the internal oblique muscle, and then the right and left rectus abdominis muscles are brought together in the midline for defect closure. However, impairment of blood flow in the abdominal wall skin and necrotic changes are recognized as potential complications.Case presentationThe CST was performed in a 4-year-old boy with a large ventral hernia who had undergone skin closure with abdominal wall relaxing incisions for the primary treatment of giant omphalocele in the neonatal period. Given his history of incisions on the abdominal wall, he was speculated to be at high risk for postoperative skin ischemia. Dissection was therefore kept to a minimum to preserve the blood supply from the superior and inferior epigastric arteries and perforating branches of those arteries through the rectus abdominis muscle. In addition, care was taken to adjust the muscle relaxant dosage while monitoring the intravesical pressure, ensuring that it did not exceed 20 mmHg to avoid impaired circulation in the abdominal wall caused by abdominal compartment syndrome. He was discharged 23 days after the surgery without any complications, and neither recurrence of the ventral hernia nor bowel obstruction was observed in 4 years.ConclusionsA giant omphalocele with primary skin closure was treated by applying the CST. The procedure can be performed safely while preserving the blood flow to the abdominal wall, even in patients with a history of relaxing incisions on the abdominal skin. The CST is expected to be effective for repairing the large abdominal wall defects seen in giant omphalocele when primary closure is not possible.

Prenatal diagnosis of fetal defects and its implications on the delivery mode.

Congenital malformations are defined as single or multiple defects of the morphogenesis of organs or body parts, identifiable during intrauterine life or at birth. With recent advances in prenatal detection of congenital malformations, many of these disorders can be identified early on a routine fetal ultrasound. The aim of the present systematic review is to systematize the current knowledge about the mode of delivery in pregnancies complicated by fetal anomalies. The databases Medline and Ebsco were searched from 2002 to 2022. The inclusion criteria were prenatally diagnosed fetal malformation, singleton pregnancy, and known delivery mode. After the first round of research, 546 studies were found. For further analysis, studies with full text available concerning human single pregnancy with known neonatal outcomes were considered. Publications were divided into six groups: congenital heart defects, neural tube defects, gastroschisis, fetal tumors, microcephaly, and lung and thorax malformations. Eighteen articles with a descripted delivery mode and neonatal outcome were chosen for further analysis. In most pregnancies complicated by the presence of fetal anomalies, spontaneous vaginal delivery should be a primary option, as it is associated with lower maternal morbidity and mortality. Cesarean delivery is generally indicated if a fetal anomaly is associated with the risk of dystocia, bleeding, or disruption of a protective sac; examples of such anomalies include giant omphaloceles, severe hydrocephalus, and large myelomeningocele and teratomas. Fetal anatomy ultrasound should be carried out early, leaving enough time to familiarize parents with all available options, including pregnancy termination, if an anomaly is detected.

Giant omphalocele: A novel approach for primary repair in the neonatal period using botulinum toxin.

Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.

Giant omphalocele: A novel approach for primary repair in the neonatal period using botulinum toxin

RESUMO Introdução: onfalocele gigante (OG) é uma condição complexa para a qual muitas alternativas terapêuticas foram desenvolvidas; no entanto, não há consenso sobre qual o melhor tratamento. Os benefícios e eficácia da toxina botulínica A (TBA) no reparo de grandes defeitos da parede abdominal em adultos foram comprovados, e o relato de uso em crianças cresceu recentemente. O objetivo deste estudo é descrever uma nova técnica para reparo primário de OG utilizando TBA durante o período neonatal e relatar nossa experiência inicial. Métodos: os pacientes foram acompanhados de agosto de 2020 a julho de 2022. A TBA foi aplicada na parede abdominal lateral nos primeiros dias de vida, seguida de correção cirúrgica do defeito abdominal. Resultados: enquanto aguardavam a cirurgia, os pacientes tiveram mínima manipulação, sem ser exigida ventilação mecânica, permaneceram em alimentação enteral plena e mantiveram contato com os pais. A linha média foi aproximada sem tensão e sem necessidade de técnicas adicionais ou uso de prótese. Os pacientes receberam alta com o defeito reparado. Conclusão: essa abordagem representa um meio-termo entre o reparo estagiado e o tratamento não-operatório. Não requer intervenções agressivas no início da vida, permitindo a manutenção do vínculo materno-infantil e a alta do paciente com defeito reparado sem a necessidade de uso de técnicas adicionais ou prótese. Acreditamos que esta técnica deva ser considerada como um novo possível recurso no manejo desta complexa condição.

A Review of Covered Abdominal Wall Defects: Cord Hernias Are Associated With Major Anomalies

IntroductionCovered abdominal wall defects (CAWD) can be categorized into giant omphaloceles (GOs), nongiant omphaloceles (NGOs), and umbilical cord hernias (UCHs). We sought to evaluate differences in management and outcomes of the different CAWD, treated at a large tertiary children's hospital, with regards to survival and association with other major congenital anomalies. MethodsA retrospective review of CAWD patients between January 2010 and January 2021 was conducted. GO was defined as a fascial defect >5 cm or >50% liver herniation. UCH were defined as fascial defects ≤ 2 cm. All others were classified as NGO. Type of repair, time to fascial closure, index hospitalization length of stay (LOS), and survival rates were compared. Four major anomaly categories were identified: cardiac, midline, Beckwith-Weidemann Syndrome, and other genetic anomalies. ResultsWe identified 105 CAWD patients (UCH n = 40; GO n = 34; and NGO n = 31). Ninety percent of UCH underwent primary repair, 10% were never repaired. NGOs were repaired by primary or staged methods in 92.9% of cases and 7.1% by delayed repair. Primary or staged repair occurred in 32.4% of GOs and delayed repair occurred in 67.6%. The median days to repair was 181 [24,427] GO, 1 [1,3] NGO, and 1 [0,1] UCHs (P < 0.01). Index hospitalization median LOS (days) was 90 [55,157] GO, 23 [10,48] NGO, 9 [5,22] UCH, (P < 0.01). There were no statistical differences in survival rates, number of patients with major anomalies (GO 35.4%, NGO 51.5%, UCH 50%), or types of anomalies. ConclusionsUCHs and omphaloceles have similar incidences of major associated anomalies. Thus, all patients with a covered abdominal wall defect should undergo workup for associated anomalies.

Silver sulfadiazine as the topical treatment for giant omphalocele: a case report

Background: Major omphalocele is defined as an abdominal defect greater than 5 cm with the presence of the liver and most parts of the bowel in the sac. The management remains challenging for pediatricians and surgeons with remarkably high mortality. Reports about topical agents/dressing used as escharotic therapy, such as silver sulfadiazine, povidone-iodine, topical antibiotics, or honey, have been published with different results. Continued application of a thick layer of silver sulfadiazine on the omphalocele surface is needed to promote eschar formation and neo-epithelialization. Case description: A term, 2700-gram newborn male infant presented with abdominal defect and herniated abdominal contents covered by a membranous sac containing liver that is widely known as omphalocele. A thick layer of silver sulfadiazine was applied repeatedly onto the omphalocele sac to promote epithelialization and successfully reduce the sac diameter. The patient showed a positive outcome as it reduced the omphalocele size after nine days. The patient family has been educated about the continued application of silver sulfadiazine. Although non-operative delayed treatment has lower mortality rates and better clinical outcomes, the patients should wait for the reconstruction surgery for a long time. Conclusion: Conservative treatment with silver sulfadiazine is safe and shows satisfying results to the giant omphalocele.