Staged reconstructive repair

Staging repair is used for the surgical treatment of umbilical abdominal bulging. Due to the developmental defect of the anterior abdominal wall of the fetus, some organs protrude from the base of the umbilical cord, and the surface has a transparent capsule membrane composed of peritoneum and amniotic membrane, and there is no skin covering. At birth, the capsule is thin, moist and transparent, and gradually becomes dry, turbid, and easily broken after several hours. Umbilical abdominal bulging deformity is clinically divided into three categories: umbilical hernia, umphalocele, and gastroschisis. Umbilical bulge is a defect in the formation of mesoderm in the abdominal wall. It has a broad base and umbilical bulge. The bulging organs are most common in the small intestine, and the liver and transverse colon can also bulge. Other organs bulge very little. Staging can be performed with a large base. In 1967, Schuster first made a bag of Teflon fabric, and stitched its edge to the inner edge of the rectus sheath around the umbilical bulge. Then changed to polyester bags. After the operation, the bag was tightened and the internal organs were gradually retracted. In 1971, Wexler et al. method was that the top of the bag was not stitched, clamped with a pliers, and the pliers were rolled down one by one to shrink the bag. Recently, silicone rubber bags have been used to directly suture the skin around the umbilical bulge, and the bag is stenciled from the top every day. After 10 to 14 days, the viscera can be satisfied and can be repaired. Applying such methods, it is necessary to do a good job of disinfection and aseptic technique of the umbilical bulge capsule and the suture of the skin and silicone rubber bag to avoid infection. Treating diseases: umbilical hernia Indication 1. The umbilical bulge is small or only in the umbilical cord, the diameter of the base is less than 5cm, or the neck of the capsule is narrow and easy to be clamped. It is expected that the organs will not cause respiratory disorders in the abdominal cavity. 2. Although the base is large, it can be used for staging. It has been suggested that non-surgical treatments are suitable for patients with large bulging and intact capsules, but they take longer and are still at risk of rupture. 3. The wall of the capsule has been broken and the internal organs are exposed. Contraindications Premature infants or those weighing less than 2kg, with a variety of other severe malformations, late onset, local capsule rupture infection or general condition can not tolerate surgery. Preoperative preparation 1. Keep warm and oxygen. This disease is more common in premature infants. It is necessary to prevent scleredema. 2. Set the nasogastric tube decompression. 3. Local protection should be given in the delivery room to prevent rupture and infection. 4. Prophylactic antibiotics. 5. Nutritional support to establish venous access. 6. Systematic examination, including chest X-rays of the abdomen, to exclude other severe malformations and umbilical bulge - Exomphalose-Macroglossia-Gigantism, or Beckwith with visceral hypertrophy and hypoglycemia - Wiedeman syndrome. 7. Surgery should be carried out within 4 to 6 hours after birth, generally no more than 24 hours. Due to the emptiness of the digestive tract in the early operation, the organ is also beneficial, and the capsule has not been ruptured, and the infection is less. Surgical procedure 1. Suture the edge of the Teflon bag with the skin of the base of the capsule for one week, and place the swelled viscera together with the capsule into the bag. When suturing, the muscle layer should be sutured first, and then the skin layer should be sutured. 2. Make a series of parallel rows of sutures on the Teflon bag to form a plurality of inwardly turned wrinkles to facilitate the inward return of the organ. After 3.2 weeks, the bag was gradually sutured from the distal end, and the general organs were completely incorporated into the abdominal cavity. At this point, the bag can be taken out, the abdominal wall is sutured, and the repair is completed.