Comparison of long-term outcomes and nutritional status between primary and non-primary fascial closure in omphalocele.

PURPOSE: Operative strategies for omphalocele vary, and long-term outcomes remain limited. We aimed to compare postoperative and long-term outcomes of omphalocele repair with primary versus non-primary fascial closure. METHODS: A retrospective study of omphalocele at 2 institutions between 2006 and 2021 was conducted. After excluding patients with genetic disorders and severe associated anomalies, 41 patients (15 primary fascial and 26 non-primary fascial closures) were reviewed. RESULTS: Although there were no significant differences in defect size or liver herniation, non-primary fascial closure was significantly associated with a concomitant non-cyanotic cardiac anomaly. Time to first enteral feeding and length of hospital stay were significantly longer in non-primary fascial closure. For long-term outcomes, non-primary fascial closure was associated with significantly higher rates of failure to thrive during infancy (76% vs. 40%) and toddlerhood (62.5% vs. 23.1%). However, there were no significant differences in ventral hernia, respiratory, or neurodevelopmental problems. CONCLUSION: Non-primary fascial closure is associated with higher rates of failure to thrive, underscoring need for long-term follow-up of nutritional status; however, the higher incidence of cardiac anomalies in this group may reflect a bias toward selecting this closure technique. When feasible and not complicated, primary fascial closure might be preferred option for omphalocele.