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Omphalocele Reduction in OEIS: Safety and Feasibility of a Custom Hydrocolloid Dressing Prior to Operative Closure
Noa Ferziger, BA, Aisha L. Siebert, MD, PhD, Mark A. Fleming II, MD, William Law, MD, Evalynn Vasquez, MD, MBA, Ted Lee, MD, MSc, Belinda Dickie, MD, PhD.
Boston Children's Hospital, Boston, MA, USA.
BACKGROUND:
Traditionally, dressings for newborns with omphalocele-exstrophy-imperforate anus-spinal anomalies (OEIS) complex involved a two-layer polyvinylidene chloride barrier, separating bladder mucosa from prolapsed ileum. We assess feasibility and safety of a custom hydrocolloid dressing (CHD) to separate urine from stool with simultaneous omphalocele reduction before first-stage closure.
METHODS:
A retrospective review was conducted of all patients who underwent CHD between May 2023 and November 2025.
RESULTS:
Infant A: Female born at 30 weeks and 1 day (30w1d) (1.4kg) underwent serial CHD application every 48-72 hours while awaiting closure and recovery from complex myelocystocele. Effort was made to completely invert the bladder during silo reduction. At age 2 months (2.8kg), she underwent single-stage bladder exstrophy closure with tubularization of cecal plate, colostomy creation, and omphalocele repair. She developed an enterovesical fistula that self-resolved with bladder decompression (Figure, A1-A3).
Infant B: Male born at 36w2d (2.59kg) underwent serial CHD application every 24-72 hours. On DOL22 (2.97kg), patient underwent first stage closure with tubularization of cecal plate, colostomy creation, midline approximation of bladder halves, and omphalocele repair. He required subsequent repair of a nonreducible inguinal hernia (Figure, B1-B3).
Infant C: Male born at 37w0d (3.34kg) underwent serial CHD application every 24-48 hours. On DOL15 (3.55kg), patient underwent first stage closure with tubularization of cecal plate, colostomy creation, midline approximation of bladder halves, and omphalocele repair. Superficial skin separation on the cephalad bladder aspect resolved with wound care (Figure, C1-C3).
CONCLUSIONS:
Serial CHD can be safely applied for omphalocele reduction with simultaneous separation of urine from stool before surgery for OEIS. Future studies are needed to assess whether omphalocele reduction before surgery allows for fascial approximation under reduced intra-abdominal tension.
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