Anaesthetic management of omphalocele repair at a tertiary hospital in Ibadan, Nigeria: A review of medical records from January 2008 through December 2017

Abstract

Background: An omphalocele is a congenital defect of the anterior abdominal wall, characterized by herniation of midline abdominal content through an extraembryonic part of the umbilical cord. Management of this condition is challenging, particularly in
resource-limited settings.

Methods: Using a standardized data collection instrument, we retrospectively reviewed the medical records of all patients who underwent surgical omphalocele management over a 10-year period at a tertiary care hospital in Ibadan, Nigeria. The review included documentation of perioperative complications, anaesthetic and surgical techniques, and patient outcomes.

Results: From January 2008 through December 2017, 57 neonates underwent surgical omphalocele repair (59.6% boys; mean age, 2.7 days; mean birth weight, 3.06 kg). In total, 33 neonates (57.9%) had major omphaloceles, and 24 (42.1%) had minor omphaloceles. At the time of surgery, about 77.2% of patients were categorized as class 1 or 2 according to the American Society of Anesthesiologists Physical Status Classification System. In total, 15 patients (26.3%) had comorbidities, including sepsis (n=10, 17.5%), anaemia (n=3, 5.3%), jaundice (n=2, 3.5%), and congenital anomalies (n=6, 10.5%). General anaesthesia with a relaxant technique was administered to all neonates, and primary closure was conducted on 52 patients (91.2%). Intraoperative complications included difficult intubation (n=5, 8.8%), hypothermia (n=7, 12.3%), tachycardia (n=37, 64.9%), and bradycardia (n=3, 5.3%). Postoperatively, 15 neonates (26.3%) required mechanical ventilation and intensive care management, and 14 (24.6%) died.

Conclusions: At this tertiary care centre in Nigeria, an appreciable number of patients with omphaloceles were surgically managed, primarily using primary wound closure. Poor postoperative outcomes, including mechanical ventilation and mortality, were common.