Placental Membrane Transplantation: Can It Be A Solution For Tissue Defect Repair In Giant Omphaloceles

Objectives

This study aimed to evaluate the effect of placental membrane covering of the omphalocele sac on the healing of giant omphaloceles requiring silo repair that could not be treated primarily.

Methods

This prospective study was performed between October 2021 and October 2023 with the approval of our hospital's ethics committee. All pregnant women diagnosed with prenatal giant omphalocele were informed that their own placenta could be used for omphalocele repair if necessary, and their consent was obtained.

Results

Over 24 months, 7 omphaloceles could not be closed primarily, and the placental amniotic membranes were wrapped around the omphalocele sacs and left for secondary healing. All patients underwent cesarean section. The mean gestational age at delivery was 37.6 ± 1.1 weeks (range, 36-39 weeks) according to the last menstruation and 35.3 ± 3.3 weeks (range, 29-39 weeks) according to ultrasound. The mean birth weight was 2814.3 ± 704.9 g (range, 1340-3400 g). Two infants were male (28.5%), and 5 were female (71.5%). The liver and intestines were in the omphalocele sacs. The mean transverse diameter, vertical diameter, and height of omphalocele sac were 15 ± 3.36 cm (range, 11-20 cm), 15.43 ± 3.1 cm (range, 12-19 cm), and 12.33 ± 3.13 cm (range, 8-16 cm), respectively. All the patients had unresectable livers that adhered to the sac. One of the patients had an omphalocele that ruptured during birth, and placental transplantation was performed after rupture repair. After wrapping with the placental membrane, all healed with tight granulation tissue. The mean hospitalization duration was 48.86 ± 26.99 days (range, 21-101 days). The median ventral hernia diameter was 7.07 ± 2.09 cm (range, 5-10 cm). The mean follow-up duration was 10.7 ± 6.8 months (range, 3-23 months). The discharge weight of the infants increased by an average of 789.28 ± 532.5 g compared with their birth weight, which was statistically significant (P = .028). The average transverse diameter of the omphalocele sac decreased by an average of 7.92 ± 3.67 cm compared with that at birth, which was statistically significant (P = .018). The vertical diameter measurement of the omphalocele sac decreased by an average of 5.75 ± 2.18 cm at discharge compared with that at birth, which was statistically significant (P = .046).

Conclusions

Wrapping the maternal placental membrane around the omphalocele sac is an inexpensive, effective, safe, and successful treatment method for preventing sac rupture during the secondary healing of giant omphaloceles.