The Schuster procedure is a staged surgical repair used for infants born with giant omphaloceles, particularly when the omphalocele contains the liver and other abdominal organs. This multi-step approach gradually returns the abdominal contents back into the baby's abdominal cavity.
Understanding Giant Omphaloceles
An omphalocele is a birth defect where the infant's intestines, liver, or other organs stick outside of the abdomen through the belly button. In a giant omphalocele, a significant portion of the abdominal organs, including the liver, are outside the body. Surgically closing the abdominal wall in one step can lead to dangerously high pressure within the abdomen, compromising breathing and blood flow.
The Schuster Procedure: A Step-by-Step Approach
The Schuster procedure addresses this problem with a gradual approach:
- Initial Covering: The exposed organs are initially covered with a sterile, protective silo or pouch made of synthetic material. This pouch is sutured to the skin around the omphalocele.
- Gradual Reduction: Over the course of several days or weeks, the abdominal contents are gradually pushed back into the abdominal cavity. The silo is progressively reduced in size, effectively squeezing the organs back into their normal position.
- Delayed Closure: Once the abdominal organs are mostly inside and the abdominal cavity has stretched enough to accommodate them without excessive pressure, the abdominal wall is surgically closed. This delayed closure minimizes the risk of respiratory distress and other complications.
- Skin Closure (if needed): Sometimes, after the organs are inside, there isn't enough skin to close the abdominal wall completely. In these cases, the remaining opening may be allowed to heal on its own, forming a planned ventral hernia that may be repaired later. Skin grafting is another option if necessary.
Why is the Schuster Procedure Necessary?
- Prevents Increased Abdominal Pressure: A single-stage closure could raise intra-abdominal pressure significantly, leading to difficulty breathing (due to diaphragm compression), impaired blood flow to the kidneys and intestines, and potentially life-threatening complications.
- Allows Abdominal Cavity to Grow: The gradual reduction allows the abdominal cavity to slowly expand and accommodate the displaced organs.
- Reduces Risk of Respiratory Distress: By minimizing abdominal pressure, the procedure reduces the risk of compromising the infant's respiratory function.
Considerations
- The Schuster procedure typically requires a prolonged hospital stay.
- Infants may need ventilator support during the process.
- Nutritional support is crucial, often provided through intravenous feeding (TPN).
- Potential complications include infection, abdominal compartment syndrome, and wound breakdown.
In summary, the Schuster procedure is a vital staged surgical technique used to manage giant omphaloceles, providing a safe and effective method for returning abdominal contents to their proper location.
