The tiny “tent” on the abdomen represents both a fragile beginning and the starting point of a journey filled with care and hope.

Recently, the hospital’s Department of Pediatric Surgery, working closely with the Pediatric Intensive Care Unit (PICU) and the Department of Anesthesiology, successfully treated four children with giant omphalocele, with support from the expert team of the Children’s Hospital, Zhejiang University School of Medicine under the “Three Famous Project.” Three children underwent staged repair using human acellular dermal matrix (HADM), while one underwent delayed surgery following a period of conservative management.

　　Among publicly reported cases in Guangdong Province, it remains uncommon for a single center to successfully perform this type of surgery in four patients within the same period. This achievement represents an important step forward in the hospital’s management of omphalocele and offers new hope to affected children and their families.

　　When the pediatric surgeons placed the final stitch, however, another critical phase of care was only beginning in the PICU.

　　Omphalocele is a serious congenital defect of the anterior abdominal wall, and giant omphalocele presents an even greater clinical challenge. In affected children, abdominal organs protrude through a defect at the umbilicus, forming a large membrane-covered sac. The condition may also be associated with serious complications such as pulmonary hypoplasia and pulmonary hypertension, posing a significant threat to the child’s life.

　　Faced with these complex cases, the team led by Director Zhang Xiaozhong of the Department of Pediatric Surgery drew on extensive clinical experience to develop individualized surgical plans for each child. The team included Associate Chief Physician Qu Zhenfan and Attending Physicians Li Yuedong and Xiao Tingting, among others.

　　As experts of the “Three Famous Project,” Professor Dou Jinfa and Director Wang Peng from the Children’s Hospital, Zhejiang University School of Medicine provided on-site guidance and shared advanced approaches to the repair of complex abdominal wall defects.

　　The anesthesiology team led by Director Huang Xiaolei provided meticulous anesthetic management throughout the procedures, while the PICU team led by Director Zhao Hongxia was fully prepared to provide the intensive postoperative care required for these critically ill children.

　　Prior to surgery, specialists from the participating departments held multiple multidisciplinary consultations and case discussions, carefully evaluating each child and refining the treatment plans. This close collaboration laid a solid foundation for the successful procedures.

　　On April 18, the surgical team worked continuously from 8:30 a.m. to 7:00 p.m. For three children with extensive abdominal wall defects, the team performed repair using HADM).

　　HADM is a biological graft material with favorable biocompatibility and the ability to support tissue regeneration and integration. Its relatively low risk of infection and good tissue incorporation make it a valuable option for the reconstruction of large abdominal wall defects.

　　With the successful completion of the final procedure, all four cases were successfully treated, marking an important milestone in the hospital’s management of giant omphalocele.

　　As the surgeons carefully returned the abdominal organs to the abdominal cavity, another critical phase of care was only beginning for the PICU team. For these children, the relatively small abdominal cavity suddenly had to accommodate organs that had remained outside it for an extended period. This could lead to a rapid rise in intra-abdominal pressure, upward displacement of the diaphragm, and impaired venous return through the inferior vena cava, placing the children at risk of life-threatening complications including respiratory failure, hemodynamic instability, and abdominal compartment syndrome.

　　The four children arrived in the PICU with different clinical challenges. The one-year-old had a low body weight and limited abdominal capacity; the two-year-old had previously undergone conservative treatment; and the three- and six-year-old children had varying degrees of intra-abdominal adhesions. Director Zhao, Head Nurse Yu Lin, Chief Physicians Wu Chunyuan and Yu Jieming, together with the entire PICU team, developed an individualized postoperative monitoring and management plan for each child.

　　Following reduction of the herniated organs, increased intra-abdominal pressure can push the diaphragm upward, restricting lung expansion and reducing pulmonary compliance. If blood pressure falls, is it due to inadequate circulating volume, impaired cardiac function, or reduced venous return caused by elevated intra-abdominal pressure? And does an increase in intra-abdominal pressure simply reflect normal postoperative adaptation, or could it be an early warning sign of abdominal compartment syndrome?

　　Under the guidance of Director Zhao, the medical and nursing team precisely set the ventilator modes and finely adjusted the parameters according to each child’s condition. Sedation, analgesia, neuromuscular blockade, and parenteral nutrition were also precisely managed. The pediatric surgery team participated in joint daily bedside rounds to assess intra-abdominal pressure, abdominal wall tension, and wound healing.

　　Through close collaboration between the surgical and intensive care teams, all four children were successfully weaned from mechanical ventilation and subsequently regained spontaneous bowel function and oral feeding. None developed feeding intolerance or postoperative intestinal obstruction.