Post-Closure Abdominal Hernias in Infants with Giant Omphaloceles: Schuster Staged Repair versus Delayed Closure

Abstract Giant omphaloceles (GOs) pose significant surgical challenges. Two common strategies to close the defect include applying a topical epithelializing agent with delayed closure and the Schuster staged closure, which approximates the abdominal wall within 2 weeks of life. Although patient selection is critical for the Schuster staged closure, it remains unclear whether the rapid rise in intra-abdominal pressure increases abdominal hernia risk. We hypothesized that abdominal hernia rates differ between closure strategies. We conducted a single-institution, retrospective cohort study comparing abdominal hernia rates in patients undergoing Schuster staged closure versus delayed closure between 2012 and 2022. Among 21 patients who met the inclusion criteria, 9 underwent the delayed closure, and 12 underwent the Schuster staged closure. Demographics were similar, but birth weight and prenatal lung volumes differed between groups, with greater values in the Schuster group. Abdominal hernias occurred more frequently after Schuster closure (n = 9, 75%) versus delayed closure (n = 2, 22%; p = 0.03) within 2 years. Bilateral inguinal hernias were most common. Infants undergoing Schuster staged closure for GOs had a higher incidence of abdominal hernias than those with delayed closure. Given underlying physiologic differences between groups, these findings should be interpreted as hypothesis-generating rather than causal.