In two adjacent operating rooms, two different but closely related surgeries are being carried out simultaneously: on one side, an obstetrician is suturing the uterus of a woman who has just undergone a cesarean section; On the other side, a pediatric surgeon is performing an operation on a little life that has only been born for half an hour. Recently, the Second Affiliated Hospital of Wenzhou Medical University successfully performed an operation on a newborn boy named Qiqi (a pseudonym) with omelocele, putting his exposed small intestine back into his stomach. This afternoon, Qiqi's mother happily told the follow-up doctor, "Now I can drink 200 milliliters of milk. My child can grow up just like a normal child!"

This brand-new "intrpartum surgical operation", which involves undergoing surgery right after birth and achieving "zero metastasis" in a sterile environment, is the first of its kind in Wenzhou. It has opened up a new situation in the early intervention of pediatric malformation surgery. It is reported that only a few hospitals in China are capable of performing intrapartinal surgical operations.

B-ultrasound revealed that the child in the womb might have exposed internal organs

Xiao Yan (a pseudonym), 33 years old, is from Cangnan. Last year, she successfully became pregnant with her second child. When she was 30 weeks pregnant, Xiaoyan went to the hospital for a B-ultrasound examination and found that there was a huge protruding mass at the umbilical cord of the baby in her womb. What impact can lumps have on children? The worried couple, Xiaoyan and her husband, sought out Professor Li Zhongrong, the director of the Department of Pediatric Surgery at the Second Affiliated Hospital of Wenzhou Medical University.

After assessment based on the B-ultrasound results, it is initially considered that this spherical mass is congenital omphalocele. "Omphalocele can expose the internal organs in the abdominal cavity, but it can be treated through surgical intervention." Director Li suggested that Xiaoyan be transferred to the hospital for delivery after reaching full term, so as to perform intrauterine surgery for the baby and put the exposed internal organs back into her body.

To ensure the smooth progress of the operation, the hospital organized a team composed of five disciplines including pediatric surgery, obstetrics, anesthesiology, neonatology and operating room to discuss Qiqi's condition and prepared multiple surgical plans based on possible situations during the operation.

One and a half hours after birth, the small intestine is put back into the stomach

The operation is scheduled for the morning of February 15th.

9:15: The first operation begins.

At 9:20, Xie Ailan, the chief obstetrician, carried Qiqi, who weighed 4.77 kilograms, out of her mother's body. As expected, Qiqi had a mass the size of a cantaloupe hanging on her abdomen - most of her small intestine was wrapped in a translucent membrane, exposed outside. Zhou Xiaojian, the chief physician of the neonatology department who was on standby nearby, immediately performed airway resuscitation and treated the skin wound for the child.

At 9:25, Qiqi was sent to the operating room next door and placed on a special operating table.

As the huge capsule and intestinal tract of the child patient are directly exposed outside the body, heat loss is rapid and hypothermia is likely to develop. Therefore, Hu Mingpin, the deputy director of the anesthesiology department, had already prepared a warm "bed" for Qiqi - placing an insulating pad on the operating table and covering Qiqi with a heating blanket, adjusting the room temperature to 26 degrees to maintain the child's normal body temperature.

At 9:55, Qiqi's operation began.

The operation was performed by Li Zhongrong, the director of the Pediatric Surgery Department, and Zhu Libin, an associate chief physician. The surgical incision was designed at Qiqi's navel, so that after the wound closed, it became the navel, no different from that of a normal child.

Qiqi has a large or medium-sized umbilical protrusion. According to past experience, it usually requires two surgeries. This not only increases the difficulty of the surgery and the pain of the newborn itself, but also leaves ugly scars that will accompany the newborn for life. Qiqi had an operation just half an hour after his birth and has not eaten, excreted or cried yet, so there is less gas in his intestines. If the intestines are still shriveled, it is easy to put them back into the abdominal cavity. Zhu Libin explained: "It's just like a balloon. Putting it in a box before it's blown up is definitely much easier than putting it back in the box after it's blown up." After a baby cries, breastfeeds and defecates after birth, the intestines are "inflated", leaving no sufficient space to store the exposed internal organs all at once.

At 10:50, the doctor completed the abdominal wall closure and navel plastic surgery, and the entire operation was finished.

Umbilical protrusion is due to the underdeveloped "bun skin"

What is umbilical protrusion? The process of fetal embryo development is similar to "making steamed buns" - during the development process, the important organs of the fetus that were originally free outside the body will gradually be wrapped back into the body by muscle tissue, and the navel is just like the pleat of a steamed bun, which is one of the factors determining whether the fetus has fully developed. Omphalocele is a neonatal malformation caused by the incomplete development of the congenital abdominal wall - the "bun skin", which forms an abdominal wall defect around the umbilical cord, resulting in the protrusion of the abdominal cavity. It is the most common congenital abdominal wall development malformation.