Background/Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without pr oblems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our instit ution using a policy of aggressive abdominal wall closure. Methods: This is a re trospective review of all infants with exomphalos treated from January 1995 to S eptember 2002. Results: There were 35 infants, all of whom underwent surgery. Th ese were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos maj or) underwent primary closure (n = 13), and group C (exomphalos major)- underwe nt staged closure involving a silo (n = 11). Infants in group C had a lower birt h weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P<.001), a longer hospital stay (P =. 001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97% ) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failur e) early after the creation of a silo. Conclusions: An aggressive surgical appro ach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly g reater resources than other options. Background / Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without pr oblems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our instit ution using a policy of aggressive abdominal wall closure. Methods: This is a re-perspective review of all infants with exomphalos treated from January 1995 toSeptember 2002. Results: There were 35 infants, all of whom underwent surgery. Th ese were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos maj or) underwent primary closure Group C (exomphalos major) - underwent staged closure a silo (n = 11). Infants in group C had a lower birt h weight (P = .05) and were less mature (P = .06). They required longerperiods of ventilation (P <.001), a longer hospital stay (P = .001), and a longer period to achieve full enteral feeds (P <.001). Overall survival was 34 (97%) of 35 infants. One Premature infant who was born with ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failur e) early after the creation of a silo. Conclusions: An aggressive surgical appro ach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly g reater resources than other options.