The patient is a 2 and 1/2-year-old male with history of a giant omphalocele. Given the size of the defect and the patient's failure to thrive with poor PO intake, the defect was initially managed non-operatively with compression wraps and petroleum gauze to allow for epithelialization of the omphalocele sac. Once he was able to independently maintain his nutrition without nasogastric tube feeding, he was scheduled for an elective repair as a joint surgical procedure with pediatric surgery and a fellowship-trained abdominal wall reconstructive surgeon. The patient underwent a successful repair of a giant omphalocele with bioabsorbable mesh implantation without complication. The repair was completed without requiring a component separation and the defect was closed primarily with sublay (preperitoneal) mesh reinforcement given the tension on the closure. He remained intubated postoperatively given increased peak airway pressures and moderate compression of the inferior chest from closing the defect and was subsequently extubated the following day. At one month of follow-up he is recovering appropriately with no complications.