# Abdominal Wall Defects — GCMD Library living collection

Also covered as: gastroschisis · omphalocele · necrotizing enterocolitis · intestinal atresia · abdominal compartment syndrome · giant omphalocele · Hirschsprung disease · umbilical hernia

Experts: Dr. Todd Ponsky, Dr. Rod Gerardo, Dr. Alex Halpern, Dr. Em Gootee

Updated: n/a · 48 episodes · 846 cited statements

## Episodes
### Fundamentals
- [Intestinal rehabilitation: What is intestinal rehab? - Episode 1](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741) — video · 14:33 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741.md)
- [Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742) — podcast · 14:33 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742.md)

### Acute Management
- [Gastroschisis: Advanced Practice Providers](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049) — video · 43:21 · [machine version](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049.md)

### Medical Management
- [Intestinal Failure with Dr. Brad Warner](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)

### Nutritional Management
- [Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824) — video · 21:09 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824.md)

### Surgical Management
- [Approach and component separation for suture closure and underlay mesh...](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430) — video · 31:03 · [machine version](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430.md)
- [Tricks - Omphalocele - Approach & Component Separation For Suture Closure &...](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635) — video · 32:30 · [machine version](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635.md)
- [Sutureless Gastroschisis Repair: Technique](https://qa.library.globalcastmd.com/watch/sutureless-gastroschisis-repair-technique-960) — video · [machine version](https://qa.library.globalcastmd.com/watch/sutureless-gastroschisis-repair-technique-960.md)
- [Staged Closure of Gastroschisis with Spring-loaded Silo](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235) — video · 27:29 · [machine version](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235.md)
- [Staged Closure of Gastroschisis with Spring-loaded Silo](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251) — video · 27:11 · [machine version](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251.md)
- [Sutureless Closure of Gastroschisis - APSA Practice Gaps 2019](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302) — video · 21:04 · [machine version](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302.md)
- [Umbilical Cord Defects with Dr. Kenneth Azarow](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298) — podcast · 30:16 · [machine version](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298.md)
- [Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436) — video · 0:56 · [machine version](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436.md)
- [Umbilical Disorders with Dr. Rebeccah Brown](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616) — podcast · 11:27 · [machine version](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616.md)
- [Update Course Rewind: Omphalocele & Gastroschisis 2020](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507) — podcast · 15:18 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507.md)

### Complications
- [Error Traps and Culture of Safety in Abdominal Wall Defects](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720) — video · [machine version](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720.md)

### Evidence & Research
- [91% Decrease in Mortality with Gastroschisis Bundle!](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816) — video · 3:12 · [machine version](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816.md)
- [Immediate vs Silo Closure for Gastroschisis](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022) — video · 0:26 · [machine version](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022.md)
- [Gastroschisis and sutureless abdominal wall closure](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557) — podcast · 12:17 · [machine version](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557.md)
- [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md)
- [Quick Literature Updates Episode 6](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636.md)
- [Quick Literature Updates Episode 11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954.md)
- [Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037) — video · 0:56 · [machine version](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154) — podcast · 17:03 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154.md)
- [Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308) — podcast · 19:28 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308.md)
- [Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626) — video · 0:55 · [machine version](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626.md)
- [Quick Literature Updates Episode 16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732) — video · 4:21 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732.md)
- [Quick Literature Updates Episode 20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554) — video · 4:03 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554.md)
- [Quick Literature Updates Ep 22](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118) — video · 4:23 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118.md)
- [A multi-institutional comparison of management techniques for infants with giant omphalocele](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385.md)
- [A multi-institutional comparison of management techniques for infants with giant omphalocele](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457.md)

### Case-Based Learning
- [Abdominal Wall Defects](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639) — video · 37:50 · [machine version](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639.md)
- [Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669) — video · 29:44 · [machine version](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669.md)
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.md)
- [Abdominal Wall Defects: Update Course 2013](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059) — video · 37:40 · [machine version](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059.md)
- [Gastroschisis - Clinical Practice Updates](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996) — video · [machine version](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996.md)
- [Gastroschisis](https://qa.library.globalcastmd.com/watch/gastroschisis-13502) — video · [machine version](https://qa.library.globalcastmd.com/watch/gastroschisis-13502.md)

### In-Depth Reviews
- [Abdominal Wall Defects with Dr. Jacob Langer](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959) — podcast · 52:45 · [machine version](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959.md)
- [7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797) — video · 285:42 · [machine version](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797.md)
- [Cloacal Exstrophy with Dr. Alberto Peña](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309) — podcast · 53:06 · [machine version](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309.md)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821) — podcast · 52:45 · [machine version](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821.md)
- [Omphalocele and Gastroschisis With Dr. Foong-Yen Lim](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006) — podcast · 9:31 · [machine version](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006.md)
- [Omphalocele & Gastroschisis](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255) — video · 9:32 · [machine version](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255.md)
- [Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405) — video · 23:20 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405.md)
- [Update Course Rewind: 2022 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766.md)

### Patient & Family Education
- [What is Omphalocele? An ERNICA animation for parents and families](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811) — video · 3:19 · [machine version](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811.md)
- [What is Gastroschisis? An ERNICA animation for parents and families](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812) — video · 2:59 · [machine version](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812.md)

### Long-Term Care
- [Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=0) Comparison of Giant Omphalocele Management Techniques (Ep 46)
- [0:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0) Introduction and Background (Ep 20)
- [4:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=243) Gastroschisis: Prenatal Counseling and Delivery Planning (Ep 20)
- [8:34](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=514) Gastroschisis: Initial Management and Closure Techniques (Ep 20)
- [17:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1024) Gastroschisis: Intestinal Atresia Management (Ep 20)
- [22:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1337) Gastroschisis: Prolonged Ileus and Complications (Ep 20)
- [28:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1707) Omphalocele: Prenatal Counseling and Associated Anomalies (Ep 20)
- [32:22](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1942) Omphalocele: Surgical Management and Reduction Techniques (Ep 20)
- [40:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2417) Omphalocele: Delayed Closure and Patch Repair (Ep 20)
- [45:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2754) Omphalocele: Feeding Issues and Associated Problems (Ep 20)
- [0:00](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=0) Introduction and Study Overview (Ep 45)
- [0:07](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=7) Study Design and Key Findings (Ep 45)
- [0:32](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=32) Clinical Implications (Ep 45)
- [0:00](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=0) Introduction and Overview of Cloacal Exstrophy (Ep 19)
- [1:31](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=91) Anatomy and Components of Cloacal Exstrophy (Ep 19)
- [6:24](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=384) Progress in Management and Functional Limitations (Ep 19)
- [7:57](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=477) Gender Assignment Controversy and Current Practice (Ep 19)
- [11:39](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=699) Multidisciplinary Team Approach (Ep 19)
- [13:01](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=781) Initial Newborn Operation: Critical Steps (Ep 19)
- [18:27](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1107) Rescue Operation for Mismanaged Cases (Ep 19)
- [20:14](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1214) Pelvic Osteotomy Considerations (Ep 19)
- [21:37](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1297) Colostomy Function and Irrigation (Ep 19)
- [23:37](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1417) Decision-Making at Age 3: Pull-Through Candidacy (Ep 19)
- [26:42](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1602) Coordination with Urology for Bladder Augmentation (Ep 19)
- [29:23](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1763) Identifying Pull-Through Candidates (Ep 19)
- [32:57](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1977) Pull-Through Surgical Technique (Ep 19)
- [37:09](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2229) Long-Term Prognosis and Orthopedic Issues (Ep 19)
- [38:41](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2321) Female Reproductive Considerations (Ep 19)
- [40:37](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2437) Urologic Long-Term Management (Ep 19)
- [42:57](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2577) Transition to Adult Care and Pull-Through Network (Ep 19)
- [45:40](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2740) Summary of Staged Operations (Ep 19)
- [46:54](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2814) Prenatal Diagnosis (Ep 19)
- [50:31](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=3031) Centers of Excellence and Closing Remarks (Ep 19)
- [0:00](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=0) Introduction and First Technique Overview (Ep 2)
- [3:01](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=181) Duoderm Silo Compression Demonstration (Ep 2)
- [5:11](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=311) Component Separation Case Presentation (Ep 2)
- [10:43](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=643) Faculty Discussion: Early vs Delayed Closure (Ep 2)
- [16:46](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1006) Patch Techniques and Biologic Materials (Ep 2)
- [25:14](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1514) Algorithm and Clinical Decision-Making (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=0) Introduction to Safety Series (Ep 11)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study examined 117 infants with giant omphalocele" — Lizzie Lee (epidemiological) [Ep 46 · 0:07](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Four treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo" — Lizzie Lee (clinical) [Ep 46 · 0:07](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Babies treated with Duoderm silo were most likely to have their abdomen closed in one surgery" — Lizzie Lee (clinical) [Ep 46 · 0:19](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=19)
- "Approximately 80% of infants treated with Duoderm silo achieved single-surgery abdominal closure" — Lizzie Lee (clinical) [Ep 46 · 0:24](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=24)
- "Some babies treated with operative silos achieved closure sooner than other methods" — Lizzie Lee (clinical) [Ep 46 · 0:25](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Complication rates were similar across all four management methods" — Lizzie Lee (clinical) [Ep 46 · 0:25](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Almost half of infants required 6 months or more before complete abdominal closure could be achieved" — Lizzie Lee (clinical) [Ep 46 · 0:32](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=32)
- "There is no universal best treatment approach for giant omphalocele" — Lizzie Lee (opinion) [Ep 46 · 0:38](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)
- "Duoderm silos may be particularly beneficial when the goal is single-stage abdominal closure" — Lizzie Lee (opinion) [Ep 46 · 0:38](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 20 · 0:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0)
- "With gastroschisis, the main issue is that the bowel gets damaged through fetal life" — Jack Langer (clinical) [Ep 20 · 4:36](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=276)
- "Most gastroschisis patients don't have any other associated anomalies, and it's pretty rare to have abnormal chromosomes" — Jack Langer (clinical) [Ep 20 · 4:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "Early papers showed a benefit to cesarean section in gastroschisis, but cesarean sections were usually done early at 36 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit" — Jack Langer (clinical) [Ep 20 · 5:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=346)
- "Many studies have failed to show an advantage to cesarean section, and most people nowadays would not do routine cesarean section for gastroschisis" — Jack Langer (clinical) [Ep 20 · 6:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery in gastroschisis" — Jack Langer (clinical) [Ep 20 · 6:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jack Langer (clinical) [Ep 20 · 6:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=418)
- "The mean gestational age of onset of labor is a lot earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by the inflamed bowel" — Jack Langer (clinical) [Ep 20 · 7:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor can usually be successfully induced at 37 weeks, unlike regular pregnancies" — Jack Langer (clinical) [Ep 20 · 7:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=450)
- "Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jack Langer (clinical) [Ep 20 · 8:36](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport of gastroschisis patients, it's important for the baby to be nursed on his or her side, usually right side down, to prevent kinking of the mesentery and ischemia of the bowel" — Jack Langer (clinical) [Ep 20 · 10:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "For gastroschisis, bedside closure is the first choice if the bowel is not too thickened and there's not too much peel" — Jack Langer (clinical) [Ep 20 · 10:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jack Langer (clinical) [Ep 20 · 11:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jack Langer (clinical) [Ep 20 · 11:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "The current approach uses pre-formed silos, slowly pushing on them with fentanyl or morphine sedation in an awake baby, aiming to keep intraabdominal pressure below 20" — Jack Langer (clinical) [Ep 20 · 11:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=707)
- "If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days" — Jack Langer (clinical) [Ep 20 · 12:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=747)
- "The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord" — Todd Ponsky (host_summary) [Ep 20 · 13:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=795)
- "A study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (host_summary) [Ep 20 · 14:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=859)
- "Umbilical hernias from plastic closure generally close by age 2 or 3 years, just like any umbilical hernia" — Jack Langer (clinical) [Ep 20 · 14:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=896)
- "Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later" — Jack Langer (clinical) [Ep 20 · 16:12](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=972)
- "The disadvantage of leaving a silo on for 24-48 hours is that the abdominal wall defect gets stretched out and bigger, taking longer to close with plastic closure" — Jack Langer (clinical) [Ep 20 · 17:25](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1045)
- "Spring-loaded silos apply pressure outward as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 20 · 18:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jack Langer (epidemiological) [Ep 20 · 18:51](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia where bowel gets very dilated but not thick-walled, and late atresia where the abdominal wall defect becomes very small causing ischemia and potentially vanishing gastroschisis" — Jack Langer (clinical) [Ep 20 · 19:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years because of intestinal failure centers, better TPN that doesn't damage the liver as much, and control of sepsis" — Jack Langer (clinical) [Ep 20 · 20:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "For atresia in gastroschisis, there are three management choices: repair at time of closure, bring out stomas, or drop everything back in and repair the atresia later" — Jack Langer (clinical) [Ep 20 · 20:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1254)
- "There's no good evidence for optimal management of atresia in gastroschisis because it's such a rare occurrence" — Jack Langer (opinion) [Ep 20 · 21:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "If bowel looks good without much peel, primary repair of atresia at initial closure is appropriate; if there's concern, drop it back in and repair later" — Jack Langer (clinical) [Ep 20 · 21:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1295)
- "Stomas are brought out only when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose" — Jack Langer (clinical) [Ep 20 · 22:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1321)
- "The umbilicus is the preferred site for neonatal stomas because it results in a scar that would have been there anyway and is convenient for appliance placement" — Jack Langer (clinical) [Ep 20 · 22:50](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jack Langer (clinical) [Ep 20 · 23:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jack Langer (clinical) [Ep 20 · 24:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1467)
- "Metoclopramide (Reglan) can be given intravenously for gastroschisis hypomotility, unlike oral prokinetics where absorption is uncertain" — Jack Langer (clinical) [Ep 20 · 25:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A UK study showed cisapride helped gastroschisis patients achieve bowel function more quickly, but cisapride is no longer available" — Jack Langer (clinical) [Ep 20 · 25:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A randomized prospective trial is currently underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jack Langer (clinical) [Ep 20 · 25:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1537)
- "At 4 weeks without bowel function, contrast enema is performed to look for mechanical obstruction, sometimes followed by upper GI if enema is inconclusive" — Jack Langer (clinical) [Ep 20 · 25:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1557)
- "If still no bowel function at 6 weeks, laparotomy is typically performed, often finding adhesions which are taken down" — Jack Langer (clinical) [Ep 20 · 26:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1604)
- "Going in too early on gastroschisis patients with prolonged ileus is a mistake" — Jack Langer (opinion) [Ep 20 · 27:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, it's usually the right testis that is extruded, and in about half the cases it finds its way down into the scrotum after being reduced" — Jack Langer (clinical) [Ep 20 · 28:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jack Langer (clinical) [Ep 20 · 28:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Karyotype analysis and testing for Beckwith-Wiedemann syndrome are routinely performed for omphalocele patients" — Jack Langer (clinical) [Ep 20 · 28:59](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1739)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jack Langer (clinical) [Ep 20 · 29:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "For small omphaloceles, there's no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery" — Jack Langer (clinical) [Ep 20 · 30:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair surgically" — Jack Langer (clinical) [Ep 20 · 30:23](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1823)
- "For giant omphaloceles (defined as any omphalocele with a lot of liver out), most surgeons recommend cesarean section, though this is not evidence-based" — Jack Langer (clinical) [Ep 20 · 31:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1864)
- "Giant omphaloceles should be delivered at a perinatal center because they need a pediatric surgeon and experienced neonatologists" — Jack Langer (clinical) [Ep 20 · 31:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1902)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jack Langer (clinical) [Ep 20 · 31:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "Some giant omphalocele patients have severe pulmonary hypoplasia requiring early intubation and respiratory support" — Jack Langer (clinical) [Ep 20 · 32:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1929)
- "The goal in omphalocele management is to reduce viscera without injury from direct trauma or increased intraabdominal pressure" — Jack Langer (clinical) [Ep 20 · 32:38](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1958)
- "Intraabdominal pressure monitoring is very helpful in omphalocele management" — Jack Langer (clinical) [Ep 20 · 33:14](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1994)
- "Stuart Lacy established the guideline of keeping intraabdominal pressure below 20 mmHg based on rabbit studies in the 1980s, which showed improved outcomes in a prospective study in children" — Jack Langer (clinical) [Ep 20 · 33:28](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Lacy also described an increase in central venous pressure of more than 4 as a concerning threshold" — Jack Langer (clinical) [Ep 20 · 33:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2036)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jack Langer (clinical) [Ep 20 · 34:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of pressure is more important than the absolute number during reduction" — Jack Langer (clinical) [Ep 20 · 34:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "Primary closure is attempted for full-term omphalocele patients without significant cardiac disease, respiratory issues, or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 20 · 34:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2083)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days to allow abdominal wall stretching" — Jack Langer (clinical) [Ep 20 · 35:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Sequential sac ligation requires a thick enough sac and umbilical cord insertion at the top rather than the side" — Jack Langer (clinical) [Ep 20 · 35:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2144)
- "Using Duoderm to gradually reduce omphaloceles appears to achieve reduction more quickly than sac ligation" — Jack Langer (clinical) [Ep 20 · 37:34](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or giant omphaloceles where reduction is not feasible" — Jack Langer (clinical) [Ep 20 · 38:12](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles have a small abdominal wall defect but large external contents, making reduction impossible" — Jack Langer (clinical) [Ep 20 · 38:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2329)
- "Sigy Ein had long experience using silver sulfadiazine (Silvadene) for escharotic therapy in omphaloceles" — Jack Langer (clinical) [Ep 20 · 39:26](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2366)
- "With escharotic therapy, the omphalocele is painted with the agent, forms an eschar, eventually epithelializes, and is later repaired like a large ventral hernia" — Jack Langer (clinical) [Ep 20 · 39:45](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2385)
- "Timing of definitive omphalocele repair after escharotic therapy depends on the individual child, ranging from 6-8 months to 3-4 years depending on defect size and medical comorbidities" — Jack Langer (clinical) [Ep 20 · 40:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2419)
- "Mushroom-shaped omphaloceles never reduce spontaneously and stay large" — Jack Langer (clinical) [Ep 20 · 41:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "For mushroom-shaped omphaloceles, the abdominal wall defect can be enlarged surgically as a first step to allow more spontaneous reduction before definitive repair" — Jack Langer (clinical) [Ep 20 · 41:20](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "The 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure" — Todd Ponsky (clinical) [Ep 20 · 42:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2526)
- "Formal adult-style component separation in small children carries risk of devascularization and can leave patients in worse condition if complications occur" — Jack Langer (clinical) [Ep 20 · 43:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2586)
- "In omphalocele closure, the defect often extends to the costal margin, making the upper portion impossible to close primarily, requiring patch placement" — Jack Langer (clinical) [Ep 20 · 43:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails in approximately 50% of omphalocele repairs, requiring reoperation with non-absorbable mesh like Prolene" — Jack Langer (clinical) [Ep 20 · 44:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2641)
- "Omphaloceles can be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jack Langer (clinical) [Ep 20 · 44:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Pentalogy of Cantrell omphaloceles tend to be more superiorly placed" — Jack Langer (clinical) [Ep 20 · 45:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2708)
- "Most pentalogy of Cantrell patients have cardiac problems requiring escharotic therapy for the omphalocele" — Jack Langer (clinical) [Ep 20 · 45:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2719)
- "In pentalogy of Cantrell, the diaphragmatic patch can be placed from above through sternotomy during cardiac surgery, with abdominal wall repair performed later" — Jack Langer (clinical) [Ep 20 · 45:31](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2731)
- "Reflux is very common in omphalocele patients, and many don't eat normally, especially with cardiac disease or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 20 · 46:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiologists can place G-tubes under fluoroscopy in giant omphalocele patients by finding a window lateral to the defect" — Jack Langer (clinical) [Ep 20 · 46:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "After G-tube maturation, a GJ tube can be placed to allow feeding despite severe reflux" — Jack Langer (clinical) [Ep 20 · 46:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2815)
- "Fundoplication in a child with unrepaired giant omphalocele is extremely difficult because the liver is midline and access to the hiatus is nearly impossible, especially with cardiac disease and congested liver" — Jack Langer (clinical) [Ep 20 · 47:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "GJ tube is a better short-term solution than fundoplication for reflux in unrepaired omphalocele, with fundoplication performed at the time of definitive abdominal wall repair" — Jack Langer (clinical) [Ep 20 · 47:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2862)
- "In giant omphaloceles with midline liver, the liver can put pressure on the duodenum or pylorus causing mechanical gastric outlet obstruction that worsens reflux" — Jack Langer (clinical) [Ep 20 · 48:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus, so Ladd's procedure is not necessary" — Jack Langer (clinical) [Ep 20 · 48:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if the surgeon performs appendectomies during Ladd's procedures" — Jack Langer (opinion) [Ep 20 · 49:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2946)
- "Children with repaired omphaloceles can develop perforated appendicitis with delayed diagnosis due to abnormal appendix location" — Jack Langer (clinical) [Ep 20 · 49:18](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2958)
- "If a child with omphalocele has renal abnormalities requiring potential Mitrofanoff procedure, the appendix should be preserved" — Jack Langer (clinical) [Ep 20 · 49:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2984)
- "During omphalocele reduction with liver, hepatic veins are very superficial and can be injured during fascial dissection if not careful" — Jack Langer (clinical) [Ep 20 · 50:16](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "Kinking of hepatic veins during omphalocele reduction is prevented by using intraabdominal pressure monitoring and not being too aggressive with reduction when pressures exceed 20" — Jack Langer (clinical) [Ep 20 · 50:38](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3038)
- "In immediate omphalocele reduction, fascial edges can usually be approximated at the bottom but often not at the top, requiring patch placement" — Jack Langer (clinical) [Ep 20 · 50:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3056)
- "For partial omphalocele reduction with liver still protruding at the top, a temporary Gore-Tex or silastic patch can be sewn on with skin closed over it, then removed in 1-2 weeks for definitive fascial closure" — Jack Langer (clinical) [Ep 20 · 51:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3069)
- "The study examined 117 infants with giant omphalocele." — Lizzie Lee (epidemiological) [Ep 45 · 0:07](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=7)
- "Four treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo." — Lizzie Lee (clinical) [Ep 45 · 0:07](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=7)
- "Babies treated with Duoderm silo were most likely to have their abdomen closed in one surgery." — Lizzie Lee (clinical) [Ep 45 · 0:19](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=19)
- "Approximately 80% of infants treated with Duoderm silo achieved single-stage abdominal closure." — Lizzie Lee (clinical) [Ep 45 · 0:24](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=24)
- "Some babies treated with operative silos achieved closure sooner than other methods." — Lizzie Lee (clinical) [Ep 45 · 0:25](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=25)
- "The overall chance of complications was similar across all four treatment methods." — Lizzie Lee (clinical) [Ep 45 · 0:25](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=25)
- "Almost half of the infants required six months or more before complete abdominal closure could be achieved." — Lizzie Lee (clinical) [Ep 45 · 0:32](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=32)
- "There is no one-size-fits-all treatment for giant omphalocele." — Lizzie Lee (opinion) [Ep 45 · 0:38](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=38)
- "Duoderm silos may be a particularly good option when the goal is single-stage abdominal closure." — Lizzie Lee (opinion) [Ep 45 · 0:38](https://qa.library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=38)
- "Cloacal exstrophy is a spectrum of congenital malformations affecting the gastrointestinal/colorectal area, urogenital tract, spine and cord, and sometimes lower extremity motion." — Alberto Peña (clinical) [Ep 19 · 1:31](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=91)
- "Babies with cloacal exstrophy are born with an omphalocele, bladder exstrophy (two separated hemibladders), open cecum between the hemibladders, and separated pubic bones." — Alberto Peña (clinical) [Ep 19 · 2:09](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=129)
- "The small bowel can become exstrophic through the ileocecal valve, creating an 'elephant trunk' appearance." — Alberto Peña (clinical) [Ep 19 · 3:08](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=188)
- "Male patients have two separated hemiphalluses with normal gonads; female patients have two hemivaginas below the exstrophic bladder leading to two hemiuteri." — Alberto Peña (clinical) [Ep 19 · 3:32](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=212)
- "Cloacal exstrophy represents a spectrum of colonic anatomy from normal colon to almost absent or completely absent colon, sometimes with two ceca or two appendices and bizarre blood supply." — Alberto Peña (clinical) [Ep 19 · 4:20](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=260)
- "The amount of colon present at birth has very important implications for the patient's management and outcomes." — Alberto Peña (clinical) [Ep 19 · 4:57](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=297)
- "A variant exists where babies are born with intact abdominal skin (no omphalocele, no bladder exstrophy externally) but have a completely open bladder inside with no bladder neck and a single large perineal orifice." — Alberto Peña (clinical) [Ep 19 · 5:44](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=344)
- "While surgical techniques, intensive care, parenteral nutrition, and metabolic management have improved, functional outcomes (bowel control, urinary control, sexual function, spinal abnormalities) remain severely limited and cannot be made normal." — Alberto Peña (clinical) [Ep 19 · 7:02](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=422)
- "Historical practice was to perform bilateral gonadectomy, remove hemiphalluses, create a vagina with bowel, and assign female gender to XY patients with cloacal exstrophy." — Alberto Peña (clinical) [Ep 19 · 8:31](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=511)
- "Patients raised as female despite XY chromosomes exhibited male attitudes and behavior, and many became upset upon learning their chromosomal sex and that gonads were removed without their consent." — Alberto Peña (clinical) [Ep 19 · 9:16](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=556)
- "Patients argued that sex is not the most important aspect of being male, that they wanted their gonads back for fertility (modern techniques allow fertilization and children), and that being male is much more than having a phallus." — Alberto Peña (opinion) [Ep 19 · 9:59](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=599)
- "Current consensus is that XY patients should be raised as male, with pediatric urologists and plastic surgeons working on phallus reconstruction techniques." — Alberto Peña (guideline) [Ep 19 · 10:34](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=634)
- "When a prominent pediatric urologist dominates management, patients receive good urologic attention but inadequate gastrointestinal care; the reverse occurs when pediatric surgeons dominate." — Alberto Peña (clinical) [Ep 19 · 12:13](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=733)
- "The pediatric surgeon's role in the initial operation is to close the omphalocele (if possible), separate urothelium from intestinal mucosa by placing stitches at the edges and making an incision, allowing the urologist to bring hemibladders together." — Alberto Peña (clinical) [Ep 19 · 13:03](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=783)
- "It is very common but very harmful for pediatric surgeons to simply create an ileostomy, leaving all colon distally attached to the urinary tract." — Alberto Peña (clinical) [Ep 19 · 14:55](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=895)
- "Leaving colon attached to the urinary tract creates a congenital bladder augmentation that causes hyperchloremic acidosis from urine absorption, interfering with growth and development." — Alberto Peña (clinical) [Ep 19 · 15:31](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=931)
- "Defunctionalized colonic tissue left distally will not grow; colon requires passage of fecal matter through its lumen to grow." — Alberto Peña (clinical) [Ep 19 · 16:03](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=963)
- "The pediatric surgeon must incorporate all gastrointestinal tissue into the fecal stream and create a true end colostomy to ensure fecal matter passes through all colonic tissue." — Alberto Peña (clinical) [Ep 19 · 16:23](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=983)
- "Patients who received ileostomy with defunctionalized colon present at 2-3 years with poor growth, hyperchloremic acidosis managed by nephrologists, and large ileostomy losses." — Alberto Peña (clinical) [Ep 19 · 16:41](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1001)
- "The rescue operation involves taking down the ileostomy, finding and incorporating colonic tissue into the GI tract, and creating an end colostomy; acidosis disappears the next day." — Alberto Peña (clinical) [Ep 19 · 17:03](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1023)
- "Surgeons must accept that cloacal exstrophy is a spectrum and be prepared to deal with complex, variable colonic anatomy rather than taking the easy way out with an ileostomy." — Alberto Peña (opinion) [Ep 19 · 19:13](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1153)
- "Some institutions routinely perform pelvic osteotomy at the initial operation to facilitate bladder and omphalocele reconstruction, while others wait 2-3 months to do it separately." — Alberto Peña (clinical) [Ep 19 · 21:00](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1260)
- "Even after osteotomy, it is very difficult to see a cloacal exstrophy patient with pubic bones completely together; they usually remain separated." — Alberto Peña (clinical) [Ep 19 · 21:09](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1269)
- "Even a technically correct end colostomy often has poor motility, and babies may not pass stool easily, sometimes developing bacterial overgrowth similar to Hirschsprung disease." — Alberto Peña (clinical) [Ep 19 · 22:06](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1326)
- "Families must be taught to irrigate the colostomy with small volumes of saline through a tube to evacuate fecal material when peristalsis is inadequate." — Alberto Peña (clinical) [Ep 19 · 23:00](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1380)
- "Decision-making for bowel control begins around age 3 when parents want to send the child to school clean and dry (no stool or urine in diaper)." — Alberto Peña (clinical) [Ep 19 · 23:30](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1410)
- "Most cloacal exstrophy patients have an inadequate, tiny bladder requiring bladder augmentation with gastrointestinal tract, necessitating coordination between pediatric surgery and urology." — Alberto Peña (clinical) [Ep 19 · 23:54](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1434)
- "Patients born with no colon are candidates for permanent colostomy and should never have terminal ileum pulled through, even if sphincter evidence exists, because they will never have bowel control." — Alberto Peña (clinical) [Ep 19 · 24:42](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1482)
- "Pull-through is only considered for patients with capacity to form solid stool (adequate colon), as bowel management only works with solid stool." — Alberto Peña (clinical) [Ep 19 · 25:04](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1504)
- "It is extremely unusual for cloacal exstrophy patients to have spontaneous bowel control; the overwhelming majority need a bowel management program (enema administration to keep patient clean)." — Alberto Peña (clinical) [Ep 19 · 25:20](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1520)
- "Pediatric surgeons should not underestimate the growth capacity of tiny colonic pieces during the newborn period; even small segments will grow over three years if fecal stream passes through them." — Alberto Peña (clinical) [Ep 19 · 25:47](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1547)
- "Annual contrast studies through the colostomy (retrograde injection) are performed to assess colonic growth." — Alberto Peña (clinical) [Ep 19 · 26:07](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1567)
- "Before committing to pull-through, a trial bowel management program is performed through the colostomy: enemas are given to empty the colonic pouch, and if the patient stays 24 hours without stool in the colostomy bag, pull-through is likely to succeed." — Alberto Peña (clinical) [Ep 19 · 26:41](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1601)
- "Bowel management trial through colostomy is typically started after age 3 when families consider avoiding the stoma for school." — Alberto Peña (clinical) [Ep 19 · 27:35](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1655)
- "If a patient has very little colon and cannot form solid stool, the urologist is free to use bowel for bladder augmentation; if the patient has borderline colon, the urologist must use stomach for augmentation to preserve bowel for fecal function." — Alberto Peña (clinical) [Ep 19 · 28:07](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1687)
- "The colon to be pulled through is the most posterior structure in the pelvis, with the bladder and augmentation anterior to it; therefore, bladder augmentation must not be done before deciding on pull-through, or accessing the colon will be extremely difficult." — Alberto Peña (clinical) [Ep 19 · 28:54](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1734)
- "Contrast enema through the colostomy can distinguish true liquid stool from paradoxical diarrhea (liquid stool around solid fecal impaction)." — Alberto Peña (clinical) [Ep 19 · 29:56](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1796)
- "Pull-through and bladder augmentation are ideally performed together in a single operation lasting approximately 12 hours, with pediatric surgery going first (posterior dissection) followed by urology (anterior augmentation)." — Alberto Peña (clinical) [Ep 19 · 31:04](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1864)
- "During pull-through, if the patient has one or two appendices, a Malone appendicostomy can be created for antegrade enema administration, as the appendix remains in the abdomen when colon is pulled down." — Alberto Peña (clinical) [Ep 19 · 31:28](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1888)
- "Urologists almost never use colon for bladder augmentation in cloacal exstrophy because colon is needed to form solid stool; they typically use small bowel or stomach." — Alberto Peña (clinical) [Ep 19 · 31:57](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1917)
- "Occasionally, when a patient has a giant colonic pouch with very poor motility, the poor motility makes it good for bowel management (irrigate once daily, stays clean between irrigations), and a piece can be shared with urology for augmentation." — Alberto Peña (clinical) [Ep 19 · 32:18](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1938)
- "Midline abdominal incision from xiphoid to pubis is used for pull-through to preserve the flanks and quadrants for potential future stomas." — Alberto Peña (clinical) [Ep 19 · 33:13](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1993)
- "The colostomy is circumferentially dissected and separated from the abdominal wall, then the blood supply is carefully studied because cloacal exstrophy patients have very bizarre, aberrant vascular anatomy." — Alberto Peña (clinical) [Ep 19 · 33:56](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2036)
- "Careful observation of the vascular anatomy allows the surgeon to decide which vessels can be ligated to mobilize the colon to the perineum without compromising blood supply; sometimes no vessels need to be ligated." — Alberto Peña (clinical) [Ep 19 · 34:39](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2079)
- "The space behind the bladder is easily created, and the bowel is placed posteriorly; patients do not need prone positioning because the exstrophy makes everything anterior, so a supine frog-leg position provides full perineal access." — Alberto Peña (clinical) [Ep 19 · 35:53](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2153)
- "Cloacal exstrophy patients are lifelong patients due to orthopedic problems (separated pubic bones causing abnormal gait) and spinal problems (tethered cord requiring neurosurgical follow-up and potential cord release)." — Alberto Peña (clinical) [Ep 19 · 37:33](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2253)
- "Some teenagers are unhappy about separated pubic bones causing abnormal gait (feet pointing laterally); some dedicated orthopedic surgeons have been able to bring pubic bones closer together." — Alberto Peña (clinical) [Ep 19 · 37:38](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2258)
- "During pull-through, vaginal reconstruction is attempted by approximating the hemivaginas as much as possible; the degree of separation varies on the spectrum." — Alberto Peña (clinical) [Ep 19 · 38:50](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2330)
- "When hemivaginas are close with only a septum separating them superiorly, the septum is removed as high as possible; when vaginas run in completely different directions, one hemivagina may be removed, leaving the one with the better-looking cervix." — Alberto Peña (clinical) [Ep 19 · 39:07](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2347)
- "Patients with functional hemiuterus may become pregnant, but it is high-risk pregnancy requiring specialized pediatric gynecology follow-up; in general, pregnancy is not advised." — Alberto Peña (clinical) [Ep 19 · 39:53](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2393)
- "Hemiuterus has a great tendency to produce miscarriages and premature labor; delivery must be by cesarean section due to limited abdominal space." — Alberto Peña (clinical) [Ep 19 · 40:10](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2410)
- "Bladder augmentation requires a Mitrofanoff conduit (appendix or part of a long appendix, sometimes shared half for urology and half for Malone) for intermittent catheterization to empty the bladder." — Alberto Peña (clinical) [Ep 19 · 40:37](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2437)
- "Augmented bladders produce large amounts of mucus; if mucus is not removed, it forms stones, so families must be taught to irrigate the bladder (not just empty it) to remove mucus and prevent infections." — Alberto Peña (clinical) [Ep 19 · 41:07](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2467)
- "Bladder irrigation is sometimes performed with gentamicin to ensure all mucus is removed." — Alberto Peña (clinical) [Ep 19 · 41:33](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2493)
- "Lifelong urologic follow-up is needed to monitor for reflux and kidney damage; the Mitrofanoff may stop working or leak urine, requiring revision or valve tightening." — Alberto Peña (clinical) [Ep 19 · 41:45](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2505)
- "Patients transitioning to adult hospitals often feel uncomfortable because adult urologists and orthopedic surgeons lack experience with these congenital malformations; patients prefer to remain in pediatric environments even as adults." — Alberto Peña (clinical) [Ep 19 · 42:29](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2549)
- "Dr. Peña observes that cloacal exstrophy patients are particularly charming, intelligent, beautiful, and charismatic when they grow up, and some have energy to help others manage their own problems." — Alberto Peña (opinion) [Ep 19 · 43:03](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2583)
- "The Pull-Through Network is a national organization (similar to cystic fibrosis or breast cancer organizations) for parents and patients with anorectal malformations, Hirschsprung disease, or bowel/urinary control problems; it has over 1000 members, holds annual meetings, and invites doctors to give talks." — Alberto Peña (clinical) [Ep 19 · 43:42](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2622)
- "Colorectal and urogenital problems have been left behind in terms of scientific approach and research funding because they are not 'elegant' problems—they involve stool, urine, and sex—and institutions are not eager to receive these patients." — Alberto Peña (opinion) [Ep 19 · 44:48](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2688)
- "The initial operation includes omphalocele closure (sometimes requiring staged closure), bowel-bladder separation, end colostomy creation, bladder closure attempt (sometimes requiring multiple stages), and in some institutions, pelvic osteotomy (either at initial operation or 2-3 months later)." — Alberto Peña (clinical) [Ep 19 · 46:00](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2760)
- "Between the initial operation and pull-through, colostomy irrigation is often needed to manage poor colonic motility." — Alberto Peña (clinical) [Ep 19 · 46:54](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2814)
- "Prenatal diagnosis of anorectal and urogenital malformations is easier for complex defects (like cloacal exstrophy) than simple defects because complex cases have associated findings (spinal problems, absent bladder) visible on imaging." — Alberto Peña (clinical) [Ep 19 · 47:58](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2878)
- "Absent bladder on prenatal ultrasound (due to exstrophy) is a bad sign and can be detected as early as week 20 of pregnancy." — Alberto Peña (clinical) [Ep 19 · 48:48](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2928)
- "Prenatal diagnosis allows families to decide about pregnancy continuation and, if continuing, to deliver at a center with a multidisciplinary team experienced in these malformations." — Alberto Peña (clinical) [Ep 19 · 49:38](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2978)
- "Certain malformations require centers of excellence where surgeons focus and sacrifice other areas of practice; attempting to train all surgeons superficially in complex conditions results in damaged children and no one becoming truly trained." — Alberto Peña (opinion) [Ep 19 · 50:04](https://qa.library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=3004)
- "In patients without pulmonary hypoplasia or bad heart problems, first choice is to try early coverage because it is quicker and easier." — Bob Langer (opinion) [Ep 2 · 0:51](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=51)
- "For patients with pulmonary hypoplasia, bad hearts, prematurity, or where the omphalocele is too big and there isn't enough skin to get over, the escharotic technique is used." — Bob Langer (clinical) [Ep 2 · 1:05](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=65)
- "Silver sulfadiazine (Flamazine in Canada) has been used for many years for omphalocele escharization, as taught by Sigy Ein." — Bob Langer (clinical) [Ep 2 · 1:09](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=69)
- "Silver-impregnated sponges offer the same advantage as Silvadene but are less messy and don't require painting." — Bob Langer (clinical) [Ep 2 · 1:44](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=104)
- "Silver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath." — Todd Ponsky (clinical) [Ep 2 · 1:54](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=114)
- "Component separation requires going up every day to adjust the compression, which is work-intensive." — Bob Langer (clinical) [Ep 2 · 5:12](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=312)
- "The most difficult cases are patients with pulmonary hypoplasia or bad hearts where intra-abdominal pressure cannot be safely increased." — Bob Langer (clinical) [Ep 2 · 5:12](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=312)
- "The objectives of component separation are to minimize postoperative risk of abdominal hypertension and compartment syndrome, increase abdominal capacity at closure, facilitate anatomically definitive midline closure regarding rectus muscles, and limit evisceration and incisional hernias." (host_summary) [Ep 2 · 6:19](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=379)
- "The case presented was a 28-week gestation, 1,130g premature female with giant omphalocele including the liver, identified by prenatal ultrasound." (host_summary) [Ep 2 · 6:42](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=402)
- "After 10 days of manipulation with the Duoderm silo, the peritoneal sac was still covered, thick, and manageable." (host_summary) [Ep 2 · 7:12](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=432)
- "The incision is made 0.5 to 1 centimeter outside the semilunar line, with dissection of the lateral fascia towards the external oblique." (host_summary) [Ep 2 · 7:57](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=477)
- "By dissecting the fascia to the mid-axillary line, you can gain between 2 and 4 centimeters of advancement." (host_summary) [Ep 2 · 8:26](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=506)
- "This case represents the probable smallest patient with lowest weight and giant omphalocele treated with Abello method and component separation for definitive anatomic closure without evisceration." (host_summary) [Ep 2 · 10:19](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=619)
- "Concern exists about whether abdominal wall musculature after component separation in a 1.3kg infant will function normally at 20 years of age." — Bob Langer (opinion) [Ep 2 · 11:41](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=701)
- "Using an absorbable patch leaves the abdominal wall musculature intact, and as the child grows, the patch becomes a smaller percentage of the abdominal wall area." — Bob Langer (clinical) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=720)
- "Surgisis was used for a long time but had many recurrences; now Strattice is used with better results." — Bob Langer (clinical) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=720)
- "Many omphaloceles have defects that go right up to the costal margin, making it difficult to close that area even with component separation." — Bob Langer (clinical) [Ep 2 · 12:36](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=756)
- "Often the lower part of the defect is closed primarily, but a patch is needed along the costal margin." — Bob Langer (clinical) [Ep 2 · 12:50](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=770)
- "Component separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure." — Todd Ponsky (clinical) [Ep 2 · 13:20](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=800)
- "Six-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together." — Todd Ponsky (clinical) [Ep 2 · 13:31](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=811)
- "Dr. Abello has long-term follow-up with the Duoderm technique showing all patients healed well without problems." (host_summary) [Ep 2 · 14:07](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=847)
- "Component separation is technically highly complicated with a huge surgical area in such a small child, and complications would be very big." (opinion) [Ep 2 · 14:55](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=895)
- "Delayed primary closure at 6-7 months after escharization with fatty gauzes is a safer alternative to early complex surgery." (opinion) [Ep 2 · 14:55](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=895)
- "With escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques." — Todd Ponsky (clinical) [Ep 2 · 16:02](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=962)
- "Most patients managed with painting and delayed primary closure can be closed without using a patch when they are older." — Holly Williams (clinical) [Ep 2 · 16:46](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1006)
- "The Duoderm technique was successful on two giant omphaloceles with liver out, performed over a longer period with gradual progress, redoing the Duoderm patch only every 3 days." — Holly Williams (clinical) [Ep 2 · 17:31](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1051)
- "Babies with giant omphaloceles managed with Duoderm can be kept on nasal cannula with morphine during manipulation and don't need intubation until the actual repair." — Holly Williams (clinical) [Ep 2 · 17:53](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1073)
- "In neonates, the Duoderm can pull the rectus out laterally when cut into diamonds, allowing primary closure at the edges so the defect requiring a patch is much smaller." — Holly Williams (clinical) [Ep 2 · 19:07](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1147)
- "Alloderm is used as a bridge patch, and leaving the amnion provides a protective layer; the patch appears to turn into thick fascia over time, resulting in a relatively small central defect similar to rectus diastasis." — Holly Williams (clinical) [Ep 2 · 19:46](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1186)
- "The benefit of early closure with Duoderm and patch is that muscle edges don't continue to get farther apart, whereas with painting and waiting, the muscle stays way out laterally and over time the defect appears bigger." — Holly Williams (clinical) [Ep 2 · 24:49](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1489)
- "The most challenging situation is smaller defects with the whole liver out, where the liver doesn't go back in with painting and waiting because it's locked out, requiring enlargement of the fascial defect to reduce the contents." — Bob Langer (clinical) [Ep 2 · 25:24](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1524)
- "Livers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult." — Todd Ponsky (clinical) [Ep 2 · 25:55](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1555)
- "Dr. Abello's algorithm starts with a relaxation test to determine how much the patient can tolerate and how much silo manipulation is needed to achieve primary closure." (host_summary) [Ep 2 · 27:15](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1635)
- "If primary closure is not possible after Duoderm silo, the next step is component separation; if intra-abdominal pressure is still too high after component separation, a mesh can be placed." (host_summary) [Ep 2 · 29:12](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1752)
- "If at any moment intra-abdominal pressure is too high or pulmonary hypertension occurs, the procedure can be aborted and traditional painting and waiting can be used." (host_summary) [Ep 2 · 30:13](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1813)
- "Dr. Abello has never had to abort the process due to patient intolerance, including in patients with cardiomyopathy or pulmonary hypertension." (host_summary) [Ep 2 · 31:32](https://qa.library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1892)
- "A culture of safety is a deliberate way of doing things to avoid complications." — Sherif Emil (clinical) [Ep 11 · 0:22](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=22)
- "Error traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well." — Sherif Emil (clinical) [Ep 11 · 1:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=60)
- "The spring loaded silo works quite well for the majority of gastroschisis patients." — Sherif Emil (clinical) [Ep 11 · 1:30](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=90)
- "The spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases." — Sherif Emil (clinical) [Ep 11 · 2:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=120)
- "Gastroschisis cases and omphalocele have really very different issues requiring separation in analysis." — Sherif Emil (clinical) [Ep 11 · 2:30](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=150)
- "There can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed." — Sherif Emil (clinical) [Ep 11 · 3:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=180)
- "One error trap in gastroschisis is to assume that there would be no reason to do a premature delivery." — Sherif Emil (clinical) [Ep 11 · 3:00](https://qa.library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=180)
- "Most damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy, supported by animal and clinical studies." (clinical) [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=165)
- "Delivering gastroschisis at 37 weeks results in better neonatal outcomes compared to waiting for spontaneous labor." (clinical) [Ep 3 · 3:14](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=194)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population." (epidemiological) [Ep 3 · 3:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=224)
- "About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks." (epidemiological) [Ep 3 · 3:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis." (epidemiological) [Ep 3 · 4:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=277)
- "Routine cesarean section for gastroschisis was standard of care 15-20 years ago but has gone out of favor." (guideline) [Ep 3 · 4:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=289)
- "Using forceps and retractors for bedside reduction can harm the bowel in some cases." (clinical) [Ep 3 · 8:18](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=498)
- "A pre-formed silo allows gentle reduction of gastroschisis contents without harming the bowel, and in about one-third of cases the bowel can be reduced immediately and the silo removed." (clinical) [Ep 3 · 8:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=507)
- "Waiting for the neonate to lose 10% of body weight reduces bowel edema and makes reduction easier." (clinical) [Ep 3 · 9:14](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=554)
- "Leaving a silo on for more than one day causes the fascial defect to enlarge significantly." (clinical) [Ep 3 · 9:41](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=581)
- "A larger fascial defect after silo removal takes longer to contract and heal if not surgically closed." (clinical) [Ep 3 · 9:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=594)
- "Rafensberger's group closed 80% of gastroschisis cases primarily; current practice has decreased to one-third to one-half primary closures." (epidemiological) [Ep 3 · 10:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=602)
- "Plastic closure (non-surgical closure with dressing) produces extremely good results for gastroschisis, often with a small umbilical hernia that closes by age 2 in the vast majority of cases." (clinical) [Ep 3 · 11:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=697)
- "Plastic closure avoids the need for operating room and general anesthesia in successful bedside reductions." (clinical) [Ep 3 · 11:50](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=710)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia not always associated with bowel thickening, and late atresia due to very small abdominal wall defect." (clinical) [Ep 3 · 15:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=958)
- "Primary repair of atresia in gastroschisis is appropriate when the bowel does not look damaged." (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=900)
- "If the bowel looks nasty or matted, the atresia should be managed by reduction and delayed repair at 6 weeks." (clinical) [Ep 3 · 15:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=909)
- "Bringing an ostomy out through the umbilicus avoids a lateral scar and makes appliance placement easier." (clinical) [Ep 3 · 16:41](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1001)
- "Gord Cameron first described umbilical ostomies in the 1980s." (epidemiological) [Ep 3 · 17:53](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1073)
- "At 4 weeks post-gastroschisis repair with feeding intolerance, waiting longer is reasonable; at 8 weeks, exploration is warranted." (opinion) [Ep 3 · 20:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1207)
- "A mechanical stricture causing feeding intolerance after gastroschisis repair, when fixed surgically, can result in full feeds within 1-2 weeks." (clinical) [Ep 3 · 19:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1186)
- "Removing the omphalocele sac and attempting closure can lead to inability to achieve closure and need for prosthetic patch." (clinical) [Ep 3 · 22:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1333)
- "A partially ruptured omphalocele sac can be closed and painted, functioning as an autogenous silo." (clinical) [Ep 3 · 22:23](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1343)
- "Schuster-type repair uses mesh sutured to fascia with gradual closure over the intact sac, eventually allowing primary repair." (clinical) [Ep 3 · 22:31](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1351)
- "For large omphalocele in a full-term baby with no other problems, staged closure with patch and skin coverage is preferable to paint-and-wait, which takes months." (opinion) [Ep 3 · 23:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1385)
- "Lateral component separation can facilitate bringing fascial edges together in omphalocele closure." (clinical) [Ep 3 · 23:32](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1412)
- "Keeping the omphalocele sac supple with antibiotic ointment, applying stacked 4x4s, and wrapping with Ace wrap can facilitate gradual reduction." (clinical) [Ep 3 · 23:53](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1433)
- "Wrapping Duoderm around an omphalocele and tightening daily can achieve gradual reduction without sutures." (host_summary) [Ep 3 · 24:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1477)
- "Botox has been used successfully in adult ventral hernia repair to relax muscle and facilitate closure." (host_summary) [Ep 3 · 24:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1497)
- "Silver sulfadiazine is commonly used to paint omphaloceles, though some use Betadine initially or Xerform." (host_summary) [Ep 3 · 26:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1568)
- "Aquacel applied to omphalocele sac is not recommended as it does not come off easily." (opinion) [Ep 3 · 26:28](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1588)
- "Pharmacy may restrict silver sulfadiazine use in the first month due to sulfa interaction concerns." (guideline) [Ep 3 · 26:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1618)
- "Ventilatory parameters are the most reliable measure of safe abdominal closure tension." (opinion) [Ep 3 · 28:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1684)
- "Bladder pressure measurement is standard practice at Cincinnati Children's for 24 hours post-closure, though its reliability is questioned." (clinical) [Ep 3 · 28:51](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1731)
- "Intragastric pressure via NG tube is easy to measure intraoperatively and provides a useful guide, with 20 mmHg as a suggested threshold." (clinical) [Ep 3 · 29:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1796)
- "Intragastric pressure of 12 mmHg with a stable baby provides reassurance that closure is safe; pressure of 35-40 mmHg raises concern even if the baby appears stable." (clinical) [Ep 3 · 31:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1865)
- "Omphaloceles with a big opening and much content externalized often reduce spontaneously over 6-12 months with paint-and-wait, making eventual closure straightforward." (clinical) [Ep 3 · 35:45](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2145)
- "Omphaloceles with a narrow opening require staged enlargement of the defect to allow gradual reduction over 2-3 stages without need for patch or component separation." (clinical) [Ep 3 · 36:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2161)
- "In older children with giant omphalocele, rapid reduction can cause abdominal compartment syndrome and death; time must be allowed for abdominal domain expansion." (clinical) [Ep 3 · 36:40](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2200)
- "When enlarging the fascial defect in a giant omphalocele with liver externalized, the inferior direction is safer to avoid hepatic veins superiorly." (clinical) [Ep 3 · 37:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2223)
- "97% of bilateral kidney tumors in children are Wilms tumor, so biopsy is not needed upfront—chemotherapy should be started empirically." — Tony Sandler (epidemiological) [Ep 4 · 9:12](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=552)
- "Current standard for bilateral Wilms tumor is to start chemotherapy, give 2 cycles, and stop when tumor shrinkage plateaus (defined as less than 50% volume reduction)." — Tony Sandler (guideline) [Ep 4 · 1:32](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=92)
- "Bilateral nephron-sparing surgery for Wilms tumor can be performed by placing kidneys on ice, clamping vessels, and performing sharp tumor dissection—surprisingly feasible even for large tumors." — Tony Sandler (clinical) [Ep 4 · 4:44](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=284)
- "When chemotherapy fails to shrink bilateral Wilms tumors and they have not been biopsied, changing to a more aggressive chemotherapy regimen should be considered to rule out anaplastic elements that might respond." — Dan (clinical) [Ep 4 · 3:02](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=182)
- "Biopsy of Wilms tumor is problematic because these are heterogeneous tumors and focal anaplasia may be missed on needle biopsy." — Dan (clinical) [Ep 4 · 3:22](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=202)
- "When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation." — Tony Sandler (clinical) [Ep 4 · 4:19](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=259)
- "Anaplastic recurrence of Wilms tumor portends a very bad outcome; salvage is difficult even with chemotherapy." — Dan (clinical) [Ep 4 · 6:48](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=408)
- "It is debated whether anaplasia in Wilms tumor is present initially or develops secondary to chemotherapy-induced differentiation; most pathologists believe it is present primarily, making these heterogeneous tumors." — Tony Sandler (opinion) [Ep 4 · 7:56](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=476)
- "Multifocal Wilms tumors raise concern about underlying embryologic kidney abnormalities and increased risk of developing additional tumors." — Dan (clinical) [Ep 4 · 8:15](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=495)
- "For gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated." — Todd Ponsky (clinical) [Ep 4 · 9:58](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=598)
- "Gastroschisis babies are being delivered earlier by high-risk obstetric teams, resulting in less thick matted bowel at birth and higher rates of successful bedside reduction." (clinical) [Ep 4 · 11:11](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=671)
- "For gastroschisis closure using Tegaderm technique, if the fascia is not cut to widen the defect, most umbilical hernias will close spontaneously and do not require repair." — Tony Sandler (clinical) [Ep 4 · 12:54](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=774)
- "Spring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level." — Todd Ponsky (opinion) [Ep 4 · 14:20](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=860)
- "Tegaderm can be applied directly over reduced gastroschisis without Betadine or other topical agents, left in place for approximately 3 days, then converted to dry dressing once tissues are adherent." — Tony Sandler (clinical) [Ep 4 · 14:52](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=892)
- "Even when a gastroschisis silo fails and the defect dilates significantly, Tegaderm-only closure can achieve successful cicatrization over 8 weeks." — Tony Sandler (clinical) [Ep 4 · 15:32](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=932)
- "For gastroschisis with intestinal atresia and pristine bowel, an ostomy can be created at the umbilical fascial ring, with the downstream limb tacked adjacent, allowing for delayed anastomosis and ostomy closure after 2-4 weeks." (clinical) [Ep 4 · 16:42](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1002)
- "For gastroschisis with atresia and thick inflamed bowel, the bowel should be reduced into the abdomen without repair, allowing inflammation to resolve, then re-explored at 4-6 weeks." (clinical) [Ep 4 · 17:23](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1043)
- "Primary anastomosis of intestinal atresia in gastroschisis is feasible if the bowel is pristine, but the size discrepancy (massively dilated proximal, decompressed distal) creates a tenuous anastomosis in bowel that has been outside the abdomen." (clinical) [Ep 4 · 18:32](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1112)
- "When gastroschisis is reduced without closing the fascia, ambient intra-abdominal pressure is lower than with fascial closure, which may benefit bowel function." — Tony Sandler (clinical) [Ep 4 · 19:26](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1166)
- "In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the presence of atresia from external appearance—exploration is necessary but resection should be avoided." — Dan (clinical) [Ep 4 · 21:01](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1261)
- "Re-exploration at 2 weeks after initial gastroschisis reduction (rather than the traditional 4-6 weeks) can reveal that inflamed 'gastroschisis bowel' has transformed into viable intestine suitable for anastomosis." — Tony Sandler (clinical) [Ep 4 · 22:07](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1327)
- "For apple-peel ileal atresia with ischemic distal bowel, if the bowel does not pink up on the operating table and is not twisted, resection with primary anastomosis is appropriate." — Tony Sandler (clinical) [Ep 4 · 24:21](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1461)
- "If apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection." — Todd Ponsky (opinion) [Ep 4 · 25:19](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1519)
- "Plication of massively dilated proximal bowel in intestinal atresia is helpful and the plication typically unravels over time, preserving bowel length for later lengthening procedures if needed." — Tony Sandler (clinical) [Ep 4 · 25:37](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1537)
- "STEP procedure in the perinatal period has poor outcomes according to the STEP registry and should be discouraged; outcomes are particularly difficult in gastroschisis patients due to motility disorders." — Greg (host_summary) [Ep 4 · 26:24](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1584)
- "Bianchi procedure is preferred over STEP for neonatal bowel lengthening because it creates two equal chambers without blind-ending outpouchings, and a patient can undergo Bianchi followed by STEP later, whereas STEP limits future lengthening options." — Greg (opinion) [Ep 4 · 26:46](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1606)
- "In newborns with questionable short-gut syndrome, tapering should be avoided to preserve bowel for potential lengthening procedures later; plication is preferred." — Tony Sandler (clinical) [Ep 4 · 28:10](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1690)
- "If a child has extensive bowel length and only a segment is dilated, tapering is reasonable." — Tony Sandler (clinical) [Ep 4 · 28:23](https://qa.library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1703)
- "In Latin American countries, mortality from gastroschisis can exceed 15%" (host_summary) [Ep 5 · 0:23](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=23)
- "The study compared outcomes in the first 42 patients treated after protocol implementation to the last 42 patients treated before protocol adoption" (host_summary) [Ep 5 · 0:41](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=41)
- "Prior to the protocol, pre-transfer communication was incredibly limited" (host_summary) [Ep 5 · 0:50](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=50)
- "After protocol implementation, the accepting hospital was in much closer communication" (host_summary) [Ep 5 · 0:55](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=55)
- "Prior to the protocol, every patient got a central line" (host_summary) [Ep 5 · 0:59](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=59)
- "After the protocol, every patient had a PICC attempted" (host_summary) [Ep 5 · 1:03](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=63)
- "Prior to the protocol, all patients were taken to the operating room for primary reduction after extension of the defect, which was limited by OR availability and required general anesthesia" (host_summary) [Ep 5 · 1:06](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=66)
- "After the protocol, bedside reduction was attempted in most patients" (host_summary) [Ep 5 · 1:19](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=79)
- "Prior to the protocol, all patients were mechanically ventilated and paralyzed, and feeding advancement was totally at the discretion of the surgeon" (host_summary) [Ep 5 · 1:22](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=82)
- "After the protocol, only patients with respiratory distress were intubated" (host_summary) [Ep 5 · 1:31](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=91)
- "After the protocol, no patients were paralyzed" (host_summary) [Ep 5 · 1:35](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "After the protocol, the authors followed a regimented feeding advancement schedule" (host_summary) [Ep 5 · 1:35](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "The authors found a shorter time to arrival after protocol implementation" (host_summary) [Ep 5 · 1:42](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=102)
- "After protocol implementation, there was less general anesthesia use" (host_summary) [Ep 5 · 1:45](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, fewer central lines were placed" (host_summary) [Ep 5 · 1:45](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, fewer patients needed to be intubated" (host_summary) [Ep 5 · 1:45](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, patients who were intubated spent less time on the ventilator" (host_summary) [Ep 5 · 1:45](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The mortality rate went from 22% to 2% after protocol implementation" (host_summary) [Ep 5 · 1:53](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=113)
- "The Hospital Infantil de Mexico team had a 22% mortality with gastroschisis before the protocol, which was higher than most" (host_summary) [Ep 5 · 2:11](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=131)
- "The five protocol changes resulted in a reduction from 22% mortality to 2% mortality" (host_summary) [Ep 5 · 2:17](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=137)
- "Moving from surgical central lines to PICC lines reduced mortality" (host_summary) [Ep 5 · 2:27](https://qa.library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=147)
- "Hawkins et al. conducted a large multi-center study comparing silo versus immediate closure in gastroschisis." (host_summary) [Ep 12 · 0:06](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=6)
- "The Hawkins et al. study was published in the August issue of GPS (Journal of Pediatric Surgery)." (host_summary) [Ep 12 · 0:13](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study showed no difference between silo and immediate closure for gastroschisis." (host_summary) [Ep 12 · 0:13](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study examined mortality, sepsis, readmission rate, and time to full feeds as outcome measures." (host_summary) [Ep 12 · 0:18](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in mortality between silo and immediate closure for gastroschisis." (host_summary) [Ep 12 · 0:18](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in sepsis rates between silo and immediate closure for gastroschisis." (host_summary) [Ep 12 · 0:18](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in readmission rates between silo and immediate closure for gastroschisis." (host_summary) [Ep 12 · 0:18](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in time to full feeds between silo and immediate closure for gastroschisis." (host_summary) [Ep 12 · 0:18](https://qa.library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "Gastroschisis has a reported incidence of 1 in 6,000 to 1 in 10,000, but is much more common in many parts of the U.S., including Southern California." (host_summary) [Ep 13 · 0:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "At this pediatric surgery practice serving two neonatal intensive care units, 30 to 40 patients per year are treated for gastroschisis, making it second only to inguinal hernias as a congenital anomaly requiring surgical correction." (epidemiological) [Ep 13 · 1:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=60)
- "Traditional staged closure with sutured silastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications." (host_summary) [Ep 13 · 2:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=120)
- "The spring-loaded silo allows for fast, pain-free, suture-less silo placement without need for a formal operation." (host_summary) [Ep 13 · 3:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=180)
- "Dr. James Fisher and colleagues from Loma Linda University were the first to publish a series of patients undergoing routine bedside silo placement." (host_summary) [Ep 13 · 4:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Several retrospective studies from large U.S. centers reported that routine silo placement with delayed closure showed one or more advantages: decreased airway pressures, earlier extubation, decreased incidence of necrotizing enterocolitis, decreased infectious complications, more rapid return of bowel function, decreased length of stay, and decreased hospital charges." (host_summary) [Ep 13 · 5:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "For the last five years on the UCI pediatric surgery service, spring-loaded silos have been routinely placed for patients with gastroschisis with excellent results." (clinical) [Ep 13 · 6:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=360)
- "At these centers, most women carrying a fetus with gastroschisis are seen by the pediatric surgeon prior to delivery, with close collaboration with perinatologists." (clinical) [Ep 13 · 7:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "Most babies are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed, nor is early labor induced." (clinical) [Ep 13 · 7:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=450)
- "The baby is sedated with fentanyl and midazolam drips, intubated, and given a single dose of Vecuronium for the silo placement procedure." (clinical) [Ep 13 · 8:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "While silo placement is feasible without sedation, intubation, or paralysis, these interventions create optimal conditions and a well-controlled situation." (opinion) [Ep 13 · 8:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=510)
- "The Bentec silo is available in seven sizes, from 3 cm to 15 cm diameter, with the ring diameter determining the volume of the silastic cylinder." (host_summary) [Ep 13 · 9:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "A ring that is 2 cm larger than the diameter of the defect is typically chosen." (clinical) [Ep 13 · 9:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=570)
- "Since most defects are 2 to 3 cm in diameter, 4 and 5 cm silos are the most commonly used." (clinical) [Ep 13 · 10:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=600)
- "A larger silo may be chosen if the bowel is more distended or edematous, or there is significant peel." (clinical) [Ep 13 · 10:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=630)
- "Gastroschisis cases involving an atresia typically contain severely distended bowel and often require a 7.5 cm silo." (clinical) [Ep 13 · 11:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "A severely distended distal colon with meconium is a good indication of the probable absence of a proximal atresia or stenosis." (clinical) [Ep 13 · 13:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=780)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction." (clinical) [Ep 13 · 13:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=810)
- "If an obstruction exists without perforation, the institutional policy is to proceed with silo placement and closure, followed by exploration four to six weeks later." (clinical) [Ep 13 · 15:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "The ring should be maintained just palpable under the fascia but not elevating the abdominal wall, which would lead to abdominal wall congestion and complicate final closure." (clinical) [Ep 13 · 18:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "If the ring is too lax and allowed to sink in the abdomen, it may cause necrosis of the underlying duodenum or small bowel, especially if the silo is left in position for a prolonged period." (clinical) [Ep 13 · 18:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1110)
- "Over the ensuing days, resolution of bowel edema, accommodation by the abdominal cavity, and gravity result in gradual spontaneous reduction, aided by once or twice daily active reduction." (clinical) [Ep 13 · 19:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1140)
- "Final closure is performed when the silo contents are within 2 cm of the abdominal wall." (clinical) [Ep 13 · 19:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1170)
- "The silo is left in place for the shortest time possible; unnecessary prolongation has no advantages, may slowly enlarge the defect making closure more involved, and may increase infectious and other potential complications." (clinical) [Ep 13 · 20:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1200)
- "The abdominal wall is stretched to aid in a tension-free closure, which often produces some minor post-operative congestion of the abdominal wall." (clinical) [Ep 13 · 21:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1290)
- "It is important to stay in the correct plane during fascial mobilization in order not to compromise the fascia or skin." (clinical) [Ep 13 · 22:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1350)
- "Skin closure suture is taken from inside out approximately three millimeters from the skin edge; the edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection." (clinical) [Ep 13 · 24:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1440)
- "Essential factors for optimal outcome include appropriate choice of silo size, avoiding mesenteric torsion, final closure when near-complete reduction is achieved and not prolonging silo duration, close observation of silo configuration and contents, purse-string closure of fascia and skin, and preservation of the umbilical stump." (clinical) [Ep 13 · 25:00](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1500)
- "The Bentec silo can be used for staged reduction of omphalocele after excision of the sac, with gradual reduction of liver along with bowel." (clinical) [Ep 13 · 26:20](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1580)
- "When a large silo is required for a prolonged period, a few corner stitches between the silo ring and the abdominal wall prevent premature dislodgement of the silo." (clinical) [Ep 13 · 26:40](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1600)
- "Gastroschisis has a reported incidence of 1 in 6000 to 1 in 10,000, but is much more common in many parts of the US including Southern California." (host_summary) [Ep 14 · 0:39](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=39)
- "At UCI pediatric surgery practice serving 2 neonatal intensive care units, 30 to 40 patients per year with gastroschisis are treated, making it second only to inguinal hernias as a congenital anomaly requiring surgical correction." (epidemiological) [Ep 14 · 0:49](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=49)
- "Traditional staged closure with sutured elastic silo involves risks of silo disruption, fascial dehiscence, and infectious complications." (host_summary) [Ep 14 · 1:11](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=71)
- "The spring-loaded silo allows for fast, pain-free, sutureless silo placement without need for a formal operation." (host_summary) [Ep 14 · 1:27](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=87)
- "Doctor James Fisher and colleagues from Loma Linda University were the first to publish a series of patients to undergo routine silo placement at the bedside." (host_summary) [Ep 14 · 2:08](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=128)
- "Several retrospective studies from large US centers reported that patients who underwent routine silo placement with delayed closure showed one or more advantages: decreased airway pressures, earlier extubation, decreased incidence of necrotizing enterocolitis, decreased infectious complications, more rapid return of bowel function, decreased length of stay, and decreased hospital charges." (host_summary) [Ep 14 · 2:43](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=163)
- "For the last 5 years on the UCI pediatric surgery service, spring-loaded silos have been routinely placed for patients with gastroschisis with excellent results." (clinical) [Ep 14 · 3:26](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=206)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed, nor is early labor induced." (clinical) [Ep 14 · 4:30](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=270)
- "For silo placement, the baby is sedated with fentanyl and midazolam drips, intubated, and given a single dose of vecuronium; while placement is feasible without these interventions, they create optimal conditions and a well-controlled situation." (clinical) [Ep 14 · 4:52](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=292)
- "The Bentek silo is available in 7 sizes from 3 centimeters to 15 centimeters, defined by the diameter of the reinforced ring." (host_summary) [Ep 14 · 5:20](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=320)
- "A ring that is 2 centimeters larger than the diameter of the defect is typically chosen; since most defects are 2 to 3 centimeters in diameter, 4 and 5 centimeter silos are most commonly used." (clinical) [Ep 14 · 5:37](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=337)
- "Gastroschisis cases involving an atresia typically contain severely distended bowel and often require a 7.5 centimeter silo." (clinical) [Ep 14 · 5:59](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=359)
- "A distal colon severely distended with meconium is typical and is a good indication of the probable absence of a proximal atresia or stenosis." (host_summary) [Ep 14 · 6:56](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=416)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction." (clinical) [Ep 14 · 7:07](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=427)
- "If an obstruction exists without perforation, the policy is to proceed with silo placement and closure, followed by exploration 4 to 6 weeks later." (clinical) [Ep 14 · 8:09](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=489)
- "If the ring has too much traction it will cause abdominal wall congestion and edema, complicating closure later on." (host_summary) [Ep 14 · 13:02](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=782)
- "Too little traction will allow the ring to exert constant pressure on the abdominal contents, most notably the duodenum, with a risk of pressure necrosis." (host_summary) [Ep 14 · 13:09](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=789)
- "Final closure is performed when the silo contents is within 2 centimeters of the abdominal wall." (clinical) [Ep 14 · 13:20](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=800)
- "The silo is left in place for the shortest time possible; unnecessary prolongation has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications." (clinical) [Ep 14 · 13:26](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=806)
- "The silo creates a closed system by completely containing the bowel and peritoneal fluid." (host_summary) [Ep 14 · 13:52](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=832)
- "Stretching the abdominal wall aids in a tension-free closure and often produces some minor postoperative congestion of the abdominal wall." (clinical) [Ep 14 · 14:47](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=887)
- "A 1 centimeter fascial edge is mobilized in both directions to the border of the umbilical stump." (host_summary) [Ep 14 · 17:06](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1026)
- "For skin closure, bites are taken approximately 3 millimeters from the skin edge because the edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection." (clinical) [Ep 14 · 21:07](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1267)
- "The baby remained stable without any increase in airway pressures during the closure procedure, which was completed in under 25 minutes." (host_summary) [Ep 14 · 23:38](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1418)
- "Essential factors for optimal outcome include: appropriate choice of silo size, avoiding mesenteric torsion, final closure when near complete reduction is achieved and not prolonging silo duration, close observation of silo configuration and contents, purse string closure of fascia and skin, and preservation of the umbilical stump." (host_summary) [Ep 14 · 24:25](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1465)
- "The Bentek silo can be used for staged reduction of omphalocele after excision of the sac, with the liver gradually reduced along with the bowel." (clinical) [Ep 14 · 25:31](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1531)
- "When a large silo is required for a prolonged period, a few corner stitches between the silo ring and the abdominal wall prevent premature dislodgement of the silo." (clinical) [Ep 14 · 26:02](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1562)
- "The silo can be used in cases of neonatal abdominal compartment syndrome, such as in severe diffuse necrotizing enterocolitis." (clinical) [Ep 14 · 26:34](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1594)
- "At the University of California Irvine, this method is applied to all patients with gastroschisis and selectively used in other situations where abdominal wall closure is not possible." (clinical) [Ep 14 · 26:59](https://qa.library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1619)
- "The sutureless gastroschisis closure technique originated when Tony Sandler at Iowa covered a large defect with umbilical cord and tachyderm, intending to return later, but found the wound had closed spontaneously." — Salim (clinical) [Ep 15 · 2:27](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147)
- "Sandler's first series of sutureless closures included about 10 patients and reported that they did not need to go to the OR and closed on their own." — Salim (clinical) [Ep 15 · 4:30](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=270)
- "Multiple retrospective studies reported that sutureless repair patients eat quicker, go home faster, and are probably cheaper to manage." — Salim (host_summary) [Ep 15 · 4:50](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=290)
- "A randomized study by Brisoni et al. published in the Journal of the American College of Surgeons found that sutureless repair patients took longer to eat and had longer hospital length of stay." — Salim (host_summary) [Ep 15 · 5:10](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=310)
- "A subsequent 98-patient study from UCSF showed a benefit for sutureless repair in terms of time to feeding and length of stay, conflicting with the Brisoni randomized trial." — Salim (host_summary) [Ep 15 · 5:40](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=340)
- "The old adage that you must close the fascia for all gastroschisis babies is probably not true; some version of skin closure is adequate." — Salim (opinion) [Ep 15 · 6:00](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Data over five years shows that about 13% of sutureless repair patients will need an umbilical hernia repair, which is higher than babies who got fascial repair." — Salim (clinical) [Ep 15 · 6:00](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Robert Baird's paper from McGill showed everything was better about tape closure, including a lower umbilical hernia rate, which was surprising." — Todd (host_summary) [Ep 15 · 6:19](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379)
- "Fear of feeding after sutureless closure—hesitation to feed because of concern about distension and evisceration—may be driving longer length of stay." — Todd (opinion) [Ep 15 · 7:20](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=440)
- "A feeding protocol was instituted at the speaker's NICU: if residual output is less than 20 per kilo, it comes out; if tolerating, advance by 20 per kilo each day." — Todd (clinical) [Ep 15 · 7:30](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=450)
- "In prospective trials, natural selection bias may occur if easier cases are chosen for sutureless closure, leading to better outcomes independent of technique." — Salim (opinion) [Ep 15 · 7:58](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=478)
- "The UCSF study with 98 patients published in JAMA Surgery found a 13% rate of umbilical hernia repair over five years of follow-up in sutureless closure patients." — Salim (host_summary) [Ep 15 · 9:45](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=585)
- "Studies have shown that when fascial closure is attempted without a silo (immediate repair), those patients tend to have a higher incidence of umbilical or ventral hernias requiring repair." — Salim (host_summary) [Ep 15 · 10:20](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=620)
- "Every single general anesthetic agent in every class (volatile gas, IV, ketamine, NMDA receptor blockers) has been shown in rat, mice, and sheep studies to cause increased apoptosis and pervasive developmental issues." — Salim (host_summary) [Ep 15 · 11:47](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=707)
- "The GAS trial and PANDA study in humans showed no difference in neurodevelopmental outcome at five years in babies randomized to spinal versus general anesthesia." — Salim (host_summary) [Ep 15 · 12:30](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=750)
- "The heterogeneity of the gastroschisis population—some cases are easy (one or two loops, little Tylenol) while others are complicated (need silo, OR)—makes a huge difference in results and biases non-randomized trials." — Mac (opinion) [Ep 15 · 12:54](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=774)
- "Tony Sandler no longer uses the umbilical cord for sutureless closure; it is not as important as once thought and just sits there." — Salim (host_summary) [Ep 15 · 15:06](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906)
- "Some surgeons put a silo on, reduce with the silo, and then apply tape, so inability to immediately reduce does not preclude sutureless closure." — Salim (clinical) [Ep 15 · 15:30](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=930)
- "At UCLA's UC fetal consortium, all gastroschisis cases are attempted without general anesthesia, without intubation, and with minimal narcotics, using standardized antibiotic and feeding protocols." (clinical) [Ep 15 · 16:02](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=962)
- "The UCLA consortium found that length of stay did not decrease with the standardized protocol, but use of antibiotics, intubation days, and opioid use significantly decreased." (clinical) [Ep 15 · 16:40](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "At UCLA, one surgeon was able to open the defect, reduce everything, and still do a skin or sutureless closure with great outcomes." (clinical) [Ep 15 · 16:40](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "Complicated gastroschisis cases (atresia, perforation) are excluded from the UCLA sutureless closure pathway." (clinical) [Ep 15 · 16:51](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1011)
- "The gastroschisis prognostic score (GPS), which assigned a score based on degree of peel, bowel distension, and matting, did not prove useful in predicting outcomes." — Salim (clinical) [Ep 15 · 17:33](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1053)
- "If a gastroschisis case has a very thick peel, very distended bowel, and lots of bowel loops out, immediate closure should not be considered; a silo should be used for reduction." — Salim (opinion) [Ep 15 · 18:40](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1120)
- "At the end of silo reduction, a sutureless repair can be performed; immediate closure is not required." — Salim (clinical) [Ep 15 · 19:20](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1160)
- "There is no real big need for fascial closure, no matter the size of the gastroschisis defect; skin closure alone is probably adequate." — Salim (opinion) [Ep 15 · 20:00](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1200)
- "Matted bowel does not play into the decision for sutureless closure; if it cannot be immediately reduced, a silo is used, and sutureless repair can be done after reduction." — Todd (clinical) [Ep 15 · 20:31](https://qa.library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1231)
- "In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself." — Rod Gerardo (host_summary) [Ep 22 · 1:44](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=104)
- "The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less antibiotic use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less ventilator use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The positive outcomes for sutureless repair were observed even when considering patients who required silo use." — Rod Gerardo (host_summary) [Ep 22 · 6:01](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster." — Jason Frischer (opinion) [Ep 22 · 7:20](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions." — Jason Frischer (opinion) [Ep 22 · 7:20](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection." — Jason Frischer (clinical) [Ep 22 · 8:05](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation." — Jason Frischer (opinion) [Ep 22 · 8:05](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates." — Jason Frischer (clinical) [Ep 22 · 8:50](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate." — Jason Frischer (host_summary) [Ep 22 · 8:50](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up." — Jason Frischer (clinical) [Ep 22 · 8:50](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure." — Rod Gerardo (host_summary) [Ep 22 · 11:22](https://qa.library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=682)
- "Giant omphalocele (≥5 cm or liver in sac) patients had greater time to full feeds, required more TPN, had greater risk of respiratory insufficiency, and higher incidence of chromosomal anomalies compared to routine omphalocele in a two-center 20-year retrospective study of 97 survivors." (clinical) [Ep 17 · 0:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "56 of 97 giant omphalocele patients were identified as having pulmonary hypertension, with most diagnosed within the first week of life." (epidemiological) [Ep 17 · 0:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Five patients with giant omphalocele had no signs of pulmonary hypertension on initial echo within first seven days but subsequently developed severe pulmonary hypertension after sepsis episodes, with two deaths and one requiring pulmonary vasodilator for more than a year." (clinical) [Ep 17 · 0:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "One patient developed severe pulmonary hypertension 52 days after initial echo showed no pulmonary hypertension, triggered by a single episode of sepsis." (clinical) [Ep 17 · 0:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "The sac-preserving active reduction technique developed by Dr. Abello from Colombia has been used in almost 40 patients over three years by Miguel Gilfoid's group." — Miguel Guelfand (clinical) [Ep 17 · 5:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days." — Miguel Guelfand (clinical) [Ep 17 · 5:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process." — Miguel Guelfand (clinical) [Ep 17 · 5:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "The hydrocolloid dressing should ideally be applied within the first 24 hours after birth so the sac doesn't become very stiff, and it keeps the sac very smooth and hydrated." — Miguel Guelfand (clinical) [Ep 17 · 6:47](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully." — Miguel Guelfand (clinical) [Ep 17 · 6:47](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable." — Miguel Guelfand (clinical) [Ep 17 · 8:01](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=481)
- "In a study by Amy Wegner comparing omphalocele and gastroschisis, gastroschisis had higher risk of adhesive bowel obstruction, but omphalocele had higher risk of midgut volvulus." (clinical) [Ep 17 · 9:16](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "Patients with omphalocele have non-rotation or malrotation and will not have the same adhesions as gastroschisis patients." (clinical) [Ep 17 · 9:16](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "If the surgical technique for omphalocele closure involves exposing the intestines, it may be worth considering a Ladd procedure, but not worth going through the sac if the technique maintains the sac." (opinion) [Ep 17 · 10:31](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631)
- "During diaphragmatic hernia repair, the key move to decrease volvulus risk is to unroll the cecum and proximal bowel if they are rolled together like a scroll, ensuring small bowel is to the right, colon to the left, and anterior surface of mesentery is exposed." (clinical) [Ep 17 · 13:10](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=790)
- "Non-rotation does not exclude the possibility of having anatomy with a narrow base of mesentery and the two ends being fairly close together, creating volvulus risk." (clinical) [Ep 17 · 14:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=873)
- "In gastroschisis, the liver is not expected to be herniated outside the abdomen." (clinical) [Ep 17 · 17:52](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1072)
- "For massive abdominal wall defects where there is no amnion and nothing to sew, Miguel Gilfoid uses a prolene mesh that stays in place until closure can be achieved, protecting it with a plastic bag around the bowel." — Miguel Guelfand (clinical) [Ep 17 · 19:10](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1150)
- "With giant abdominal wall defects, when a spring-loaded (tech) silo is placed and pushed down, the forces go outward and can actually make the defect much bigger over time." (clinical) [Ep 17 · 20:24](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1224)
- "Biologic mesh can be used as a scaffold that sticks to the bowel and allows skin to epithelialize over massive defects." (clinical) [Ep 17 · 21:23](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1283)
- "Miguel Gilfoid reports that 80% of massive gastroschisis cases can be closed within two to three months using prolene mesh that remains in place for months." — Miguel Guelfand (clinical) [Ep 17 · 23:21](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401)
- "Tissue expanders placed inside the belly without any domain would push all contents up and out rather than creating useful space, according to plastic surgery colleagues." (host_summary) [Ep 17 · 26:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "Component separation technique involves separating tissue at the external oblique about a centimeter beyond the rectus sheath bilaterally, then dissecting between external oblique and the transversus/internal oblique, which creates substantial room for closure." (clinical) [Ep 17 · 26:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "An incision on top of the anterior rectus sheath can provide another centimeter of advancement during component separation." (clinical) [Ep 17 · 26:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "A group from UT Houston (Cogen, Rich, and Recy) reported using component separation in nine children aged 7 days to 10 years, majority with omphalocele and giant defects, achieving fascial closure in almost every case, with some requiring mesh to bridge defects." (host_summary) [Ep 17 · 26:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "Until recently, there was no standardized definition for intestinal failure." — Paul Wales (clinical) [Ep 23 · 1:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=116)
- "Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth." — Paul Wales (clinical) [Ep 23 · 2:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=123)
- "New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function." — Rod Gerardo (host_summary) [Ep 23 · 2:24](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent." — Michael Helmrath (clinical) [Ep 23 · 2:40](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines." — Paul Wales (guideline) [Ep 23 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth." — Rod Gerardo (host_summary) [Ep 23 · 3:33](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=213)
- "The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers." — Paul Wales (clinical) [Ep 23 · 3:44](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=224)
- "Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing." — Michael Helmrath (clinical) [Ep 23 · 4:07](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation." — Michael Helmrath (clinical) [Ep 23 · 4:19](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies." — Paul Wales (clinical) [Ep 23 · 4:39](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=279)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients." — Paul Wales (epidemiological) [Ep 23 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis)." — Paul Wales (clinical) [Ep 23 · 5:06](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool." — Paul Wales (clinical) [Ep 23 · 5:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly." — Paul Wales (clinical) [Ep 23 · 6:17](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects in enteropathies lead to hypersecretion and profuse fluid losses, preventing nutrient absorption." — Ellen Encisco (host_summary) [Ep 23 · 6:30](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients have elements of two or all three categories of intestinal failure in their presentation." — Paul Wales (clinical) [Ep 23 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "Gastroschisis can involve all three categories: short bowel from nonviable tissue, inflammation affecting absorption, and motility issues." — Ellen Encisco (host_summary) [Ep 23 · 7:22](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- "Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis." — Paul Wales (epidemiological) [Ep 23 · 7:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Access and availability to intestinal rehabilitation programs is still very rare." — Rod Gerardo (host_summary) [Ep 23 · 8:41](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress." — Michael Helmrath (clinical) [Ep 23 · 8:53](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=533)
- "Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes." — Michael Helmrath (opinion) [Ep 23 · 10:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=615)
- "Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed." — Michael Helmrath (clinical) [Ep 23 · 10:51](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology." — Michael Helmrath (clinical) [Ep 23 · 11:52](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=712)
- "Overall long-term survival in major intestinal rehabilitation programs is usually over 90%." — Rod Gerardo (host_summary) [Ep 23 · 12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems." — Paul Wales (clinical) [Ep 23 · 12:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Until recently, there was no standardized definition for intestinal failure." — Paul Wales (guideline) [Ep 24 · 1:56](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=116)
- "Intestinal failure is a functional problem where gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth." — Paul Wales (clinical) [Ep 24 · 2:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=123)
- "New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days." — Rod Gerardo (host_summary) [Ep 24 · 2:24](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "Earlier recognition and taking advantage of the gut's adaptive biology are time dependent." — Michael Helmrath (clinical) [Ep 24 · 2:40](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines." — Paul Wales (guideline) [Ep 24 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth." — Rod Gerardo (host_summary) [Ep 24 · 3:33](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=213)
- "Intestinal rehabilitation streamlines care and improves communication between family and care providers through an amalgamation of experts providing holistic, comprehensive, coordinated care." — Paul Wales (clinical) [Ep 24 · 3:44](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=224)
- "Intestinal rehabilitation depends on key factors: nutrition in the gut, nutrition in the body, and healing." — Michael Helmrath (clinical) [Ep 24 · 4:07](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple expert eyes observing a patient over time is essential in intestinal rehabilitation." — Michael Helmrath (clinical) [Ep 24 · 4:19](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients." — Paul Wales (epidemiological) [Ep 24 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome are usually related to neonatal disorders including congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) or acquired diseases (necrotizing enterocolitis)." — Paul Wales (clinical) [Ep 24 · 4:50](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves controlling that muscle prevent coordinated propulsion of food and stool, making patients dependent on intravenous support." — Paul Wales (clinical) [Ep 24 · 5:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Enteropathies or congenital diarrheas are conditions where the patient has all of their bowel but the mucosal lining that digests and absorbs does not work, leading to hypersecretion and profuse fluid losses." — Paul Wales (clinical) [Ep 24 · 6:17](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or all three categories of intestinal failure; for example, gastroschisis can involve short bowel, inflammation affecting absorption, and motility issues." — Paul Wales (clinical) [Ep 24 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "Although most intestinal failure patients are infants or babies, older pediatric patients can develop intestinal failure from inflammatory bowel disease, Crohn's disease complications, trauma, malignancy, or vascular thrombosis leading to gut loss." — Paul Wales (clinical) [Ep 24 · 7:45](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=465)
- "Families reach intestinal rehabilitation programs at three time points: prenatal diagnosis (typically atresia with cystic fibrosis or gastroschisis), postnatal acquired problems (volvulus or NEC), and later diagnosis after discharge when patients fail to progress." — Michael Helmrath (clinical) [Ep 24 · 8:53](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Innovation comes from multiple approaches to a problem and different visions; bringing in more expertise leads to better outcomes." — Michael Helmrath (opinion) [Ep 24 · 10:15](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=615)
- "Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being met." — Michael Helmrath (clinical) [Ep 24 · 10:51](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=651)
- "The intestinal rehabilitation team includes dietitians (understanding nutritional needs), social work, nurse practitioners, pharmacy, interventional radiology, pathology, and subspecialties including endocrinology and nephrology." — Michael Helmrath (clinical) [Ep 24 · 11:52](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Overall survival in big intestinal rehabilitation programs is usually over 90% long-term." — Rod Gerardo (host_summary) [Ep 24 · 12:34](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Improved survival has revealed chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life concerns." — Paul Wales (clinical) [Ep 24 · 12:46](https://qa.library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover." — Fung-Yen Lim (clinical) [Ep 25 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover." — Fung-Yen Lim (clinical) [Ep 25 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development." — Fung-Yen Lim (clinical) [Ep 25 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Very high level of alpha fetal protein is associated with gastroschisis or omphalocele." — Fung-Yen Lim (clinical) [Ep 25 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects." — Fung-Yen Lim (clinical) [Ep 25 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging." — Fung-Yen Lim (clinical) [Ep 25 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies." — Fung-Yen Lim (clinical) [Ep 25 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction." — Fung-Yen Lim (clinical) [Ep 25 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients." — Fung-Yen Lim (clinical) [Ep 25 · 2:56](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=176)
- "If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery." — Fung-Yen Lim (clinical) [Ep 25 · 2:56](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=176)
- "Gastroschisis affects approximately one in every 2,200 live births." — Todd Ponsky (host_summary) [Ep 25 · 3:15](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=195)
- "Gastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies." — Fung-Yen Lim (epidemiological) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Nearly 60% of gastroschisis cases are premature." — Fung-Yen Lim (epidemiological) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction." — Fung-Yen Lim (epidemiological) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7." — Fung-Yen Lim (epidemiological) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions." — Fung-Yen Lim (epidemiological) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3." — Fung-Yen Lim (epidemiological) [Ep 25 · 4:19](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele." — Fung-Yen Lim (epidemiological) [Ep 25 · 4:19](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold." — Fung-Yen Lim (clinical) [Ep 25 · 5:02](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "These babies can have significant acidosis and pulmonary hypertension." — Fung-Yen Lim (clinical) [Ep 25 · 5:02](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "Primary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly." — Fung-Yen Lim (clinical) [Ep 25 · 5:34](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=334)
- "Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation." — Fung-Yen Lim (clinical) [Ep 25 · 6:07](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Some patients develop intestinal perforation after only two to four days of enteral feeding." — Fung-Yen Lim (clinical) [Ep 25 · 6:07](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "In the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure." — Todd Ponsky (host_summary) [Ep 25 · 6:34](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=394)
- "In sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time." — Fung-Yen Lim (clinical) [Ep 25 · 6:58](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering." — Fung-Yen Lim (clinical) [Ep 25 · 7:29](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=449)
- "For omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane." — Fung-Yen Lim (clinical) [Ep 25 · 7:57](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=477)
- "At Cincinnati Children's, Duoderm silo is placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin." — Todd Ponsky (host_summary) [Ep 25 · 8:17](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=497)
- "After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin." — Fung-Yen Lim (clinical) [Ep 25 · 8:43](https://qa.library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=523)
- "Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have." — Gail Besner (opinion) [Ep 26 · 1:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101)
- "The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work." — Gail Besner (clinical) [Ep 26 · 2:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175)
- "Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits." — Gail Besner (clinical) [Ep 26 · 3:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable." — Gail Besner (clinical) [Ep 26 · 3:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=207)
- "After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding." (host_summary) [Ep 26 · 3:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase." — Rod Gerardo (host_summary) [Ep 26 · 3:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases." — Todd Ponsky (clinical) [Ep 26 · 5:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303)
- "The BC Children's Hospital gastroschisis study was a retrospective review comparing outcomes before and after implementation of a protocol in 2012, covering patients from 2008 to 2019." (host_summary) [Ep 26 · 5:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine Hospital, the approach to gastroschisis differed from other institutions in that there was very low use of silos, with pretty much every patient having an attempt at immediate bedside sutureless closure following a protocol developed several years prior." — Charza Jaharifard (clinical) [Ep 26 · 6:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=418)
- "Before and after protocol implementation at BC Children's Hospital, approximately 75% of gastroschisis patients could be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation." — Charza Jaharifard (clinical) [Ep 26 · 7:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced." — Charza Jaharifard (clinical) [Ep 26 · 8:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure of gastroschisis, if babies are extubated within 48 hours, parents can hold them within 48 hours, or immediately if managed without intubation." — Charza Jaharifard (clinical) [Ep 26 · 8:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "In prior studies of placental mesenchymal stem cells for in utero MMC repair, two surgeries were performed on lambs: one to create the defect and one to repair it, both in utero, with PMSCs used during repair." (host_summary) [Ep 26 · 10:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=617)
- "In the current study, a single operation was performed at approximately 100 days gestational age where the MMC defect was created and repaired simultaneously, with PMSCs placed directly onto the spinal cord." (host_summary) [Ep 26 · 10:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "The PMSCs did not persist in the placentas, uteri, or lambs at 3 months follow-up." (host_summary) [Ep 26 · 11:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683)
- "There was no histological evidence of abnormal growth or tumor development in the ovine model at 3 months." (host_summary) [Ep 26 · 11:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690)
- "Human trials using PMSCs for in utero myelomeningocele repair have been initiated with the first two patients enrolled." (host_summary) [Ep 26 · 11:52](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover." — Fung Lim (clinical) [Ep 27 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover." — Fung Lim (clinical) [Ep 27 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development." — Fung Lim (clinical) [Ep 27 · 0:55](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "For large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases." — Todd Ponsky (host_summary) [Ep 27 · 1:31](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=91)
- "A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele." — Fung Lim (clinical) [Ep 27 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects." — Fung Lim (clinical) [Ep 27 · 1:54](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "For gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging." — Todd Ponsky (host_summary) [Ep 27 · 2:12](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies." — Todd Ponsky (host_summary) [Ep 27 · 2:12](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "Fetal growth is tracked monthly in these cases because there is concern for significant growth restriction." — Todd Ponsky (host_summary) [Ep 27 · 2:12](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients." — Fung Lim (clinical) [Ep 27 · 2:51](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently." — Fung Lim (clinical) [Ep 27 · 2:51](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "Gastroschisis affects approximately one in every 2200 live births." — Todd Ponsky (host_summary) [Ep 27 · 3:15](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=195)
- "Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis infants are premature." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Acetaminophen is identified as a risk factor for gastroschisis." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions." — Fung Lim (epidemiological) [Ep 27 · 3:27](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3." — Fung Lim (epidemiological) [Ep 27 · 4:21](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele." — Fung Lim (epidemiological) [Ep 27 · 4:21](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "Minimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold." — Fung Lim (clinical) [Ep 27 · 5:02](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "These babies can have significant acidosis and pulmonary hypertension." — Fung Lim (clinical) [Ep 27 · 5:02](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "Primary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly." — Fung Lim (clinical) [Ep 27 · 5:32](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=332)
- "Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation." — Fung Lim (clinical) [Ep 27 · 6:03](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "Some patients develop intestinal perforation after only two to four days of enteral feeding." — Fung Lim (clinical) [Ep 27 · 6:03](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure." — Fung Lim (clinical) [Ep 27 · 6:46](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "In the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time." — Fung Lim (clinical) [Ep 27 · 6:46](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering." — Fung Lim (clinical) [Ep 27 · 7:25](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=445)
- "For omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane." — Fung Lim (clinical) [Ep 27 · 7:54](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "At Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin." — Fung Lim (clinical) [Ep 27 · 7:54](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "After sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin." — Todd Ponsky (host_summary) [Ep 27 · 8:38](https://qa.library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=518)
- "Several hospitals have changed their gastroschisis protocols based on recent publications." — Todd Ponsky (host_summary) [Ep 29 · 0:00](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=0)
- "Some institutions start feeds when NG output is less than 20 mL/kg/day." — Justin (clinical) [Ep 29 · 1:45](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=105)
- "Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting." — Jason Frischer (clinical) [Ep 29 · 3:10](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "Fraser's institution does not intubate gastroschisis babies for reduction." — Jason Frischer (clinical) [Ep 29 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=234)
- "Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching." — Jason Frischer (clinical) [Ep 29 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=313)
- "Some institutions perform gastroschisis reduction under general anesthesia." — Bindi (clinical) [Ep 29 · 5:52](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=352)
- "Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory." — Jason Frischer (clinical) [Ep 29 · 6:19](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=379)
- "Cincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients." — Beth Rymeski (clinical) [Ep 29 · 6:52](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Cincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late." — Beth Rymeski (clinical) [Ep 29 · 8:10](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=490)
- "Cincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years." — Beth Rymeski (clinical) [Ep 29 · 8:40](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=520)
- "In a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants." — Beth Rymeski (host_summary) [Ep 29 · 10:01](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=601)
- "The reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself." — Jason Frischer (opinion) [Ep 29 · 10:30](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "The multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions." — Jason Frischer (epidemiological) [Ep 29 · 10:30](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network." — Jason Frischer (epidemiological) [Ep 29 · 11:20](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=680)
- "After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years." — Jason Frischer (epidemiological) [Ep 29 · 12:10](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=730)
- "Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020)." — Jason Frischer (epidemiological) [Ep 29 · 12:10](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=730)
- "Continuous feeds in gastroschisis patients can lead to oral aversion and prolonged length of stay when patients are not taking anything orally." — Justin (clinical) [Ep 29 · 13:14](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=794)
- "Cincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year." — Beth Rymeski (clinical) [Ep 29 · 13:51](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Approximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support." — Beth Rymeski (epidemiological) [Ep 29 · 13:51](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Cincinnati Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization." — Jason Frischer (clinical) [Ep 29 · 14:20](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=860)
- "Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement." — Jason Frischer (host_summary) [Ep 29 · 15:17](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=917)
- "The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition." — Jason Frischer (opinion) [Ep 29 · 16:00](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=960)
- "For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based." — Jason Frischer (clinical) [Ep 29 · 16:40](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1000)
- "Cincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families." — Beth Rymeski (clinical) [Ep 29 · 16:58](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1018)
- "One recent Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end." — Jason Frischer (clinical) [Ep 29 · 17:22](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1042)
- "Cincinnati Children's current average gastroschisis length of stay is 30 to 34 days." — Jason Frischer (epidemiological) [Ep 29 · 17:22](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1042)
- "Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data." — Jason Frischer (epidemiological) [Ep 29 · 18:14](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1094)
- "Much of the data supporting early feeding in gastroschisis originated from resource-limited countries without TPN access, though implementing this approach in Africa has proven difficult due to poor tolerance." — Justin (epidemiological) [Ep 29 · 18:28](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1108)
- "At Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure." — Jason Frischer (clinical) [Ep 29 · 18:56](https://qa.library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1136)
- "Teodoro et al. studied pediatric trauma patients presenting to a level one trauma center with gunshot wounds or MVCs between 2009 and 2019." — Ellen Encisco (host_summary) [Ep 30 · 0:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Teodoro et al. examined California Department of Public Health data on pediatric gunshot wounds and MVCs from 2006 to 2015." — Ellen Encisco (host_summary) [Ep 30 · 0:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims." — Ellen Encisco (host_summary) [Ep 30 · 0:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were 7.8 times more likely to die than MVC victims." — Ellen Encisco (host_summary) [Ep 30 · 0:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "In California statewide data, the case fatality rate for gunshot wound victims was higher than that for motor vehicle collisions." — Ellen Encisco (host_summary) [Ep 30 · 0:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "The case fatality rate for pediatric gunshot wounds increased from 2006 to 2015." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Petterson et al. examined 10 years of data comprising approximately 8800 pediatric trauma patients transported by helicopter or ground to pediatric trauma centers." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Children transported via helicopter had a higher injury severity score than those transported by ground." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "1.3% of children transported by helicopter required an emergency operation, compared to 0.2% of those transported by ground." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "98.7% of children transported by helicopter did not require an emergency intervention." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Helicopter transport may be over-utilized in pediatric trauma." — Britney Levy (host_summary) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Miyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure." — Rod Gerardo (host_summary) [Ep 30 · 2:50](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis." — Rod Gerardo (host_summary) [Ep 30 · 2:50](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "Philips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers." — Cecilia Gigena (host_summary) [Ep 30 · 3:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients receiving massive transfusions had shortened alpha angles on TEG analysis." — Cecilia Gigena (host_summary) [Ep 30 · 3:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients receiving massive transfusions had lower maximum amplitude values on TEG analysis." — Cecilia Gigena (host_summary) [Ep 30 · 3:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients receiving massive transfusions had lower platelet counts." — Cecilia Gigena (host_summary) [Ep 30 · 3:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions." — Cecilia Gigena (host_summary) [Ep 30 · 3:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Stevens et al. examined CDC Wonder database data between 1999 and 2020 for pediatric firearm and automobile fatalities." — Ellen Encisco (host_summary) [Ep 32 · 0:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Stevens et al. used the Gifford's Law Center annual gun law scorecard between 2014 and 2020 to assess state gun law scores." — Ellen Encisco (host_summary) [Ep 32 · 0:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "In recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children." — Ellen Encisco (host_summary) [Ep 32 · 0:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Stronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws." — Ellen Encisco (host_summary) [Ep 32 · 0:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Gabapentin is an anticonvulsant often used off-label as part of multimodal pain control after major surgery." — Alex Halpern (host_summary) [Ep 32 · 2:11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Lascano et al. performed a retrospective cohort study at Children's Hospital of LA looking at kids age 2 to 18 who underwent appendectomy for perforated appendicitis between 2014 and 2019." — Alex Halpern (host_summary) [Ep 32 · 2:11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "In the Lascano et al. study, kids who received gabapentin had decreased postoperative opioid use." — Alex Halpern (host_summary) [Ep 32 · 2:11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "In the Lascano et al. study, kids who received gabapentin had decreased postoperative length of stay." — Alex Halpern (host_summary) [Ep 32 · 2:11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "The overall rate for periumbilical hernias after gastroschisis closure was 22.7%." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk." — Cecilia Gigena (host_summary) [Ep 32 · 3:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Infants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds." — Em Tombash (host_summary) [Ep 31 · 1:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60)
- "Based on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated." — Em Tombash (host_summary) [Ep 31 · 2:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=120)
- "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds." — Em Tombash (host_summary) [Ep 31 · 2:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150)
- "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis." — Em Tombash (host_summary) [Ep 31 · 2:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=165)
- "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis." — Em Tombash (host_summary) [Ep 31 · 4:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=240)
- "Serial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area." — Em Tombash (host_summary) [Ep 31 · 4:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=255)
- "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component." — Em Tombash (host_summary) [Ep 31 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=270)
- "Initial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected." — Em Tombash (host_summary) [Ep 31 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=285)
- "Management of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines." — Em Tombash (host_summary) [Ep 31 · 5:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=345)
- "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction." — Em Tombash (host_summary) [Ep 31 · 6:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=360)
- "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention." — Em Tombash (host_summary) [Ep 31 · 6:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=390)
- "Outpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality." — Em Tombash (host_summary) [Ep 31 · 6:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=405)
- "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 31 · 7:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450)
- "Recent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections." — Em Tombash (host_summary) [Ep 31 · 7:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=465)
- "Adult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 31 · 8:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Recent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations." — Em Tombash (host_summary) [Ep 31 · 8:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=495)
- "Case-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery." — Em Tombash (host_summary) [Ep 31 · 8:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=525)
- "Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019." — Em Tombash (host_summary) [Ep 31 · 9:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=585)
- "There are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country." — Em Tombash (host_summary) [Ep 31 · 10:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600)
- "As pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is." — Em Tombash (host_summary) [Ep 31 · 10:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=615)
- "Pediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy." — Em Tombash (host_summary) [Ep 31 · 10:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=645)
- "Unwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray." — Em Tombash (host_summary) [Ep 31 · 11:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=705)
- "The gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise." — Em Tombash (host_summary) [Ep 31 · 12:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=720)
- "CT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress." — Em Tombash (host_summary) [Ep 31 · 12:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=735)
- "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies." — Em Tombash (host_summary) [Ep 31 · 12:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=750)
- "CT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure." — Em Tombash (host_summary) [Ep 31 · 12:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=765)
- "The largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months." — Em Tombash (host_summary) [Ep 31 · 13:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=810)
- "Death or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage." — Em Tombash (host_summary) [Ep 31 · 14:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840)
- "The prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC." — Em Tombash (host_summary) [Ep 31 · 14:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=855)
- "For infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies." — Em Tombash (host_summary) [Ep 31 · 14:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=885)
- "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups." — Em Tombash (host_summary) [Ep 31 · 15:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=945)
- "Individuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments." — Em Tombash (host_summary) [Ep 31 · 16:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960)
- "Placing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging." — Em Tombash (host_summary) [Ep 31 · 16:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=975)
- "Bystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions." — Em Tombash (host_summary) [Ep 31 · 16:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1005)
- "Blunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures." — Em Tombash (host_summary) [Ep 31 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1050)
- "A 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission." — Em Tombash (host_summary) [Ep 31 · 18:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1095)
- "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation." — Em Tombash (host_summary) [Ep 31 · 18:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1125)
- "The IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome." — Em Tombash (host_summary) [Ep 31 · 19:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1170)
- "Patients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy." — Em Tombash (host_summary) [Ep 31 · 20:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200)
- "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy." — Em Tombash (host_summary) [Ep 31 · 20:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1215)
- "Monotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis." — Em Tombash (host_summary) [Ep 31 · 20:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230)
- "Gastroschisis occurs when the front of a baby's belly does not form properly during early pregnancy, resulting in an opening on the right side of the belly button through which the intestines pass." (host_summary) [Ep 34 · 0:06](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=6)
- "Gastroschisis is classed as a rare birth defect." (host_summary) [Ep 34 · 0:19](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=19)
- "The cause of gastroschisis is unknown." (host_summary) [Ep 34 · 0:24](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=24)
- "Gastroschisis may mean that the intestines are not able to work properly." (host_summary) [Ep 34 · 0:27](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=27)
- "Gastroschisis is not usually associated with other malformations." (host_summary) [Ep 34 · 0:32](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=32)
- "A diagnosis of gastroschisis can be made before birth using ultrasound." (host_summary) [Ep 34 · 0:36](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=36)
- "Many babies with gastroschisis are born prematurely (before 37 weeks)." (host_summary) [Ep 34 · 0:45](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=45)
- "Ongoing care for babies with gastroschisis should be provided at a specialist center by a dedicated team of professionals with knowledge and experience of the condition." (host_summary) [Ep 34 · 0:51](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=51)
- "Gastroschisis is a serious condition and can be life threatening for the baby before and after birth as a newborn." (host_summary) [Ep 34 · 1:03](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=63)
- "Most babies with gastroschisis do survive." (host_summary) [Ep 34 · 1:10](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=70)
- "Some babies with gastroschisis may be transferred to a dedicated intensive care unit if they are born prematurely." (host_summary) [Ep 34 · 1:18](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=78)
- "After birth, the baby's intestines are wrapped in a sterile bag to avoid damage." (host_summary) [Ep 34 · 1:24](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "Babies with gastroschisis receive the fluid they need via a tube that delivers it through a vein." (host_summary) [Ep 34 · 1:24](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "When the baby is stable, surgery is performed to place the intestines back in the belly and close the opening." (host_summary) [Ep 34 · 1:33](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=93)
- "Surgical repair can be done in one operation (primary repair) or in several steps (staged repair), depending on the baby's circumstances and severity of gastroschisis." (host_summary) [Ep 34 · 1:41](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=101)
- "Further surgery may be needed if other malformations are also present." (host_summary) [Ep 34 · 1:54](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=114)
- "While the intestines recover, the baby receives feed through a tube that delivers it through a vein, a method called parenteral nutrition." (host_summary) [Ep 34 · 1:59](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=119)
- "Hospital stay duration differs depending on the severity of gastroschisis, any complications, and how well the baby responds to treatment, often ranging between 2 to 10 weeks but may be longer." (host_summary) [Ep 34 · 2:10](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=130)
- "Follow-up care by a multidisciplinary team (MDT) of different clinical specialists is required to monitor the baby's growth and development." (host_summary) [Ep 34 · 2:25](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=145)
- "Some babies may experience ongoing difficulties that require different types and levels of care." (host_summary) [Ep 34 · 2:37](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=157)
- "Identifying any complications or difficulties early is very important." (host_summary) [Ep 34 · 2:43](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=163)
- "Some babies may require parenteral nutrition for a longer period to promote continued growth." (host_summary) [Ep 34 · 2:49](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=169)
- "Peer support can be accessed through patient and family support groups." (host_summary) [Ep 34 · 2:55](https://qa.library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=175)
- "McMaster University team performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis examining feeding outcomes." — Alex Halpern (host_summary) [Ep 35 · 0:13](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=13)
- "Infants with exclusive breast milk intake and those with supplemental or exclusive formula intake had similar outcomes in uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:24](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between exclusive breast milk and formula groups in time to reach full enteral feeds in infants with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:24](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between exclusive breast milk and formula groups in duration of parenteral nutrition in infants with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:24](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between exclusive breast milk and formula groups in rates of necrotizing enterocolitis in infants with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:24](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between exclusive breast milk and formula groups in length of hospital stay in infants with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:24](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "Formula intake versus exclusive breast milk intake does not appear to affect outcomes in uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 35 · 0:44](https://qa.library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=44)
- "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (host_summary) [Ep 36 · 1:25](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85)
- "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (host_summary) [Ep 36 · 1:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103)
- "In a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (host_summary) [Ep 36 · 1:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=116)
- "Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin" — Em Gootee (host_summary) [Ep 36 · 2:36](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=156)
- "GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts" — Em Gootee (host_summary) [Ep 36 · 3:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182)
- "Biliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes" — Em Gootee (host_summary) [Ep 36 · 3:19](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=199)
- "Having lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis" — Em Gootee (host_summary) [Ep 36 · 4:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249)
- "The mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown" — Em Gootee (host_summary) [Ep 36 · 4:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281)
- "In a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants" — Em Gootee (host_summary) [Ep 36 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422)
- "Of 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula" — Em Gootee (host_summary) [Ep 36 · 7:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463)
- "Patients with uncomplicated gastroschisis who had some exposure to formula in the first 28 days of life did not have increased risk of necrotizing enterocolitis or major differences in reaching full enteral feeds" — Mike Livingston (clinical) [Ep 36 · 8:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=492)
- "There were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis" — Em Gootee (host_summary) [Ep 36 · 8:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507)
- "Patients with uncomplicated gastroschisis who received some formula appeared to have slightly faster time getting to full feeds, likely related to timing of closure rather than feeding type" — Mike Livingston (clinical) [Ep 36 · 8:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514)
- "Patients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Em Gootee (host_summary) [Ep 36 · 8:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533)
- "A systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (host_summary) [Ep 36 · 12:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766)
- "There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)" — Em Gootee (host_summary) [Ep 36 · 13:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=796)
- "The life course progression of anorectal malformation and Hirschsprung disease is not well understood" — Em Gootee (opinion) [Ep 36 · 13:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=810)
- "Barriers and enablers of successful transition for surgical colorectal patients showed agreement with those for medical patients that existing guidelines were based on" — Sebastian King (clinical) [Ep 36 · 13:42](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "Patients felt that clinicians did not always understand the need for transitioning their child's care from pediatric to adult settings, including the reasons, processes, and how to make transitions smooth" — Sebastian King (clinical) [Ep 36 · 13:42](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "There was little evidence that transfer of colorectal patients from pediatric to adult care happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 36 · 14:22](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862)
- "No models of transfer of care for colorectal patients from pediatric to adult settings were identified in the systematic review" — Whit Holcomb (clinical) [Ep 36 · 14:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878)
- "MMP7 could be used to distinguish biliary atresia from other cholestatic diseases." (host_summary) [Ep 28 · 3:47](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "Intraoperative ICG can be used to determine biliary flow or identify a transaction in biliary atresia surgery." (host_summary) [Ep 28 · 3:47](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it." — Todd Ponsky (epidemiological) [Ep 28 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=285)
- "MMP7 is a send-out test at many non-freestanding children's hospitals, limiting its clinical utility for time-sensitive biliary atresia diagnosis in children presenting at five weeks of age." (clinical) [Ep 28 · 5:48](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "For a hypotensive, tachycardic pediatric blunt trauma patient who has received 20 cc/kg crystalloid, the next steps should be early blood therapy and potentially massive transfusion protocol with balanced resuscitation, consistent with ATLS guidelines." (guideline) [Ep 28 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "There is currently no great definition of what constitutes a massive transfusion protocol (MTP) in pediatric patients; approximately 40 cc/kg blood triggers consideration of balanced resuscitation." (clinical) [Ep 28 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "For rectal prolapse sclerotherapy, 46% of respondents use hypertonic saline, while 10-16% use phenol, ethyl alcohol, or dextrose in water." (epidemiological) [Ep 28 · 10:35](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=635)
- "Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions." — Todd Ponsky (clinical) [Ep 28 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "There are case reports showing mucosal sloughing with phenol sclerotherapy." — Todd Ponsky (host_summary) [Ep 28 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "3% sotradecal is used as a sclerotherapy agent for rectal prolapse." (clinical) [Ep 28 · 11:48](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=708)
- "D50 (dextrose 50% from the code cart) is used as a hypertonic sclerotherapy agent and may be easier to acquire in the operating room than 3% saline." (clinical) [Ep 28 · 11:56](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=716)
- "Deflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy." — Todd Ponsky (host_summary) [Ep 28 · 10:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "Approximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it." — Todd Ponsky (epidemiological) [Ep 28 · 12:23](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "The adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously." — Todd Ponsky (epidemiological) [Ep 28 · 12:23](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "ERAS (Enhanced Recovery After Surgery) is a bundle of interventions to help patients get through the hospital faster with less pain and fewer narcotics, including early mobilization." (clinical) [Ep 28 · 15:59](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=959)
- "ERAS protocols include giving patients a carbohydrate drink two hours before surgery, replacing traditional NPO requirements." (clinical) [Ep 28 · 16:14](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "Implementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively." — Todd Ponsky (clinical) [Ep 28 · 16:42](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1002)
- "ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy, unlike single-procedure changes like sutureless gastroschisis closure." (opinion) [Ep 28 · 17:55](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1075)
- "Starting ERAS implementation with surgical pathways standardizes care and has led to decreased cost, antibiotic utilization, and length of stay; hospitalists and pediatric residents use surgical pathways more than other pathways." (clinical) [Ep 28 · 19:09](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "A strategy for ERAS implementation is to chip away at individual components (such as decreasing opioid use intraoperatively and perioperatively) before building a larger protocol." (clinical) [Ep 28 · 19:42](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1182)
- "For bleeding from a pulmonary vessel during thoracoscopic lobectomy, start with an energy/sealing device (effective in low-pressure systems), then escalate to clips or sutures if needed." (clinical) [Ep 28 · 21:18](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1278)
- "Multiple hemostasis options (energy, clips, sutures) should be available during thoracoscopic procedures." (clinical) [Ep 28 · 21:38](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1298)
- "Most institutions are either taking steps to address social determinants of health or working on it; few report no action." — Todd Ponsky (epidemiological) [Ep 28 · 21:50](https://qa.library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1310)
- "Ziegler et al. performed a prospective study in 10 patients with giant omphalocele and 6 with complicated gastroschisis evaluating a vertical traction device." — Alex Halpern (host_summary) [Ep 38 · 0:14](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=14)
- "The study utilized Fascia Tenses Pediatric, a traction-assisted abdominal wall closure device." — Alex Halpern (host_summary) [Ep 38 · 0:24](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=24)
- "Complete fascial closure was achieved after a median time of 7 days in children with giant omphalocele." — Alex Halpern (host_summary) [Ep 38 · 0:29](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=29)
- "Complete fascial closure was achieved after a median time of 5 days in children with complicated gastroschisis." — Alex Halpern (host_summary) [Ep 38 · 0:36](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=36)
- "No patients developed abdominal compartment syndrome in the study." — Alex Halpern (host_summary) [Ep 38 · 0:39](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=39)
- "No ventral hernias occurred after a median follow-up of 12 months." — Alex Halpern (host_summary) [Ep 38 · 0:39](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=39)
- "Fascia Tenses Pediatric helps facilitate early fascial closure in patients with congenital abdominal wall defects." — Alex Halpern (host_summary) [Ep 38 · 0:46](https://qa.library.globalcastmd.com/watch/use-of-a-new-vertical-traction-device-for-early-traction-assisted-staged-closure-of-congenital-abdominal-wall-defects-a-prospective-series-of-16-patients-9436?t=46)
- "The ABSA Outcomes and Evidence-based Practice Committee performed a systematic review on optimal initial management of gastroschisis." — Alex Halpern (host_summary) [Ep 40 · 0:10](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=10)
- "Delivery after 37 weeks is optimal for infants with gastroschisis." — Alex Halpern (host_summary) [Ep 40 · 0:17](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=17)
- "Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis." — Alex Halpern (host_summary) [Ep 40 · 0:21](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=21)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit." — Alex Halpern (host_summary) [Ep 40 · 0:27](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair for gastroschisis is safe and effective." — Alex Halpern (host_summary) [Ep 40 · 0:27](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair does not delay feeding or increase length of stay in gastroschisis patients." — Alex Halpern (host_summary) [Ep 40 · 0:37](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=37)
- "There is a need for high quality randomized controlled trials to help provide evidence-based care for infants with gastroschisis." — Alex Halpern (host_summary) [Ep 40 · 0:41](https://qa.library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=41)
- "Connecticut Children's Medical Center implemented an algorithm for managing esophageal button batteries in 2019 that includes activating the critical airway response team." — Eleanor Cisco (host_summary) [Ep 41 · 1:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=60)
- "The Brent et al. study compared patients presenting with esophageal button batteries before algorithm implementation (2015-2019) to those after implementation (2019-2022)." — Eleanor Cisco (host_summary) [Ep 41 · 1:12](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=72)
- "There was a significant reduction in time from chest X-ray to OR for button battery removal after implementing the new algorithm at Connecticut Children's." — Eleanor Cisco (host_summary) [Ep 41 · 1:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=85)
- "The McMaster University team performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 41 · 2:08](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=128)
- "Infants with uncomplicated gastroschisis who received exclusive breast milk had similar outcomes to those with supplemental or exclusive formula intake." — Alex Halpern (host_summary) [Ep 41 · 2:17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "In uncomplicated gastroschisis, there were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, rates of necrotizing enterocolitis, and length of hospital stay." — Alex Halpern (host_summary) [Ep 41 · 2:17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience." — Cecilia Jenna (host_summary) [Ep 41 · 3:08](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia." — Cecilia Jenna (host_summary) [Ep 41 · 3:27](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=207)
- "Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter." — Cecilia Jenna (host_summary) [Ep 41 · 3:32](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter." — Cecilia Jenna (host_summary) [Ep 41 · 3:32](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures." — Cecilia Jenna (opinion) [Ep 41 · 3:44](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=224)
- "The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix)." — Em Gootee (host_summary) [Ep 39 · 0:34](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=34)
- "Umbilical cords usually fall off at 2 to 3 weeks after birth." — Em Gootee (host_summary) [Ep 39 · 0:50](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Delayed umbilical cord separation can be a manifestation of an immune deficiency." — Em Gootee (host_summary) [Ep 39 · 0:50](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora." — Rebecca Brown (clinical) [Ep 39 · 1:12](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=72)
- "Mild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours." — Em Gootee (host_summary) [Ep 39 · 1:20](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=80)
- "In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation." — Rebecca Brown (clinical) [Ep 39 · 1:30](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=90)
- "16% of patients admitted with omphalitis develop necrotizing fasciitis." — Em Gootee (host_summary) [Ep 39 · 1:40](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=100)
- "Necrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate." — Em Gootee (host_summary) [Ep 39 · 1:46](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=106)
- "Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants." — Rebecca Brown (epidemiological) [Ep 39 · 2:17](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=137)
- "Umbilical hernias can be associated with trisomy 13, 18, and 21." — Em Gootee (host_summary) [Ep 39 · 2:27](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=147)
- "Dr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself." — Em Gootee (host_summary) [Ep 39 · 2:47](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=167)
- "In Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age." — Em Gootee (host_summary) [Ep 39 · 2:55](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=175)
- "Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects." — Rebecca Brown (epidemiological) [Ep 39 · 3:21](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=201)
- "In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age." — Rebecca Brown (epidemiological) [Ep 39 · 3:42](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=222)
- "A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size." — Rebecca Brown (guideline) [Ep 39 · 4:06](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=246)
- "In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age." — Rebecca Brown (epidemiological) [Ep 39 · 4:40](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=280)
- "Unplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old." — Em Gootee (host_summary) [Ep 39 · 4:54](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=294)
- "Asymptomatic umbilical hernia repair should be delayed until greater than 4 years of age." — Em Gootee (host_summary) [Ep 39 · 5:10](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=310)
- "In Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5." — Em Gootee (host_summary) [Ep 39 · 5:18](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=318)
- "In Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%." — Em Gootee (host_summary) [Ep 39 · 5:53](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=353)
- "If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5." — Rebecca Brown (epidemiological) [Ep 39 · 6:03](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=363)
- "Rangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure." — Em Gootee (host_summary) [Ep 39 · 6:12](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=372)
- "Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously." — Rebecca Brown (opinion) [Ep 39 · 6:34](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=394)
- "Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school." — Rebecca Brown (guideline) [Ep 39 · 6:43](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=403)
- "Proboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall." — Em Gootee (host_summary) [Ep 39 · 6:56](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=416)
- "It is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child." — Em Gootee (host_summary) [Ep 39 · 7:05](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=425)
- "Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms." — Rebecca Brown (opinion) [Ep 39 · 7:11](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=431)
- "Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus." — Rebecca Brown (clinical) [Ep 39 · 7:22](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=442)
- "Dr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus." — Em Gootee (host_summary) [Ep 39 · 8:00](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=480)
- "Umbilical granulomas are the most common umbilical masses in newborns." — Rebecca Brown (epidemiological) [Ep 39 · 8:52](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=532)
- "Umbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time." — Em Gootee (host_summary) [Ep 39 · 8:55](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=535)
- "Umbilical granulomas often respond to silver nitrate treatment." — Em Gootee (host_summary) [Ep 39 · 9:00](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=540)
- "Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading." — Rebecca Brown (clinical) [Ep 39 · 9:17](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=557)
- "Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas." — Rebecca Brown (clinical) [Ep 39 · 9:40](https://qa.library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=580)
- "This is a retrospective study using educational data from children born between 1991 and 2022." — Lizzie Lee (host_summary) [Ep 42 · 0:11](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=11)
- "Researchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments between 208 children with gastroschisis and over 2000 age-matched controls." — Lizzie Lee (host_summary) [Ep 42 · 0:18](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=18)
- "Children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments." — Lizzie Lee (host_summary) [Ep 42 · 0:33](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=33)
- "Children with gastroschisis may face long-term learning challenges and could benefit from early educational support." — Lizzie Lee (host_summary) [Ep 42 · 0:41](https://qa.library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=41)
- "The Beotti et al. prospective study on postoperative calibrations in Hirschsprung disease took place 2021 to 2023 and included 33 patients under six months old who underwent endorectal pull-through surgeries." — Lizzie Lee (host_summary) [Ep 44 · 1:03](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=63)
- "In the Beotti study, patients were assigned to a new non-dilation protocol group or a traditional dilation group." — Lizzie Lee (host_summary) [Ep 44 · 1:14](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=74)
- "The Beotti study primary outcomes were anastomotic complications, enterocolitis, and constipation." — Lizzie Lee (host_summary) [Ep 44 · 1:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=80)
- "In the Beotti study, there was no significant difference in anastomotic complications between the two groups, but the non-dilation group had less enterocolitis and less constipation." — Lizzie Lee (host_summary) [Ep 44 · 1:27](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "Choosing not to do postoperative anal dilations after Hirschsprung pull-through may be a good alternative with benefits like lower constipation and enterocolitis." — Lizzie Lee (host_summary) [Ep 44 · 1:36](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=96)
- "The APSA Outcomes and Evidence-based Practice Committee systematic review by Slidell et al. found that delivery after 37 weeks is optimal for gastroschisis." — Alex Halpern (host_summary) [Ep 44 · 2:11](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=131)
- "For gastroschisis, prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure." — Alex Halpern (host_summary) [Ep 44 · 2:21](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=141)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit." — Alex Halpern (host_summary) [Ep 44 · 2:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "Sutureless repair for gastroschisis is safe, effective, and does not delay feeding or increase length of stay." — Alex Halpern (host_summary) [Ep 44 · 2:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "The APSA systematic review concluded that there is a need for high quality randomized controlled trials to help provide evidence-based care for gastroschisis infants." — Alex Halpern (host_summary) [Ep 44 · 2:42](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=162)
- "The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume." — Cecilia Gigena (host_summary) [Ep 44 · 3:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=196)
- "The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers." — Cecilia Gigena (host_summary) [Ep 44 · 3:32](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=212)
- "High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients." — Cecilia Gigena (host_summary) [Ep 44 · 3:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had significantly shorter length of stay for CDH patients." — Cecilia Gigena (host_summary) [Ep 44 · 3:46](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had better outcomes for patients with CDH." — Cecilia Gigena (host_summary) [Ep 44 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=240)
- "Giant omphalocele is typically defined as five centimeters or greater or liver in the sac" (clinical) [Ep 48 · 0:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "In a two-center retrospective study encompassing 20 years with 97 survivors of giant omphalocele, patients had greater time to full feeds, required more TPN, had more chromosomal anomalies, and had higher incidence of respiratory insufficiency" (epidemiological) [Ep 48 · 0:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "56 patients of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within the first week of life" (epidemiological) [Ep 48 · 1:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Five patients out of 56 with pulmonary hypertension had no signs in their first echo within the first seven days of life, then subsequently developed severe pulmonary hypertension after an episode of sepsis; two died and one required pulmonary vasodilator for more than a year" (clinical) [Ep 48 · 1:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Even in omphalocele patients without signs of respiratory compromise early, sepsis later puts these patients at high risk for pulmonary hypertension" (clinical) [Ep 48 · 1:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Dr. Miguel Guelfand uses hydrocolloid dressing to make a silo for giant omphalocele without painting the sac, achieving closure in 97% within 30 days and 92% within 15 days in 40 patients" (clinical) [Ep 48 · 3:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=226)
- "For hydrocolloid dressing technique, the dressing should be placed within the first 24 hours so the sac doesn't get very stiff, and the hydrocolloid makes the sac very smooth and hydrated" (clinical) [Ep 48 · 4:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=266)
- "Dr. Guelfand's team keeps all giant omphalocele patients in ICU ventilated and completely paralyzed during active reduction" (clinical) [Ep 48 · 4:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=260)
- "For ruptured omphalocele, Dr. Guelfand's team sutures the omphalocele and then applies the hydrocolloid dressing; they have treated three such patients" (clinical) [Ep 48 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=285)
- "The risk of midgut volvulus was higher in patients with omphalocele compared to gastroschisis, and there was increased risk of adhesive bowel obstruction with gastroschisis" (epidemiological) [Ep 48 · 5:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "If exposing the intestines in omphalocele patients, it is worthwhile doing a Ladd procedure at the time because these patients have non-rotation or mal-rotation, and non-rotation does not exclude the possibility of having anatomy with a narrow base of mesentery" (clinical) [Ep 48 · 5:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Dr. Guelfand uses proline mesh for huge gastroschisis or omphalocele cases when there is no place for hydrocolloid, protecting it with a plastic bag within the bowel; this technique has been used for 15 years" (clinical) [Ep 48 · 8:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=498)
- "When a Bentec spring-loaded silo is placed for giant abdominal wall defect and pushed down, the forces go out and actually make the defect much bigger over time" (clinical) [Ep 48 · 8:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=529)
- "Dr. Islam's team used biologic mesh as a scaffold for a large abdominal wall defect, which sticks to the bowel and creates a scaffold to allow skin to epithelialize, then used circumcision skin as a graft, followed by plastic surgery tissue expanders and flaps for coverage" (clinical) [Ep 48 · 9:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Component separation technique involves separating tissue at the external oblique about a centimeter beyond the rectus sheath on both sides, dissecting between external and internal oblique, and optionally making an incision on the anterior rectus sheath for another centimeter of space" — Ellen Encisco (host_summary) [Ep 48 · 10:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "A Texas report described component separation use in nine children aged seven days to 10 years, mostly for omphaloceles and giant defects, achieving fascial closure in the vast majority with some mesh use for bridging" — Ellen Encisco (host_summary) [Ep 48 · 10:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Complex gastroschisis is almost a different disease from simple variety; everything is worse including hospital length of stay, requirement for further operations, and sepsis rates" (clinical) [Ep 48 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "In sutureless gastroschisis closure, the silo is placed or bowel is tucked in with occlusive dressing, changed at five days, and mostly closed by the next change, then simple dressings can be used" (clinical) [Ep 48 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Comparing sutured versus sutureless gastroschisis closure, there was no difference in time to full feeds, TPN use, or duration of hospital stay, but sutureless had fewer anesthetics, less frequent antibiotic use, and fewer infections and septic events" (epidemiological) [Ep 48 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "A randomized trial of over 50 gastroschisis patients found no difference between immediate closure and silo placement" (epidemiological) [Ep 48 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "The finding of no difference between silo and immediate closure paved the way for studying sutureless closure, because it established that immediate closure was not superior before moving to sutureless technique" (opinion) [Ep 48 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "spk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles" — Todd Ponsky (clinical) [Ep 1 · 0:27](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=27)
- "Jack's first choice for omphalocele without pulmonary hypoplasia or cardiac problems is early skin coverage" — Jack (clinical) [Ep 1 · 0:42](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=42)
- "For patients with pulmonary hypoplasia, bad hearts, prematurity, or defects too large for skin coverage, Jack uses escharotic technique" — Jack (clinical) [Ep 1 · 0:56](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=56)
- "Jack's team uses silver sulfadiazine (Flamazine in Canada) for escharotic treatment, a technique taught by Sigy Ein" — Jack (clinical) [Ep 1 · 1:11](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=71)
- "Silver-impregnated sponges offer same advantage as Silvadene but are less messy and don't require painting" — Jack (clinical) [Ep 1 · 1:32](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=92)
- "spk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster" — Todd Ponsky (clinical) [Ep 1 · 1:45](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=105)
- "Dr. Abello's Duoderm technique involves creating T-shaped Duoderm pieces that form an external silo, which is progressively compressed like gastroschisis reduction over approximately 1-2 weeks" — Todd Ponsky (host_summary) [Ep 1 · 3:16](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=196)
- "The Duoderm compression technique requires daily adjustments and significant work" — Jack (clinical) [Ep 1 · 5:02](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=302)
- "The Duoderm technique cannot be used in patients with pulmonary hypoplasia or bad hearts where intra-abdominal pressure cannot be safely increased" — Jack (clinical) [Ep 1 · 5:02](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=302)
- "Case presented: 28-week gestation, 1130g premature female with giant omphalocele including liver, identified by prenatal ultrasound" (host_summary) [Ep 1 · 6:32](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=392)
- "Component separation as described by Ramirez involves incision parallel to semilunar line with dissection of lateral fascia toward external oblique to mid-axillary line, gaining 2-4 centimeters" (host_summary) [Ep 1 · 8:07](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=487)
- "In the presented case, rectus muscles were joined centrally and umbilical cord mobilized caudally to create future umbilicus" (host_summary) [Ep 1 · 9:30](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=570)
- "Dr. Abello reports this as probably the smallest patient with lowest weight and giant omphalocele treated with his method and component separation for definitive anatomic closure without eventration" (host_summary) [Ep 1 · 10:19](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=619)
- "Component separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together" — Todd Ponsky (clinical) [Ep 1 · 11:07](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=667)
- "Jack's concern about component separation: uncertain what the abdominal wall will be like when the patient is 20 years old and whether they will be able to function normally" — Jack (opinion) [Ep 1 · 11:38](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=698)
- "Jack uses absorbable patches (previously Surgisis with many recurrences, now Strattice with better results) to leave abdominal wall musculature intact" — Jack (clinical) [Ep 1 · 11:51](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=711)
- "Advantage of patch approach: as child grows, the patch becomes a smaller percentage of the abdominal wall area" — Jack (clinical) [Ep 1 · 12:07](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=727)
- "Many omphaloceles have defects extending to the costal margin, making complete closure difficult even with component separation" — Jack (clinical) [Ep 1 · 12:27](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=747)
- "Jack often closes the lower defect primarily but requires a patch along the costal margin" — Jack (clinical) [Ep 1 · 12:40](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=760)
- "Component separation requires dissection to the mid-axillary line to adequately mobilize tissue" — Todd Ponsky (clinical) [Ep 1 · 13:10](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=790)
- "spk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together" — Todd Ponsky (clinical) [Ep 1 · 13:22](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=802)
- "Dr. Abello has long-term follow-up with the Duoderm technique showing all patients healed well without problems, but no long-term follow-up yet with component separation" (host_summary) [Ep 1 · 14:00](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=840)
- "Delayed closure approach: apply fatty gauzes until epithelialization, wait until 6-7 months, then perform delayed primary closure" (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=900)
- "Suad manages most giant omphaloceles with painting followed by delayed primary closure when older, usually achieving closure without patch" (clinical) [Ep 1 · 16:27](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=987)
- "Holly Williams successfully used Duoderm technique on two giant omphaloceles with liver out, maintaining patients on nasal cannula with morphine during manipulation, avoiding intubation until repair" (clinical) [Ep 1 · 17:22](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1042)
- "Holly Williams applied Duoderm and redid it only every 3 days, making very gradual progress" (clinical) [Ep 1 · 18:03](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1083)
- "Holly Williams previously used multi-stage operations with patches over a couple of years rather than painting" (clinical) [Ep 1 · 18:33](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1113)
- "In neonates, tissue compliance allows significant reduction with Duoderm pulling; the amnion is left (usually stuck to liver centrally), Duoderm applied over it, then skin closed" (clinical) [Ep 1 · 18:57](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1137)
- "Holly Williams uses Alloderm as bridging material, which over time turns into thick fascia resembling rectus diastasis" (clinical) [Ep 1 · 19:36](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1176)
- "Benefit of Alloderm approach: muscle edges don't continue to separate over time, unlike painting-and-waiting where muscle stays lateral and defect may enlarge" (clinical) [Ep 1 · 24:40](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1480)
- "Most challenging cases are smaller defects with entire liver out - these don't reduce with painting-and-waiting because the liver is 'locked out' with a mushroom shape" — Jack (clinical) [Ep 1 · 25:15](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1515)
- "For locked-out liver cases, the fascial defect must be enlarged to allow reduction" — Jack (clinical) [Ep 1 · 25:39](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1539)
- "spk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure" — Todd Ponsky (clinical) [Ep 1 · 21:57](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1317)
- "Biologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent" — Todd Ponsky (clinical) [Ep 1 · 22:57](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1377)
- "Cardiac surgeons report biologic patches in VSD closure turn into cardiac muscle" — Todd Ponsky (host_summary) [Ep 1 · 23:10](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1390)
- "spk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar" — Todd Ponsky (clinical) [Ep 1 · 23:25](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1405)
- "Dr. Abello's algorithm: first perform relaxation test under sedation to assess how much stretching is needed and determine silo size requirements" (host_summary) [Ep 1 · 27:04](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1624)
- "Dr. Abello's decision tree: if primary closure tolerated, proceed; if not, perform component separation; if intra-abdominal pressure still too high after component separation, add mesh" (host_summary) [Ep 1 · 29:03](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1743)
- "If at any point pressure becomes too high or pulmonary hypertension occurs, Dr. Abello aborts the procedure and reverts to traditional painting-and-waiting" (host_summary) [Ep 1 · 30:33](https://qa.library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1833)
- "Most umbilical hernias will close spontaneously in the first year and some in the second year." — Kenneth Azarow (clinical) [Ep 21 · 2:58](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=178)
- "Age 2 is the earliest Dr. Azarow would consider umbilical hernia repair, and only after extensive counseling; optimal timing is before school entry (age 4–5)." — Kenneth Azarow (opinion) [Ep 21 · 3:05](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=185)
- "A long proboscis does not affect the decision to operate early on an umbilical hernia." — Kenneth Azarow (opinion) [Ep 21 · 3:47](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=227)
- "Larger umbilical defects (>1 cm) are less likely to close spontaneously, but this does not justify early surgery." — Kenneth Azarow (clinical) [Ep 21 · 4:12](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=252)
- "Race or ethnicity of the child does not affect the decision on timing of umbilical hernia repair." — Kenneth Azarow (opinion) [Ep 21 · 4:40](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=280)
- "Emerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair." — Todd Ponsky (host_summary) [Ep 21 · 4:54](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=294)
- "True incarcerated umbilical hernias requiring emergency surgery must present with bowel obstruction symptoms (vomiting, inability to feed)." — Kenneth Azarow (clinical) [Ep 21 · 5:38](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=338)
- "Red, tender umbilical lumps in children are usually incarcerated omentum, preperitoneal fat, or infected urachal cysts—not incarcerated bowel." — Kenneth Azarow (clinical) [Ep 21 · 5:49](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=349)
- "Incarcerated omentum or fat at the umbilicus can be treated with NSAIDs; infected urachal cysts with antibiotics." — Kenneth Azarow (clinical) [Ep 21 · 6:09](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=369)
- "Dr. Azarow cannot recall ever performing emergency surgery for an incarcerated umbilical hernia." — Kenneth Azarow (opinion) [Ep 21 · 6:19](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=379)
- "LMA anesthesia can be used for umbilical hernia repair if adequate abdominal wall relaxation is achieved, but this is anesthesiologist-dependent." — Kenneth Azarow (clinical) [Ep 21 · 7:47](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=467)
- "PDS or Maxon suture is preferred for umbilical hernia repair because it lasts twice as long as Vicryl and is non-braided (lower infection risk in semi-contaminated field)." — Kenneth Azarow (clinical) [Ep 21 · 8:26](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=506)
- "Dr. Azarow uses prophylactic antibiotics for umbilical hernia repair but acknowledges this is anecdotal practice." — Kenneth Azarow (opinion) [Ep 21 · 8:51](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=531)
- "Umbilicoplasty (excision of redundant skin) should be performed during umbilical hernia repair to achieve a flat, cosmetically acceptable result." — Kenneth Azarow (opinion) [Ep 21 · 10:19](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=619)
- "Umbilicoplasty technique involves creating a pedicled skin flap with blood supply from above or below, avoiding complete circumferential incision." — Kenneth Azarow (clinical) [Ep 21 · 10:37](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=637)
- "Tacking the undersurface of umbilical skin to the fascia with braided suture (Vicryl) promotes inflammatory adhesion and prevents recurrent proboscis." — Kenneth Azarow (clinical) [Ep 21 · 11:42](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=702)
- "A pressure dressing should remain in place for 3 days after umbilical hernia repair." — Kenneth Azarow (clinical) [Ep 21 · 12:22](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=742)
- "Gastroschisis is actually an umbilical ring defect, not a paraumbilical defect, because the natural history is for the hole to close spontaneously (which only occurs at the umbilical ring)." — Kenneth Azarow (clinical) [Ep 21 · 12:37](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=757)
- "Over half of gastroschisis patients closed with sutureless technique develop large umbilical hernias, but most close spontaneously over 2–3 years." — Kenneth Azarow (clinical) [Ep 21 · 13:24](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=804)
- "A Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure." — Todd Ponsky (host_summary) [Ep 21 · 13:45](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=825)
- "Suturing the gastroschisis defect makes the umbilical ring edge ischemic and destroys its integrity, leading to hernias that won't close spontaneously." — Kenneth Azarow (clinical) [Ep 21 · 14:13](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=853)
- "Omphalocele repair should be delayed as long as possible to allow abdominal domain expansion; operating too early is a mistake." — Kenneth Azarow (opinion) [Ep 21 · 15:00](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=900)
- "Parents should watch for the child's flanks bulging when lying flat—this indicates the abdominal girth is expanding and primary closure may be achievable." — Kenneth Azarow (clinical) [Ep 21 · 15:34](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=934)
- "If mesh placement seems inevitable for omphalocele, wait longer—many can be primarily closed if given sufficient time." — Kenneth Azarow (opinion) [Ep 21 · 15:13](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=913)
- "For large umbilical hernias in older teenagers, laparoscopic repair with mesh can be considered if primary closure seems unlikely." — Kenneth Azarow (clinical) [Ep 21 · 16:48](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1008)
- "A 5 mm umbilical defect very rarely causes intestinal incarceration; small pieces of fat may get caught and cause discomfort." — Kenneth Azarow (clinical) [Ep 21 · 17:23](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1043)
- "Repair of small asymptomatic umbilical hernias is not absolutely indicated and can be watched indefinitely if the child has no symptoms." — Kenneth Azarow (opinion) [Ep 21 · 17:17](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1037)
- "A Nebraska study showed that operating on umbilical drainage in the first 3 months increases complication rates; many resolve spontaneously by 6 months." — Kenneth Azarow (epidemiological) [Ep 21 · 19:17](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1157)
- "Infants with tiny drops of clear or whitish umbilical drainage should be watched for 6 months before considering surgery." — Kenneth Azarow (opinion) [Ep 21 · 19:08](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1148)
- "Dr. Azarow has stopped operating in the first 6 months for minor umbilical drainage or granulomas." — Kenneth Azarow (opinion) [Ep 21 · 19:29](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1169)
- "Umbilical granulomas can be treated with silver nitrate application; many resolve without surgery." — Kenneth Azarow (clinical) [Ep 21 · 20:59](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1259)
- "Office ligation of umbilical granulomas is not recommended unless the stalk is very narrow; they often don't fall off easily." — Kenneth Azarow (opinion) [Ep 21 · 21:11](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1271)
- "A prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early." — Todd Ponsky (epidemiological) [Ep 21 · 21:33](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1293)
- "Steroid cream works better than silver nitrate for granulation tissue at gastrostomy sites, so the same principle applies to umbilical granulomas." — Kenneth Azarow (clinical) [Ep 21 · 21:49](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1309)
- "For persistent umbilical drainage at 6–12 months, perform umbilical exploration through a hernia repair incision, divide the fascia inferiorly to visualize the urachal track, and bluntly dissect to the bladder dome." — Kenneth Azarow (clinical) [Ep 21 · 22:10](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1330)
- "The distal epithelialized portion of the urachal remnant must be excised from the umbilical skin, taking care not to devascularize the umbilicus." — Kenneth Azarow (clinical) [Ep 21 · 22:32](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1352)
- "A Nebraska study found no VCUG or ultrasound findings that changed management of urachal remnants, so Dr. Azarow does not perform preoperative imaging." — Kenneth Azarow (epidemiological) [Ep 21 · 24:05](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1445)
- "Infected urachal cysts can usually be treated with antibiotics alone; true abscesses require percutaneous drainage by interventional radiology." — Kenneth Azarow (clinical) [Ep 21 · 24:52](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1492)
- "After cooling down an infected urachal cyst, the entire congenital remnant should be excised electively to prevent recurrent abscess." — Kenneth Azarow (clinical) [Ep 21 · 25:01](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1501)
- "Elective urachal remnant excision is performed laparoscopically with a supraumbilical port and a 12 mm lateral port for stapling across the bladder dome." — Kenneth Azarow (clinical) [Ep 21 · 25:31](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1531)
- "Patent omphalomesenteric duct with stool draining from the umbilicus will not close spontaneously and requires surgery before hospital discharge." — Kenneth Azarow (clinical) [Ep 21 · 26:23](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1583)
- "Patent omphalomesenteric duct poses risk of volvulus from small bowel wrapping around the fistula tract." — Kenneth Azarow (clinical) [Ep 21 · 26:36](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1596)
- "Patent omphalomesenteric duct is approached through umbilical exploration; laparoscopy can assist if bowel is already twisted around the tract." — Kenneth Azarow (clinical) [Ep 21 · 26:56](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1616)
- "Epigastric hernias (epiploceles) are purely elective and should only be repaired if causing discomfort; they are preperitoneal fat through a pinhole defect, not true hernias." — Kenneth Azarow (clinical) [Ep 21 · 28:06](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1686)
- "The fascial defect in epigastric hernias is typically only 1 millimeter in diameter." — Kenneth Azarow (clinical) [Ep 21 · 28:46](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1726)
- "Analysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years." — Todd Ponsky (epidemiological) [Ep 21 · 29:22](https://qa.library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1762)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 18 · 1:42](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 18 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "A 24-25 week premature infant with 20-25 cm of bowel will likely increase to at least 50 cm just on the basis of growth alone" — Brad Warner (clinical) [Ep 18 · 3:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=193)
- "For a neonate with ileocecal valve and entire colon, 10-15 cm of small intestine is a ballpark figure for potential viability" — Brad Warner (clinical) [Ep 18 · 4:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15-20 cm of small intestine would be needed for potential viability in a neonate" — Brad Warner (clinical) [Ep 18 · 4:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adult studies, patients with less than 50 cm of intestine have about 40% mortality after 5-10 years" — Brad Warner (epidemiological) [Ep 18 · 4:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "According to Pediatric Intestinal Failure Research Consortium data, of children on TPN for more than several months due to short gut syndrome: 25% die, 25% need transplant, and 50% can wean off TPN" — Brad Warner (epidemiological) [Ep 18 · 6:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=398)
- "Common causes of death in intestinal failure include liver failure, septic episodes from central line or bacterial overgrowth, variceal bleeding from liver disease, and loss of IV access" — Brad Warner (clinical) [Ep 18 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=431)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 18 · 7:49](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "The goal of management is to wean TPN and push enteral feeding, accepting stool outputs of up to 40 cc per kilo per day as the limit" — Brad Warner (clinical) [Ep 18 · 8:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=499)
- "The most common reasons children develop short gut syndrome are necrotizing enterocolitis, gastroschisis, midgut volvulus, and atresias" — Brad Warner (epidemiological) [Ep 18 · 9:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=562)
- "For TPN, target about 100-120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (clinical) [Ep 18 · 10:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Shoot for about 2-3 g of protein per kilo per day and about 2-3 g of fat per kilo per day in TPN" — Brad Warner (clinical) [Ep 18 · 10:45](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "Begin enteral feeding as soon as feasible after resection and reanastomosis when they start stooling, generally starting with slow continuous drip" — Brad Warner (clinical) [Ep 18 · 11:06](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=666)
- "With continuous drip feeding, nutrient transporters are upregulated and ability to get more nutrition in may be advantageous" — Brad Warner (opinion) [Ep 18 · 11:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=683)
- "Want a baby to gain about 20-30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 18 · 12:05](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes fat from 2-3 g per kilo per day given daily down to about 1 g per kilo per day delivered twice or 3 times a week, which has been effective in reducing TPN-associated cholestasis" — Brad Warner (clinical) [Ep 18 · 12:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat containing primarily omega-3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega-6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 18 · 14:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "When fish oil (omegaven) is introduced to children getting jaundiced, there has been demonstrated significant fall in their jaundice levels" — Brad Warner (clinical) [Ep 18 · 14:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=878)
- "SMOF lipid contains soybean-based lipid (essential fatty acids), medium chain triglycerides (more easily digested), olive oil, and fish oil, and has recently been FDA approved in the United States" — Brad Warner (clinical) [Ep 18 · 15:08](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains proper fat, growth factors like EGF and IGF, and milk oligosaccharides that enhance adaptation" — Brad Warner (opinion) [Ep 18 · 18:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (opinion) [Ep 18 · 19:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, with 90% enteral feeding having far less risk of TPN-related cholestasis than 10% enteral" — Brad Warner (clinical) [Ep 18 · 21:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when enteral tolerance plateaus and then declines (going backward rather than forward), or with multiple sepsis episodes plus abdominal distention and dilated bowel loops, or when child starts getting jaundiced" — Brad Warner (clinical) [Ep 18 · 22:33](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Dilated bowel loops can cause subclinical portal bacteremia contributing to jaundice, and bacterial overgrowth causes secretory diarrhea that impairs enzyme function" — Brad Warner (clinical) [Ep 18 · 23:28](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1408)
- "More than 4-5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (clinical) [Ep 18 · 25:43](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "If a child has over 100 centimeters of intestine, less than 5-10% should require TPN, suggesting there may be an underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 18 · 27:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "For bowel lengthening, need less than 100 cm (ideally less than 50 cm) of intestine and bowel that is at least 4-5 cm dilated" — Brad Warner (clinical) [Ep 18 · 28:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP (serial transverse enteroplasty) procedure has emerged as the most commonly performed lengthening operation" — Brad Warner (epidemiological) [Ep 18 · 29:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "The Bianchi procedure takes advantage of the V-shaped blood supply bifurcation before reaching the bowel wall, allowing creation of two tubes each supplied by one arm of the V" — Brad Warner (clinical) [Ep 18 · 30:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1800)
- "STEP procedure is easier to perform with less risk of injuring mesenteric blood supply because you only cut partially across the bowel at right angles" — Brad Warner (clinical) [Ep 18 · 32:30](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1950)
- "STEP can redilate requiring redo procedures, and outcomes are not as good if you have to redo a STEP compared to never needing a redo" — Brad Warner (clinical) [Ep 18 · 32:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 18 · 33:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "In a case where a STEP was acting as a brake causing dysmotility, removing the distal stepped bowel allowed the patient to completely wean off TPN" — Brad Warner (clinical) [Ep 18 · 35:04](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90-100 centimeters of intestinal length" — Brad Warner (clinical) [Ep 18 · 38:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2303)
- "Strategies for TPN cholestasis include bile salts (chenodeoxycholic acid), changing lipid composition, and increasing enteral feeds" — Brad Warner (clinical) [Ep 18 · 39:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Dan Teitelbaum's trial of cholecystokinin to promote bile flow and mitigate TPN cholestasis did not work" — Brad Warner (clinical) [Ep 18 · 39:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Dilated bowel is a nidus for infection encouraging translocation of bacteria and endotoxin into portal circulation, damaging the liver" — Brad Warner (clinical) [Ep 18 · 39:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2391)
- "Medical management of bacterial overgrowth includes oral antibiotics (Cipro, Flagyl), probiotics (lactobacilli), prebiotics, and potentially fecal transplantation" — Brad Warner (clinical) [Ep 18 · 40:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2426)
- "The gut bacteria in short gut syndrome become more efficient, creating an obesogenic-like microbiome that helps adapt by encouraging greater absorption and digestion" — Brad Warner (clinical) [Ep 18 · 41:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse studies, oral vancomycin to knock out gram-positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 18 · 42:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide (GLP-2 analog) has been shown in randomized prospective trials in adults to reduce TPN requirements by about 1-2 liters per week" — Brad Warner (clinical) [Ep 18 · 43:57](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2637)
- "Teduglutide is not yet approved for children in the United States, with concerns about malignancy risk due to promoting proliferation" — Brad Warner (clinical) [Ep 18 · 44:34](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth factors shown to promote adaptation in animal studies include EGF, HB-EGF (demonstrated by Gail Bessner), interleukins, and growth hormone with glutamine" — Brad Warner (clinical) [Ep 18 · 45:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2713)
- "Growth hormone and glutamine combinations in patients have shown primarily mixed results and are expensive" — Brad Warner (clinical) [Ep 18 · 45:46](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2746)
- "Survival for small bowel transplant is about 50-60% at 5 years, with one-year survivals now above 70-80%" — Brad Warner (epidemiological) [Ep 18 · 46:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is highly immunogenic, filled with white cells and macrophages that mount a huge graft-versus-host response, requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 18 · 47:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have significantly reduced the number of sepsis episodes in patients with short gut syndrome who have Broviac catheters" — Brad Warner (clinical) [Ep 18 · 49:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID specialists, and interventional radiologists improve survival in intestinal failure patients, as demonstrated in series from Boston, Michigan, and Texas" — Brad Warner (clinical) [Ep 18 · 51:20](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3080)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 6 · 0:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=0)
- "Most gastroschisis patients don't have any other associated anomalies, and it's rare to have abnormal chromosomes with gastroschisis" — Jack Langer (clinical) [Ep 6 · 4:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=286)
- "Early papers showed benefit to cesarean section for gastroschisis, but those cesarean sections were usually done early at 36 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit" — Jack Langer (clinical) [Ep 6 · 5:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=346)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis, and most people nowadays would not do routine cesarean section" — Jack Langer (clinical) [Ep 6 · 6:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jack Langer (clinical) [Ep 6 · 6:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=389)
- "Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jack Langer (clinical) [Ep 6 · 6:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by the inflamed bowel" — Jack Langer (clinical) [Ep 6 · 7:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=427)
- "Labor induction at 37 weeks is successful most of the time in gastroschisis pregnancies, unlike regular pregnancies" — Jack Langer (clinical) [Ep 6 · 7:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=450)
- "Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jack Langer (clinical) [Ep 6 · 8:36](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and ischemia of the bowel" — Jack Langer (clinical) [Ep 6 · 10:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=601)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jack Langer (clinical) [Ep 6 · 11:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jack Langer (clinical) [Ep 6 · 11:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=689)
- "Current technique uses pre-formed silos with fentanyl or morphine sedation without intubation in awake babies, slowly pushing bowel in while monitoring intraabdominal pressure to keep it below 20" — Jack Langer (clinical) [Ep 6 · 11:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=707)
- "If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days" — Jack Langer (clinical) [Ep 6 · 12:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=747)
- "Anthony Sandler championed the sutureless plastic closure approach after training in Toronto" — Jack Langer (clinical) [Ep 6 · 13:40](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=820)
- "Dr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (host_summary) [Ep 6 · 14:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=859)
- "Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later" — Jack Langer (clinical) [Ep 6 · 16:12](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=972)
- "Leaving a silo on for 24-48 hours causes the abdominal wall defect to stretch and get bigger, taking longer to close with plastic closure" — Jack Langer (clinical) [Ep 6 · 17:25](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1045)
- "Spring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 6 · 18:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jack Langer (epidemiological) [Ep 6 · 18:51](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia with dilated but not thick-walled bowel, and late atresia from a constricting defect causing ischemia and potentially vanishing gastroschisis" — Jack Langer (clinical) [Ep 6 · 19:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1141)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN that doesn't damage the liver, and improved sepsis control" — Jack Langer (clinical) [Ep 6 · 20:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1215)
- "Three management options for atresia in gastroschisis: repair at time of closure, bring out stomas, or reduce everything and repair atresia in a couple months" — Jack Langer (clinical) [Ep 6 · 20:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1254)
- "There is no good evidence for optimal management of atresia in gastroschisis because it's rare, so approach should be individualized" — Jack Langer (opinion) [Ep 6 · 21:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1275)
- "If bowel looks good without much peel, repair the atresia and reduce at the same sitting; if concerning, drop it back in without repair" — Jack Langer (clinical) [Ep 6 · 21:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1295)
- "Stomas are only brought out when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose" — Jack Langer (clinical) [Ep 6 · 22:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1321)
- "The umbilicus is the preferred site for neonatal stomas; prolapse occurs regardless of location" — Jack Langer (clinical) [Ep 6 · 22:50](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1370)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jack Langer (clinical) [Ep 6 · 24:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1467)
- "Metoclopramide (Reglan) can be given intravenously as a prokinetic agent in gastroschisis patients with hypomotility" — Jack Langer (clinical) [Ep 6 · 24:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1495)
- "A UK study showed cisapride shortened time to bowel function, but cisapride is no longer available" — Jack Langer (clinical) [Ep 6 · 25:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1502)
- "Toronto is conducting a randomized prospective trial to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jack Langer (clinical) [Ep 6 · 25:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1537)
- "At 4 weeks without bowel function, start with contrast enema to look for mechanical obstruction, can also do upper GI" — Jack Langer (clinical) [Ep 6 · 25:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1557)
- "If still no resolution at 6 weeks, laparotomy is usually performed; sometimes mechanical obstruction is found, sometimes just adhesions" — Jack Langer (clinical) [Ep 6 · 26:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1604)
- "Going in too early on gastroschisis patients with prolonged ileus is a mistake" — Jack Langer (opinion) [Ep 6 · 27:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1641)
- "Undescended testis (usually right) in gastroschisis is directed down into the pelvis during reduction; in about half the cases it finds its way to the scrotum" — Jack Langer (clinical) [Ep 6 · 28:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1683)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jack Langer (clinical) [Ep 6 · 28:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1723)
- "Karyotype analysis and testing for Beckwith-Wiedemann syndrome are routinely done for omphalocele patients" — Jack Langer (clinical) [Ep 6 · 28:59](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1739)
- "Small omphaloceles without liver are counterintuitively more likely to be associated with abnormal chromosomes than large omphaloceles" — Jack Langer (clinical) [Ep 6 · 29:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1787)
- "There is no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery for small omphaloceles" — Jack Langer (clinical) [Ep 6 · 30:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1805)
- "Small omphaloceles are simple to repair surgically" — Jack Langer (clinical) [Ep 6 · 30:23](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1823)
- "For giant omphaloceles (with significant liver), most recommend cesarean section, though this is not evidence-based" — Jack Langer (clinical) [Ep 6 · 31:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1864)
- "Giant omphaloceles should be delivered at a perinatal center due to need for pediatric surgeon and experienced neonatologists" — Jack Langer (clinical) [Ep 6 · 31:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1902)
- "Pulmonary hypoplasia is associated with giant omphaloceles but is very difficult to diagnose prenatally; some patients require early intubation and respiratory support" — Jack Langer (clinical) [Ep 6 · 31:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1915)
- "Stuart Lacy established intraabdominal pressure guideline of 20 mmHg based on rabbit studies in the 1980s, then validated in prospective study in children showing improved outcomes" — Jack Langer (clinical) [Ep 6 · 33:28](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2008)
- "Lacy also described increase in central venous pressure of more than 4 as a concerning threshold" — Jack Langer (clinical) [Ep 6 · 33:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2036)
- "Intraabdominal pressure can be measured through nasogastric tube or Foley catheter (intravesical pressure); the trend is more important than absolute number" — Jack Langer (clinical) [Ep 6 · 34:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2042)
- "Primary closure is attempted for full-term omphalocele patients without significant cardiac disease, respiratory issues, or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 6 · 34:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2083)
- "The Montreal group described using the omphalocele sac as a silo, sequentially ligating it over days to allow abdominal wall stretching before definitive closure" — Jack Langer (clinical) [Ep 6 · 35:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2107)
- "Sequential sac ligation requires a thick enough sac and umbilical cord coming off the top rather than the side" — Jack Langer (clinical) [Ep 6 · 35:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2144)
- "Cristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time" — Todd Ponsky (host_summary) [Ep 6 · 37:22](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2242)
- "Duoderm compression appears to achieve reduction more quickly than sac ligation and doesn't require a sac amenable to ligation" — Jack Langer (clinical) [Ep 6 · 37:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2263)
- "Indications for escharotic therapy include prematurity, bad cardiac disease, pulmonary hypoplasia, multiple anomalies, abnormal chromosomes, or omphalocele too giant to reduce" — Jack Langer (clinical) [Ep 6 · 38:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2295)
- "Mushroom-shaped omphaloceles (small abdominal wall defect with large amount of viscera out) are impossible to reduce primarily" — Jack Langer (clinical) [Ep 6 · 38:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2329)
- "Sigy Ein used silver sulfadiazine (Silvadene) for escharotic therapy in omphaloceles for many years; Toronto published long-term follow-up" — Jack Langer (clinical) [Ep 6 · 39:26](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2366)
- "Timing of delayed omphalocele repair depends on patient specifics; some can be repaired at 6-8 months if defect reduces spontaneously, others require waiting 3-4 years for cardiac or pulmonary optimization" — Jack Langer (clinical) [Ep 6 · 40:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2419)
- "Mushroom-shaped omphaloceles never reduce spontaneously and stay large" — Jack Langer (clinical) [Ep 6 · 41:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2470)
- "For mushroom-shaped omphaloceles, the abdominal wall defect can be enlarged as a first step by incising the lower edge fascia, closing skin, and allowing more spontaneous reduction before definitive repair" — Jack Langer (clinical) [Ep 6 · 41:20](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2480)
- "Phil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer" — Todd Ponsky (clinical) [Ep 6 · 42:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2523)
- "Formal adult-style component separation in small children carries risk of devascularization and worsening the situation" — Jack Langer (clinical) [Ep 6 · 43:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2586)
- "In omphaloceles extending to the costal margin, the upper defect cannot be closed, so inferior defect is closed and a patch placed superiorly" — Jack Langer (clinical) [Ep 6 · 43:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2615)
- "Surgisis patch fails about 50% of the time in omphalocele closure; can be replaced with non-absorbable prolene mesh" — Jack Langer (clinical) [Ep 6 · 44:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2641)
- "Stratus is being used more recently for patches but long-term follow-up is not yet available to compare with Surgisis" — Jack Langer (clinical) [Ep 6 · 44:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2659)
- "Omphaloceles can be part of pentalogy of Cantrell, often with missing pericardium or Morgagni hernia; these tend to be more superiorly placed" — Jack Langer (clinical) [Ep 6 · 44:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2684)
- "For pentalogy of Cantrell patients, escharotic therapy is used due to cardiac problems; cardiac surgeons can patch the diaphragm from above through sternotomy, then abdominal wall is repaired later after cardiac optimization" — Jack Langer (clinical) [Ep 6 · 45:24](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2724)
- "Reflux is very common in omphalocele patients, especially those with bad hearts or pulmonary hypoplasia who don't eat normally" — Jack Langer (clinical) [Ep 6 · 46:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2768)
- "Interventional radiologists can place G-tubes under fluoroscopy in giant omphalocele patients by finding a window lateral to the defect, then convert to GJ tube after maturation" — Jack Langer (clinical) [Ep 6 · 46:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2790)
- "Fundoplication in a child with a large omphalocele defect is extremely difficult because the liver is midline and accessing the hiatus is nearly impossible, especially with cardiac disease and congested liver" — Jack Langer (clinical) [Ep 6 · 47:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2835)
- "GJ tube is a better short-term solution for reflux in omphalocele; fundoplication can be performed when fixing the abdominal wall defect after medical optimization" — Jack Langer (clinical) [Ep 6 · 47:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2862)
- "In large omphaloceles with midline liver, the liver can put pressure on the duodenum or pylorus causing mechanical gastric outlet obstruction that worsens reflux" — Jack Langer (clinical) [Ep 6 · 48:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888)
- "Non-rotation in omphalocele is not a problem because it's not associated with risk of midgut volvulus, unlike malrotation" — Jack Langer (clinical) [Ep 6 · 48:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2929)
- "Inversion appendectomy during Ladd procedure makes sense if the appendix is encountered, as several omphalocele patients have developed perforated appendicitis with delayed diagnosis due to abnormal appendix location" — Jack Langer (clinical) [Ep 6 · 49:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2946)
- "If a child has renal abnormality requiring potential Mitrofanoff, the appendix should be preserved" — Jack Langer (clinical) [Ep 6 · 49:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2984)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not careful" — Jack Langer (clinical) [Ep 6 · 50:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3010)
- "Kinking of hepatic veins during reduction has not been a problem when using intraabdominal pressure monitoring and not being too aggressive with pressures above 20" — Jack Langer (clinical) [Ep 6 · 50:31](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3031)
- "In immediate omphalocele reduction, fascial edges can usually be approximated at the bottom but often not at the top, requiring patch placement" — Jack Langer (clinical) [Ep 6 · 50:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3056)
- "For partial reductions with liver still protruding superiorly, Gore-Tex or silastic can be sewn on, skin closed over it, then removed in 1-2 weeks after stretching allows fascial closure" — Jack Langer (clinical) [Ep 6 · 51:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3069)
- "97% of bilateral kidney tumors in children are Wilms tumor, with only a small percentage being other diagnoses" — Tony Sandler (epidemiological) [Ep 8 · 9:12](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- "Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction)" — Tony Sandler (guideline) [Ep 8 · 1:32](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- "When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 8 · 4:19](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- "Bilateral nephron-sparing surgery is feasible even in large bilateral Wilms tumors by placing kidneys on ice, clamping vessels, and performing sharp dissection" — Tony Sandler (clinical) [Ep 8 · 4:44](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 8 · 3:27](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- "Recurrence of anaplastic Wilms tumor portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 8 · 6:48](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- "Multifocal Wilms tumors raise concern about underlying embryologic abnormalities of the kidney and risk of developing additional tumors" — Dan (clinical) [Ep 8 · 8:15](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- "Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy" — Tony Sandler (opinion) [Ep 8 · 7:56](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- "For gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl" — Todd Ponsky (clinical) [Ep 8 · 9:58](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=598)
- "Tegaderm closure of gastroschisis without fascial closure allows cicatrization over 3 days to 8 weeks, with feeding started when bowel function returns rather than waiting for complete closure" — Tony Sandler (clinical) [Ep 8 · 14:52](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=892)
- "When gastroschisis defect dilates during silo reduction attempts, Tegaderm closure alone can still achieve successful cicatrization without fascial closure" — Tony Sandler (clinical) [Ep 8 · 15:32](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=932)
- "Umbilical hernias after gastroschisis closure will close spontaneously if no fascia was cut; if fascia is cut, a permanent defect results" — Tony Sandler (clinical) [Ep 8 · 12:54](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- "Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally" — Todd Ponsky (opinion) [Ep 8 · 14:27](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=867)
- "In gastroschisis with intestinal atresia and pristine bowel, creating an ostomy through the umbilical fascial ring is technically favorable because the bowel size matches the ring and provides good tissue for suturing" (clinical) [Ep 8 · 17:49](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- "Primary anastomosis in gastroschisis with atresia is risky because the proximal bowel is massively dilated and distal bowel is decompressed, creating a tenuous anastomosis in bowel that has been outside the abdomen" (clinical) [Ep 8 · 18:36](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- "In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the extent of remaining intra-abdominal bowel from external examination" — Tony Sandler (clinical) [Ep 8 · 21:01](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1261)
- "Re-exploration at 2 weeks after gastroschisis closure (rather than the traditional 4-6 weeks) can reveal that inflamed gastroschisis bowel has transformed into functional intestine suitable for anastomosis" — Tony Sandler (clinical) [Ep 8 · 22:07](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- "The STEP registry discourages performing STEP procedures in the perinatal period due to difficult outcomes at best" — Greg (host_summary) [Ep 8 · 26:24](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1584)
- "STEP procedures in patients with gastroschisis are not particularly beneficial due to underlying motility disorders" — Greg (host_summary) [Ep 8 · 26:33](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- "Bianchi procedure is preferred over STEP for bowel lengthening because a patient can undergo Bianchi followed by STEP if needed, but once STEP is performed, lengthening options are limited" — Greg (opinion) [Ep 8 · 26:46](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- "In neonatal ileal atresia with dilated proximal bowel, plication is preferred over tapering to preserve bowel length for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 8 · 28:10](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- "Plication of dilated bowel in ileal atresia usually unravels with time, allowing the bowel to be used later for lengthening procedures" — Tony Sandler (clinical) [Ep 8 · 26:13](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1573)
- "In many centers, high-risk obstetric teams deliver gastroschisis cases early by C-section, resulting in less thick and matted bowel at birth" (clinical) [Ep 8 · 11:11](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- "For gastroschisis reduction at bedside, babies are intubated and paralyzed, a stitch is placed in the fascia with cord left as a biological patch, and Opsite dressing is applied; patients are kept paralyzed for 1-2 days" (clinical) [Ep 8 · 11:53](https://qa.library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=713)
- "The abdominal wall forms around the 4th week of gestation, well before most women know they are pregnant." — Joyce (clinical) [Ep 9 · 0:31](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=31)
- "During the 6th week of gestation, rapid growth of intestines and liver expansion causes herniation of the midgut into the umbilical cord." — Joyce (clinical) [Ep 9 · 0:40](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=40)
- "Around the 10th week of gestation, herniated bowel loops return to the abdominal cavity and the small bowel and colon assume a fixed position." — Joyce (clinical) [Ep 9 · 0:50](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=50)
- "In gastroschisis, the umbilical cord is located to the left of the defect; in omphalocele it is in the center." — Joyce (clinical) [Ep 9 · 1:24](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=84)
- "With gastroschisis, bowel is exposed in utero causing it to be thickened, matted, and inflamed; with omphalocele the bowel is covered and remains normal." — Joyce (clinical) [Ep 9 · 1:32](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=92)
- "Associated anomalies occur in around 10% of gastroschisis cases but 60-75% of omphalocele cases, correlating with increased mortality in omphalocele." — Joyce (epidemiological) [Ep 9 · 1:52](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=112)
- "Gastroschisis is herniation of intestinal loops through a full-thickness defect in the anterior abdominal wall, usually lateral to the umbilicus on the right more than the left, around 4 cm in size, with no covering sac." — Joyce (clinical) [Ep 9 · 2:14](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=134)
- "The etiology of gastroschisis remains unknown. Leading theories propose a vascular event involving the right umbilical vein or right omphalomesenteric artery causing necrosis and abdominal wall weakening." — Joyce (clinical) [Ep 9 · 2:40](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=160)
- "The incidence of gastroschisis has risen over the last 20 years to as high as 5 per 10,000 live births." — Joyce (epidemiological) [Ep 9 · 3:06](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=186)
- "Gastroschisis is associated with young maternal age, prematurity, and low birth weight." — Joyce (epidemiological) [Ep 9 · 3:16](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=196)
- "Risk factors for gastroschisis are multifactorial but include young maternal age (<20 years), smoking, and use of vasoconstrictive medications." — Joyce (epidemiological) [Ep 9 · 3:37](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=217)
- "Around 90% of gastroschisis cases are diagnosed prenatally on routine ultrasound." — Joyce (epidemiological) [Ep 9 · 3:51](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231)
- "There is no evidence in the literature to support either C-section or vaginal delivery in regards to outcome for gastroschisis." — Joyce (clinical) [Ep 9 · 4:48](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=288)
- "Initial delivery room management focuses on supporting the infant and keeping the bowel warm and moist: assess airway/breathing/circulation, assess bowel viability, place bowel and lower extremities in bowel bag with intestines central to decrease kinking risk." — Joyce (guideline) [Ep 9 · 5:01](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=301)
- "Gastroschisis infants experience excessive fluid losses from exposed bowel and require maintenance of temperature >36°C to decrease stress." — Joyce (clinical) [Ep 9 · 5:35](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=335)
- "An NG or OG tube is placed to decompress the stomach and prevent further intestinal distention in gastroschisis." — Joyce (guideline) [Ep 9 · 5:51](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=351)
- "There is about a 10% associated occurrence of intestinal atresia with gastroschisis." — Joyce (epidemiological) [Ep 9 · 7:10](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430)
- "Intestinal atresia in gastroschisis can be treated at time of abdominal wall closure with resection and primary anastomosis, or the bowel can be reduced with atresia intact and repaired 4-12 weeks later, possibly requiring temporary ostomy especially with distal atresia." — Joyce (clinical) [Ep 9 · 7:22](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=442)
- "Surgical management of gastroschisis focuses on safe viscera reduction, identifying and treating associated defects (atresia, perforation), closure of the defect, early recognition of complications, and nutritional support." — Joyce (guideline) [Ep 9 · 7:47](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=467)
- "Closure is accomplished through either primary surgical closure or staged reduction with silo. Defect size, intestinal condition, and abdominal cavity size impact the decision." — Joyce (clinical) [Ep 9 · 8:14](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=494)
- "Staged closure with silo is accomplished gradually over 1 to 14 days, then surgically closed either at bedside or in the OR." — Joyce (clinical) [Ep 9 · 8:40](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=520)
- "At Cincinnati Children's, out of 41 gastroschisis patients in the last 3 years, almost all had staged closures with silos; only a handful with small defects were closed primarily." — Joyce (clinical) [Ep 9 · 8:52](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=532)
- "Lucille Packard Children's Hospital uses a sutureless technique: silo reduction followed by covering the remaining defect with Mepilex and Tegaderm dressings until fully healed (about 6 weeks), leaving an umbilical hernia that may need later repair." — Joyce (clinical) [Ep 9 · 9:37](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=577)
- "Todd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results." — Todd Ponsky (clinical) [Ep 9 · 10:22](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=622)
- "In a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair." — Todd Ponsky (epidemiological) [Ep 9 · 11:03](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663)
- "For non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks)." — Todd Ponsky (clinical) [Ep 9 · 11:53](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=713)
- "Complications of primary gastroschisis closure stem mainly from increased abdominal pressure leading to decreased venous return and possible abdominal compartment syndrome with ischemic injury." — Joyce (clinical) [Ep 9 · 13:06](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=786)
- "It is important to monitor intra-abdominal pressure during and post gastroschisis closure using bladder pressures, frequent physical exam, urine output monitoring, and assessment of respiratory support requirements." — Joyce (guideline) [Ep 9 · 13:22](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=802)
- "Literature review shows debate about gastroschisis closure method: some groups report earlier feeding and decreased length of stay with primary closure, others report decreased ventilator time, shorter stay, and lower cost with silo reduction. Overall survival is >95% regardless of closure type." — Joyce (epidemiological) [Ep 9 · 15:06](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906)
- "Post-silo placement nursing care focuses on quick complication recognition: support silo and bowel to avoid kinking/twisting, bowel should be pink with serous (not stool-containing) fluid in bag, monitor lower extremity perfusion, urine output, edema, oxygen requirement, respiratory difficulty, and temperature." — Joyce (guideline) [Ep 9 · 15:38](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=938)
- "Gastroschisis patients may require as much as 140-150 mL/kg/day of fluids to manage losses." — Joyce (clinical) [Ep 9 · 16:54](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1014)
- "At Cincinnati Children's, Betadine-soaked gauze is used around the silo base and changed twice daily." — Joyce (clinical) [Ep 9 · 17:24](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1044)
- "Todd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output." — Todd Ponsky (opinion) [Ep 9 · 29:22](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1762)
- "Dean agrees that bladder pressures are not routinely used; peak airway pressures are very good, or in pressure-control ventilation watch for significant tidal volume changes, plus good physical exam of the belly for tightness." — Dean (opinion) [Ep 9 · 30:13](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1813)
- "Jenny emphasizes that in Seattle the majority of gastroschisis care is done by advanced practitioners: non-surgical closure, kids out of ICU within days, then weeks on floors managed by nurse practitioners doing fluid management, feeding advancement, and wound care." — Jenny (clinical) [Ep 9 · 30:59](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1859)
- "Of all potential gastroschisis complications, dysmotility is the most universal." — Joyce (clinical) [Ep 9 · 19:56](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1196)
- "Gastroschisis prognosis is mainly dependent on severity of associated problems (prematurity, initial post-op complications) and degree of dysmotility, all impacting course and length of stay." — Joyce (clinical) [Ep 9 · 20:08](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1208)
- "NEC is reported in about 5-10% of gastroschisis patients, tends to occur later in the course, should be treated same as isolated NEC, and shows no correlation with type of closure performed." — Joyce (clinical) [Ep 9 · 20:30](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1230)
- "Cincinnati feeding protocol: enteral feedings start 24 hours after NG tube removal (when NG output <20 mL/kg/day for 24 hours), begin at 1 mL/hr, increase by 1 mL/hr daily until day 5, then BID increases, then q8h increases by day 8 if tolerated. PO feedings introduced with windows off tube feeds as tolerated, TPN gradually dialed down." — Joyce (guideline) [Ep 9 · 33:46](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2026)
- "Cincinnati is enrolling gastroschisis patients in a feeding study randomizing to either the enteral feeding protocol arm or PO ad-lib feedings arm." — Joyce (clinical) [Ep 9 · 34:33](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2073)
- "Cincinnati data 2010-present: 36 gastroschisis patients required long-term TPN (>30 days). Simple gastroschisis (n=22) averaged 35 days TPN with 3 still on TPN at 1 year. Complex with atresia (n=4) averaged 146 days TPN but all were off TPN on enteral feeds within 10 months." — Joyce (epidemiological) [Ep 9 · 36:31](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2191)
- "Studies show about 1/3 of gastroschisis children are below 10th percentile for weight at 1 year but without neurodevelopmental delays at time of evaluation." — Joyce (host_summary) [Ep 9 · 37:24](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2244)
- "Fallon et al 2012 retrospective review reported that gestational age <37 weeks and development of cholestasis were independently linked to poor growth in gastroschisis, whereas small-for-gestational-age or low birth weight was not." — Joyce (host_summary) [Ep 9 · 38:06](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2286)
- "Cincinnati group 2010 outcomes for 71 gastroschisis infants (6 complex) treated with standardized nutritional protocol (2006-2009): enteral feedings started around day 16, median length of stay 42 days, 6 patients discharged on TPN, 24% on tube feedings, rest on oral feeding." — Joyce (host_summary) [Ep 9 · 38:30](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310)
- "Cincinnati 2006-2008 readmission data (n=58, 21% primary closure, remainder silo): 40% readmitted at least once within first year, >25% of readmissions directly gastroschisis-related. Most common reasons: bowel obstruction, abdominal pain/distention." — Joyce (host_summary) [Ep 9 · 39:25](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2365)
- "Cincinnati readmission analysis found no relationship with place of birth, bowel resection requirement, complex vs simple gastroschisis, small-for-gestational-age, delivery mode, feeding timing, TPN duration, length of stay, gender, maternal age, or prenatal diagnosis." — Joyce (host_summary) [Ep 9 · 40:07](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2407)
- "Cincinnati data showed interesting trend (not statistically significant): 67% of primary closure patients readmitted vs 20% of silo patients; bowel obstruction occurred in 17% of primary closure group vs 7% of silo group." — Joyce (host_summary) [Ep 9 · 40:50](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2450)
- "Holland 2010 article 'Gastroschisis: An Update' summarized that there is a need for multi-center prospective studies (due to small numbers at individual centers) and focus on improved evaluation of long-term nutritional and neurodevelopmental outcomes in these relatively well-doing patients." — Joyce (host_summary) [Ep 9 · 41:19](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2479)
- "For gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed." — Todd Ponsky (clinical) [Ep 9 · 42:18](https://qa.library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2538)
- "Most of the damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy, based on animal studies and clinical studies" (clinical) [Ep 10 · 2:45](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=165)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" (epidemiological) [Ep 10 · 3:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=224)
- "About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks" (epidemiological) [Ep 10 · 3:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=236)
- "No perinatal center in Canada was doing routine cesarean sections for gastroschisis based on a national survey" (epidemiological) [Ep 10 · 4:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=277)
- "15 or 20 years ago, routine cesarean section for gastroschisis was pretty much the standard of care" (clinical) [Ep 10 · 4:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=289)
- "Using a pre-formed silo allows gentle reduction of gastroschisis bowel without trauma, and in about a third of cases the bowel can be reduced immediately and the silo removed" (clinical) [Ep 10 · 8:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=507)
- "Waiting for gastroschisis babies to lose their first 10% of body weight reduces bowel edema and makes reduction easier" (clinical) [Ep 10 · 9:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=545)
- "Leaving a silo on for more than a day causes the fascial defect to get much bigger" (clinical) [Ep 10 · 9:41](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=581)
- "Using plastic closure (non-surgical closure) for gastroschisis gives extremely good results, often with a small umbilical hernia that closes by age 2" (clinical) [Ep 10 · 11:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=697)
- "There are two kinds of intestinal atresia in gastroschisis: early-developing atresia not always associated with bowel thickening, and late-occurring atresia from a very small abdominal wall defect" (clinical) [Ep 10 · 15:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=955)
- "Bringing an ostomy out through the umbilicus avoids additional scars and makes subsequent closure easier" (clinical) [Ep 10 · 16:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=973)
- "Gord Cameron in Hamilton in the 1980s was the first to describe umbilical ostomies" (clinical) [Ep 10 · 17:53](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1073)
- "At 4 weeks post-gastroschisis repair with feeding intolerance, waiting longer is reasonable as the bowel may still be recovering from motility disorder" (opinion) [Ep 10 · 20:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1204)
- "At 8 weeks post-repair with persistent feeding intolerance, exploration is warranted to rule out mechanical obstruction" (opinion) [Ep 10 · 20:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1246)
- "For large omphalocele, attempting to remove the sac and close primarily can lead to inability to achieve closure and need for prosthetic patch" (clinical) [Ep 10 · 22:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1333)
- "The Schuster repair uses mesh sutured to fascia over intact omphalocele sac with gradual closure, eventually allowing primary repair" (clinical) [Ep 10 · 22:31](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1351)
- "For large omphalocele, patch covered by skin or skin coverage alone is better than paint-and-wait which takes months" (opinion) [Ep 10 · 23:11](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1391)
- "Lateral component separation makes it easier to bring fascial edges together in omphalocele repair" (clinical) [Ep 10 · 23:32](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1412)
- "Antibiotic ointment on omphalocele sac keeps it supple, and using 4x4s with Ace wrap compression can gradually reduce the defect" (clinical) [Ep 10 · 23:53](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1433)
- "Dr. Abello uses Duoderm wrapped around omphalocele and tightens it daily to achieve gradual reduction" (host_summary) [Ep 10 · 24:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1477)
- "Botox has been used successfully by adult hernia surgeons to relax muscle and facilitate closure of large ventral hernias" (host_summary) [Ep 10 · 24:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1497)
- "Intragastric pressure monitoring via NG tube is easy to perform in the OR and provides useful guidance, with 20 as a suggested threshold" (clinical) [Ep 10 · 29:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1796)
- "Bladder pressure measurement in tiny newborns is unreliable and cannot be trusted consistently" (opinion) [Ep 10 · 29:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1740)
- "Ventilatory parameters are the most reliable measure for assessing safe closure tension" (opinion) [Ep 10 · 28:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1684)
- "For giant omphalocele in older children, enlarging the fascial defect and allowing staged closure over time without forcing reduction prevents abdominal compartment syndrome" (clinical) [Ep 10 · 36:14](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2174)
- "In older children with giant omphalocele, the abdomen does not expand as rapidly as in newborns and requires more time between stages" (clinical) [Ep 10 · 36:40](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2200)
- "When opening the fascial ring in giant omphalocele, opening inferiorly avoids encountering hepatic veins at the superior aspect" (clinical) [Ep 10 · 36:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2218)
- "Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality" — Alex Gibbons (host_summary) [Ep 16 · 0:26](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=26)
- "Exception to restrictive transfusion is sickle cell disease where hematocrit needs to be around 30 or HbSS below 50%" (clinical) [Ep 16 · 1:45](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=105)
- "Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality" (host_summary) [Ep 16 · 2:20](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and is equally tolerated" (host_summary) [Ep 16 · 2:20](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still have recovery afterwards and it helps preserve fertility" (host_summary) [Ep 16 · 3:29](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "Ultrasound is not a great tool for diagnosis of ovarian torsion; clinical judgment should not be based primarily on ultrasound findings" (host_summary) [Ep 16 · 3:29](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin" (host_summary) [Ep 16 · 4:05](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7" (host_summary) [Ep 16 · 4:05](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "At our institution, VTE prophylaxis policy is for patients 12 years and over" (clinical) [Ep 16 · 4:53](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "High risk for VTE includes femur fractures, cervical spine fracture, and intubated patients" (clinical) [Ep 16 · 4:53](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "Kids with IBD are probably the most at-risk group for deep venous thromboses" (clinical) [Ep 16 · 5:50](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=350)
- "Burnout directly impacts patient care and outcomes" (host_summary) [Ep 16 · 6:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Support systems for physician wellness need to be established proactively during education and practice because burnt out surgeons are not likely to seek help" (host_summary) [Ep 16 · 6:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Physicians should talk to patients about whether there's a firearm in the home and if there is, whether it's safely stored" (host_summary) [Ep 16 · 8:23](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=503)
- "Isotonic fluids should be continued throughout hospitalization instead of switching to hypotonic fluids for maintenance, which decreases the risk of hyponatremia with similar morbidity and mortality" (host_summary) [Ep 16 · 11:27](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=687)
- "In Wilms tumor operations, failure to remove lymph nodes automatically upstages the patient" — Liz Byerly (host_summary) [Ep 16 · 14:30](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "Pulmonary metastasis in Wilms tumor doesn't preclude doing a primary nephrectomy" — Liz Byerly (host_summary) [Ep 16 · 14:30](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "It is important to take lymph nodes in Wilms tumor regardless of whether the patient has lung metastases because you treat the local disease and it has an impact on treatment for abdominal disease" — Dan (clinical) [Ep 16 · 15:37](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=937)
- "Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures" (host_summary) [Ep 16 · 16:41](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1001)
- "The important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction" — Todd Ponsky (host_summary) [Ep 16 · 17:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "In the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy" — Todd Ponsky (host_summary) [Ep 16 · 17:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "Parents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study" — Todd Ponsky (host_summary) [Ep 16 · 17:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "For Wilms tumor lymph node sampling, there are data to show that nine nodes or seven nodes are probably adequate, but plucking nodes from the mesentery or pelvis is not helpful just to get a number" — Dan (clinical) [Ep 16 · 22:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1321)
- "For Wilms tumor, you should take nodes from both sides of the cava and the aorta, but you don't have to dive into the renal hilum on the other side or open Gerota's fascia" (clinical) [Ep 16 · 23:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1381)
- "Recommendations for opioid crisis management include reducing total amount of opioids prescribed, using non-opioid analgesia and non-pharmacological approaches, and educating on disposal of unused opioids" (host_summary) [Ep 16 · 23:29](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- "Enhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge" — Todd Ponsky (host_summary) [Ep 16 · 23:29](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- "For well-appearing neonates with intact omphalocele and no maternal fever or chorioamnionitis, preoperative antibiotic given one hour before incision and discontinued within 72 hours is most appropriate" (host_summary) [Ep 16 · 26:19](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1579)
- "Babies don't need antibiotics just because they showed up in the NICU; they only need standard prophylactic antibiotics when going to the OR" (clinical) [Ep 16 · 28:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "Based on AAP and neonatology recommendations, as long as the baby is well and mother has no signs of sepsis or chorioamnionitis, you don't need to give antibiotics for children that don't have an open abdomen" (host_summary) [Ep 16 · 28:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "Children with ruptured omphalocele or gastroschisis have an open abdomen and probably should receive antibiotics" (clinical) [Ep 16 · 28:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "Children with duodenal atresia probably don't need antibiotics if they're going to the operating room within the next 24 to 48 hours" (clinical) [Ep 16 · 28:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "For intact omphalocele managed with paint and wait, no antibiotics are needed as long as mom didn't have chorioamnionitis and baby doesn't have fever" (clinical) [Ep 16 · 28:02](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "According to Surviving Sepsis Campaign guidelines, give 20 cc per kilo boluses of isotonic fluid up to 60 ml per kilo total, with goal of perfusion improvement" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Stop fluid boluses if you see over-perfusion such as rales on auscultation or enlarged liver" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Must start broad-spectrum antibiotics in sepsis; data shows in adults that if you wait over three hours to start antibiotics in a septic patient, survival goes down" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "If hematocrit or hemoglobin is less than 10 in septic patient, transfusion may be indicated" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "For pediatric sepsis, epinephrine is the vasopressor of choice; two randomized trials showed mortality was better with epi in one study and epi had better improvement in systolic blood pressure in the other compared to dopamine" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Hydrocortisone has a role in sepsis for patients who are vasopressor refractory, meaning vasopressors were started and systolic blood pressure remains low" — Stephen Lee (host_summary) [Ep 16 · 33:01](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Broad-spectrum antimicrobial therapy for sepsis means extended-spectrum penicillin like piperacillin-tazobactam or ampicillin-sulbactam to cover everything empirically" — Stephen Lee (clinical) [Ep 16 · 36:49](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Draw blood for lactate level and cultures just prior to starting antibiotics in sepsis, but don't delay starting antibiotics while waiting" — Stephen Lee (host_summary) [Ep 16 · 36:49](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Antibiotic stewardship in sepsis means following cultures and titrating antibiotics down or stopping them altogether if in three or four days patients have improved and it's no longer an infectious issue" — Stephen Lee (host_summary) [Ep 16 · 36:49](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "The odds ratio for not starting antibiotics within three hours in children with sepsis was 3.92 for mortality - almost four times more likely to die" — Salim Islam (host_summary) [Ep 16 · 36:49](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "ECMO survival for patients with severe sepsis and recalcitrant hypotension is about 46% overall, which is better than zero" — Salim Islam (epidemiological) [Ep 16 · 36:49](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Updated APSA blunt liver-spleen injury guidelines recommend treating based on patients' hemodynamic status, not injury grade" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Modified shock index for pediatrics (heart rate over systolic blood pressure) can determine if patient is still bleeding; if so, recommend ICU admission" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "If patient with solid organ injury has responded to normal saline bolus and remains hemodynamically stable, they just need to be observed on the ward" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "For ward admission with solid organ injury, patient needs only another hemoglobin check in six hours, can have regular diet, and no activity restrictions needed" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "After first 20 ml per kilo normal saline bolus in trauma, if patient still requires additional fluids, give blood (10 cc per kilo)" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Angioembolization in stable patients with solid organ injury does not need to be done even with contrast blush, particularly in splenic injuries which have been shown not to continue bleeding" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "If there's evidence of ongoing bleeding in solid organ injury, then angioembolization should be performed" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Based on ATOMIC protocol, 40 mLs per kilogram of packed red blood cells is the threshold; when you need more than 40 cc per kilo, you should go to the operating room" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "ATOMIC was started in 2010 as a group of level one pediatric trauma centers (Arkansas, Texas, Oklahoma, Memphis, Arizona) coming together to study vital trauma questions prospectively" (host_summary) [Ep 16 · 43:16](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Cervical spine injury is about 1 to 2% of all pediatric traumas" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In older children, 70 to 80% of cervical spine injuries are bony injuries following adult patterns" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In younger children less than or equal to 8 years, about 50% have isolated fractures and 50% have ligamentous injury, dislocations, or SCIWORA" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "60 to 80% of vertebral injuries in kids are in the cervical spine compared to 30 to 40% in adults" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "AAST study of over 12,000 children with blunt trauma found 0.6% had cervical spine injury; four independent predictors were GCS less than 14, involved in motor vehicle crash, age greater than or equal to 2 years" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Patients with cervical spine injury score of 0-1 points had negative predictive value over 99% and did not need imaging" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "For cervical spine clearance imaging in children, use AP and lateral x-rays; if cross-sectional imaging needed, use MRI not CT because most injuries are ligamentous not bony" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "46% of institutions don't have a protocol for cervical spine clearance in children" — Meera Kotagal (host_summary) [Ep 16 · 59:25](https://qa.library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Omphalocele occurs when the front of a baby's belly does not form properly during early pregnancy, resulting in an opening at the belly button." (host_summary) [Ep 33 · 0:06](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=6)
- "In omphalocele, the baby's abdominal organs pass through the umbilical opening and are covered by a thin sac." (host_summary) [Ep 33 · 0:15](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=15)
- "Omphalocele is classed as a rare birth defect." (host_summary) [Ep 33 · 0:21](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=21)
- "In some cases of omphalocele, only a portion of the small intestine passes through the opening." (host_summary) [Ep 33 · 0:26](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=26)
- "In other cases, more organs including some or most of the liver pass through the opening; this is called large or giant omphalocele." (host_summary) [Ep 33 · 0:30](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=30)
- "The cause of omphalocele is unknown." (host_summary) [Ep 33 · 0:40](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=40)
- "Omphalocele can be a feature of many genetic syndromes." (host_summary) [Ep 33 · 0:43](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "Many babies with omphalocele have other birth defects." (host_summary) [Ep 33 · 0:43](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "A diagnosis of omphalocele can be made before birth using ultrasound." (host_summary) [Ep 33 · 0:51](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=51)
- "Prenatal tests should be carried out to identify any associated anomalies in babies with omphalocele." (host_summary) [Ep 33 · 1:00](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=60)
- "Ongoing care for babies with omphalocele should be provided at a specialist center by a dedicated team of professionals with knowledge and experience of the condition." (host_summary) [Ep 33 · 1:06](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=66)
- "Omphalocele is a serious condition and can be life threatening for the baby before birth and as a newborn." (host_summary) [Ep 33 · 1:17](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=77)
- "Most babies with omphalocele do survive." (host_summary) [Ep 33 · 1:24](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=84)
- "Some babies with giant omphalocele may be transferred to a dedicated intensive care unit after birth." (host_summary) [Ep 33 · 1:32](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=92)
- "After birth, the contents of the belly that have passed through the opening are wrapped in a sterile bag to avoid damage." (host_summary) [Ep 33 · 1:39](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=99)
- "When the baby is stable, surgery can be performed to place the organs back in the belly and close the opening." (host_summary) [Ep 33 · 1:46](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=106)
- "Small omphaloceles can be repaired in one operation, called a primary repair." (host_summary) [Ep 33 · 1:54](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=114)
- "For babies with giant omphalocele, repair is done in several steps, called a staged repair." (host_summary) [Ep 33 · 2:01](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=121)
- "In some giant omphalocele cases, there may not be enough room in the newborn baby's belly for the organs to fit back inside." (host_summary) [Ep 33 · 2:08](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=128)
- "When the abdominal cavity is inadequate, surgery may be postponed for weeks or months to allow the lungs and body to grow first." (host_summary) [Ep 33 · 2:17](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=137)
- "Babies with giant omphalocele may be able to return home during the period of delayed surgery with appropriate nursing care in place." (host_summary) [Ep 33 · 2:27](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=147)
- "The amount of time a baby with omphalocele spends in hospital differs depending on the severity of the omphalocele, any associated anomalies or complications, and how well they respond to treatment." (host_summary) [Ep 33 · 2:33](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=153)
- "Follow-up care by a multidisciplinary team (MDT) of different clinical specialists is required for babies with omphalocele." (host_summary) [Ep 33 · 2:45](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=165)
- "Some babies with omphalocele may experience ongoing difficulties such as feeding or breathing difficulties that require different types and levels of care." (host_summary) [Ep 33 · 2:55](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=175)
- "Identifying any complications or difficulties early is very important in babies with omphalocele." (host_summary) [Ep 33 · 3:05](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=185)
- "Babies with giant omphaloceles need to be monitored more closely." (host_summary) [Ep 33 · 3:10](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=190)
- "Peer support can be accessed through patient and family support groups for families of babies with omphalocele." (host_summary) [Ep 33 · 3:15](https://qa.library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=195)
- "The PCPLC multi-institutional registry includes a number of institutions throughout the United States." — Em Gootee (host_summary) [Ep 37 · 1:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=116)
- "The study included 679 patients diagnosed with Hirschsprung's disease." — Colin Martin (clinical) [Ep 37 · 2:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=176)
- "85% of Hirschsprung patients were diagnosed at less than 1 year of age." — Em Gootee (host_summary) [Ep 37 · 3:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=200)
- "Kids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age." — Em Gootee (host_summary) [Ep 37 · 3:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=225)
- "Children with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium." — Em Gootee (host_summary) [Ep 37 · 3:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=237)
- "Delayed diagnosis of Hirschsprung's disease does not impact postoperative outcomes nor the need for revision surgery of the pull-through, but is associated with increased need for fecal diversion after pull through." — Colin Martin (clinical) [Ep 37 · 4:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=252)
- "Approximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through." — Em Gootee (host_summary) [Ep 37 · 4:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=266)
- "There was no difference in overall rates of redo pull-throughs across age groups." — Em Gootee (host_summary) [Ep 37 · 5:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=301)
- "Older children were more likely to need a redo pull-through due to an anastomotic leak." — Em Gootee (host_summary) [Ep 37 · 5:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=307)
- "Higher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak." — Em Gootee (host_summary) [Ep 37 · 5:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=313)
- "The only outcome difference seen was nighttime soiling or incontinence in the older patient population." — Em Gootee (host_summary) [Ep 37 · 5:24](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=324)
- "The systematic review on gastroschisis included 28 high quality manuscripts." — Em Gootee (host_summary) [Ep 37 · 8:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=489)
- "Two randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered." — Em Gootee (host_summary) [Ep 37 · 8:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=495)
- "There is significant practice variation regarding the optimal timing of delivery for infants with gastroschisis." — Mark Slidell (clinical) [Ep 37 · 9:22](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=562)
- "Currently there's no evidence to suggest that earlier delivery prior to 37 weeks is justified for gastroschisis." — Casey Culkins (clinical) [Ep 37 · 9:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=579)
- "Planned delivery before 37 weeks gestational age for gastroschisis is probably not beneficial and may in fact be harmful." — Mark Slidell (clinical) [Ep 37 · 9:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=596)
- "Early delivery of gastroschisis may promote complications of prematurity." — Mark Slidell (clinical) [Ep 37 · 10:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Delivery of infants with gastroschisis after 37 weeks post-conception seems to be preferable." — Mark Slidell (clinical) [Ep 37 · 10:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Clinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis." — Em Gootee (host_summary) [Ep 37 · 10:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=637)
- "Gastroschisis infants have a fairly high rate of wound infection." — Em Gootee (host_summary) [Ep 37 · 10:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=644)
- "Silo closures have a higher rate of infection than other closure methods for gastroschisis." — Em Gootee (host_summary) [Ep 37 · 10:50](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "Sutureless closure has the lowest rate of infection for gastroschisis." — Em Gootee (host_summary) [Ep 37 · 10:50](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "The recommendation for gastroschisis is to provide antibiotic coverage for skin flora until the defect is closed and potentially for an additional 24 hours thereafter if the infant is clinically stable." — Em Gootee (host_summary) [Ep 37 · 10:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=657)
- "Once the gastroschisis defect is closed, antibiotics can be safely stopped unless there's some other reason to continue." — Casey Culkins (guideline) [Ep 37 · 11:11](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=671)
- "Stable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes." — Em Gootee (host_summary) [Ep 37 · 12:22](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=742)
- "Minimizing fluids and paralytics in gastroschisis infants improves their results." — Em Gootee (host_summary) [Ep 37 · 12:29](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=749)
- "Gastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner." — Em Gootee (host_summary) [Ep 37 · 12:35](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=755)
- "Sutureless repair for gastroschisis is safe and effective and associated with a clear decrease in the need for mechanical ventilation." — Casey Culkins (clinical) [Ep 37 · 13:05](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=785)
- "The literature on gastroschisis suffers from a lack of level 1 randomized controlled trials or high level comparative studies." — Mark Slidell (opinion) [Ep 37 · 13:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=797)
- "There was no pediatric surgery-specific classification system for complications prior to the Clavien-Madadi system." — Whit Holcomb (clinical) [Ep 37 · 14:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=870)
- "The Clavien-Dindo classification was validated in the adult world but used in pediatric surgery despite not being validated for that population." — Whit Holcomb (clinical) [Ep 37 · 14:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=870)
- "The benefits of the Clavien-Dindo classification reported from adult surgical literature were not transferrable into pediatric surgery." — Omid Madadi-Sanjani (clinical) [Ep 37 · 14:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=883)
- "The Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication." — Em Gootee (host_summary) [Ep 37 · 15:11](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=911)
- "The validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies)." — Em Gootee (host_summary) [Ep 37 · 15:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=946)
- "An unexpected event includes any event with a subsequent deviation from the planned pre-intra and post-operative course of children." — Omid Madadi-Sanjani (clinical) [Ep 37 · 16:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=961)
- "59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire." — Em Gootee (host_summary) [Ep 37 · 16:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=994)
- "The Clavien-Madadi classification showed improved agreement rates of respondents at 85% versus 76% for the Clavien-Dindo classification." — Whit Holcomb (clinical) [Ep 37 · 16:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=999)
- "The Clavien-Madadi classification was less frequently considered inaccurate for rating in the pediatric population compared to the Clavien-Dindo classification." — Whit Holcomb (clinical) [Ep 37 · 16:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1013)
- "43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification." — Em Gootee (host_summary) [Ep 37 · 17:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1024)
- "Nearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification." — Em Gootee (host_summary) [Ep 37 · 17:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1024)
- "Meta-analysis by Shibuya et al. included 709 patients from 15 research studies across multiple international centers comparing thoracoscopic versus open repair for congenital diaphragmatic hernia." — Lizzie Lee (host_summary) [Ep 43 · 1:03](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=63)
- "Thoracoscopic repair for congenital diaphragmatic hernia has higher recurrence rates compared to open repair." — Lizzie Lee (host_summary) [Ep 43 · 1:18](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- "Thoracoscopic repair for congenital diaphragmatic hernia has longer operative times compared to open repair." — Lizzie Lee (host_summary) [Ep 43 · 1:18](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- "Thoracoscopic repair for congenital diaphragmatic hernia has a lower incidence of postoperative bowel obstruction compared to open repair." — Lizzie Lee (host_summary) [Ep 43 · 1:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=85)
- "Ziegler et al. prospective study included 10 patients with giant omphalocele and 6 with complicated gastroschisis using a traction-assisted abdominal wall closure device (Fascia Tense Pediatric)." — Alex Halpern (host_summary) [Ep 43 · 1:58](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=118)
- "Complete fascial closure was achieved after a median of 7 days in children with giant omphalocele using the Fascia Tense Pediatric device." — Alex Halpern (host_summary) [Ep 43 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133)
- "Complete fascial closure was achieved after a median of 5 days in children with complicated gastroschisis using the Fascia Tense Pediatric device." — Alex Halpern (host_summary) [Ep 43 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133)
- "No patients developed abdominal compartment syndrome after traction-assisted closure with Fascia Tense Pediatric." — Alex Halpern (host_summary) [Ep 43 · 2:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143)
- "No ventral hernias occurred after a median follow-up of 12 months in patients who underwent traction-assisted closure with Fascia Tense Pediatric." — Alex Halpern (host_summary) [Ep 43 · 2:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143)
- "Esposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two)." — Cecilia Gigena (host_summary) [Ep 43 · 3:01](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=181)
- "Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG." — Cecilia Gigena (host_summary) [Ep 43 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- "Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG." — Cecilia Gigena (host_summary) [Ep 43 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- "Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG." — Cecilia Gigena (host_summary) [Ep 43 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- "Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice." — Cecilia Gigena (host_summary) [Ep 43 · 3:38](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=218)

## Common questions
### How to manage necrotizing enterocolitis?
Management of necrotizing enterocolitis involves surgical intervention decisions and supportive care strategies. For surgical management, laparotomy and peritoneal drainage show different outcomes: laparotomy resulted in improved long-term neurodevelopmental outcomes despite similar overall survival rates. Silo placement with delayed closure offers multiple advantages including decreased incidence of necrotizing enterocolitis, earlier extubation, decreased airway pressures, more rapid bowel function recovery, and shorter hospital stays. Severe diffuse necrotizing enterocolitis causing abdominal compartment syndrome may be managed using a silo. Intestinal rehabilitation programs provide multidisciplinary coordinated care for children developing short bowel syndrome as a consequence of necrotizing enterocolitis.
### What is hernia?
A hernia is a protrusion through a defect in the abdominal wall. In the context of abdominal wall defects, hernias occur when tissue or bowel extends through an opening. Umbilical hernias, the most common type discussed, can present with varying sizes and clinical significance. True incarcerated umbilical hernias present with bowel obstruction symptoms; however, if a child is eating well, it is not an emergent incarcerated hernia. Most umbilical hernias close spontaneously during early childhood, though larger defects are less likely to close without intervention.
### What is omphalocele?
Omphalocele is a rare birth defect that is serious and can be life-threatening for babies before and after birth. It occurs right through the middle of the umbilicus and has a membranous cover. The cause is unknown. Omphaloceles can be classified by size: giant omphalocele is typically defined as five centimeters or greater or when liver is in the sac. Omphalocele can be a feature of many genetic syndromes, with trisomy 13, 18, and 21 being major risk factors, occurring in 35–90% of patients. Patients with omphalocele have non-rotation or malrotation of the bowel.

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 1 item hidden — never mention Abdominal Wall Defects; unhide from the owner view
- Aug 31: 58 doctors auto-found from episode dossiers
- Aug 30: 43 doctors auto-found from episode dossiers
- Aug 30: 34 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 45 doctors auto-found from episode dossiers
- Aug 29: 46 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 60 items, 36 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 2 audience(s)

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