# Neonatal & Pediatric Minimally Invasive Surgery — GCMD Library living collection

Updated: n/a · 31 episodes · 79 cited statements

## Episodes
### Esophageal Anomalies
- [Staged thoracoscopic internal traction approach for early repair of long-gap esophageal atresia (LGEA) with distal tracheoesophageal fistula (TEF)](https://qa.library.globalcastmd.com/article/staged-thoracoscopic-internal-traction-approach-for-early-repair-of-long-gap-eso-13453) — article · [machine version](https://qa.library.globalcastmd.com/article/staged-thoracoscopic-internal-traction-approach-for-early-repair-of-long-gap-eso-13453.md)
- [Congenital and acquired tracheoesophageal fistulas in children](https://qa.library.globalcastmd.com/article/congenital-and-acquired-tracheoesophageal-fistulas-in-children-13456) — article · [machine version](https://qa.library.globalcastmd.com/article/congenital-and-acquired-tracheoesophageal-fistulas-in-children-13456.md)
- [Thoracoscopic repair of esophageal atresia with and without tracheoesophageal fistula Reparación toracoscópica de atresia esofágica con y sin fistula traqueoesofágica](https://qa.library.globalcastmd.com/article/thoracoscopic-repair-of-esophageal-atresia-with-and-without-tracheoesophageal-fi-13472) — article · [machine version](https://qa.library.globalcastmd.com/article/thoracoscopic-repair-of-esophageal-atresia-with-and-without-tracheoesophageal-fi-13472.md)
- [Reparación toracoscópica de atresia esofágica con y sin fistula traqueoesofágica](https://qa.library.globalcastmd.com/article/reparaci-n-toracosc-pica-de-atresia-esof-gica-con-y-sin-fistula-traqueoesof-gica-13471) — article · [machine version](https://qa.library.globalcastmd.com/article/reparaci-n-toracosc-pica-de-atresia-esof-gica-con-y-sin-fistula-traqueoesof-gica-13471.md)
- [Atresia de Esófago Compleja Dr. Miguel Guelfand](https://qa.library.globalcastmd.com/watch/atresia-de-es-fago-compleja-dr-miguel-guelfand-13479) — video · [machine version](https://qa.library.globalcastmd.com/watch/atresia-de-es-fago-compleja-dr-miguel-guelfand-13479.md)
- [Atresia Esofágica sin Fístula  Long Gap - Dr. Miguel Guelfand Clínica Las Condes](https://qa.library.globalcastmd.com/watch/atresia-esof-gica-sin-f-stula-long-gap-dr-miguel-guelfand-cl-nica-las-condes-13483) — video · [machine version](https://qa.library.globalcastmd.com/watch/atresia-esof-gica-sin-f-stula-long-gap-dr-miguel-guelfand-cl-nica-las-condes-13483.md)
- [Atresia Esofágica con Fístula Dr. Miguel Guelfand Clínica Las Condes](https://qa.library.globalcastmd.com/watch/atresia-esof-gica-con-f-stula-dr-miguel-guelfand-cl-nica-las-condes-13484) — video · [machine version](https://qa.library.globalcastmd.com/watch/atresia-esof-gica-con-f-stula-dr-miguel-guelfand-cl-nica-las-condes-13484.md)
- [Early Management of Esophageal Leak in Esophageal Atresia: Changing Paradigms](https://qa.library.globalcastmd.com/article/early-management-of-esophageal-leak-in-esophageal-atresia-changing-paradigms-13643) — article · [machine version](https://qa.library.globalcastmd.com/article/early-management-of-esophageal-leak-in-esophageal-atresia-changing-paradigms-13643.md)
- [Update Course Rewind: Management of Esophageal Leaks 2022](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505) — podcast · 8:02 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505.md)

### Abdominal Wall Defects
- [Management of giant omphalocele with a simple and efficient nonsurgical silo](https://qa.library.globalcastmd.com/article/management-of-giant-omphalocele-with-a-simple-and-efficient-nonsurgical-silo-13457) — article · [machine version](https://qa.library.globalcastmd.com/article/management-of-giant-omphalocele-with-a-simple-and-efficient-nonsurgical-silo-13457.md)
- [EUPSA Webinar "GIANT OMPHALOCELE II"](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651) — video · 1:04:07 · [machine version](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651.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)
- [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)

### Intestinal Conditions
- [Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia](https://qa.library.globalcastmd.com/article/laparoscopic-management-of-congenital-intestinal-obstruction-duodenal-atresia-an-13455) — article · [machine version](https://qa.library.globalcastmd.com/article/laparoscopic-management-of-congenital-intestinal-obstruction-duodenal-atresia-an-13455.md)
- [Laparoscopic Approach to Intestinal Duplication](https://qa.library.globalcastmd.com/article/laparoscopic-approach-to-intestinal-duplication-13648) — article · [machine version](https://qa.library.globalcastmd.com/article/laparoscopic-approach-to-intestinal-duplication-13648.md)
- [Laparoscopic excision of a gastric duplication cyst detected on antenatal ultrasound scan](https://qa.library.globalcastmd.com/article/laparoscopic-excision-of-a-gastric-duplication-cyst-detected-on-antenatal-ultras-13645) — article · [machine version](https://qa.library.globalcastmd.com/article/laparoscopic-excision-of-a-gastric-duplication-cyst-detected-on-antenatal-ultras-13645.md)
- [Primary anastomosis in necrotizing enterocolitis: the first option to consider](https://qa.library.globalcastmd.com/article/primary-anastomosis-in-necrotizing-enterocolitis-the-first-option-to-consider-13644) — article · [machine version](https://qa.library.globalcastmd.com/article/primary-anastomosis-in-necrotizing-enterocolitis-the-first-option-to-consider-13644.md)
- [Anastomosis primaria en enterocolitis necrotizante](https://qa.library.globalcastmd.com/article/anastomosis-primaria-en-enterocolitis-necrotizante-13475) — article · [machine version](https://qa.library.globalcastmd.com/article/anastomosis-primaria-en-enterocolitis-necrotizante-13475.md)
- [Mucous Fistula Refeeding](https://qa.library.globalcastmd.com/watch/mucous-fistula-refeeding-333) — video · [machine version](https://qa.library.globalcastmd.com/watch/mucous-fistula-refeeding-333.md)
- [Association between visceral myopathy and Hirschsprung's disease: A case report](https://qa.library.globalcastmd.com/article/association-between-visceral-myopathy-and-hirschsprung-s-disease-a-case-report-13461) — article · [machine version](https://qa.library.globalcastmd.com/article/association-between-visceral-myopathy-and-hirschsprung-s-disease-a-case-report-13461.md)

### Anorectal Malformations
- [Urethral diverticulum after laparoscopically-assisted anorectal pull-through (LAARP) for anorectal malformation: is resection of the diverticulum always necessary?](https://qa.library.globalcastmd.com/article/urethral-diverticulum-after-laparoscopically-assisted-anorectal-pull-through-for-13458) — article · [machine version](https://qa.library.globalcastmd.com/article/urethral-diverticulum-after-laparoscopically-assisted-anorectal-pull-through-for-13458.md)
- [¿Divertículo uretral tras descenso anorectal asistido por laparoscopia (DARAL) en malformacion anorectal: es siempre necesario resecar el diverticulo?](https://qa.library.globalcastmd.com/article/divert-culo-uretral-tras-descenso-anorectal-asistido-por-laparoscopia-en-malform-13650) — article · [machine version](https://qa.library.globalcastmd.com/article/divert-culo-uretral-tras-descenso-anorectal-asistido-por-laparoscopia-en-malform-13650.md)

### Other Congenital Anomalies
- [Enfoque actual de las malformaciones pulmonares](https://qa.library.globalcastmd.com/article/enfoque-actual-de-las-malformaciones-pulmonares-13469) — article · [machine version](https://qa.library.globalcastmd.com/article/enfoque-actual-de-las-malformaciones-pulmonares-13469.md)
- [[Common bile duct stricture caused by vascular ring: a case report]](https://qa.library.globalcastmd.com/article/common-bile-duct-stricture-caused-by-vascular-ring-a-case-report-13647) — article · [machine version](https://qa.library.globalcastmd.com/article/common-bile-duct-stricture-caused-by-vascular-ring-a-case-report-13647.md)

### Techniques & Procedures
- [Guest Editorial Pediatric Special Section: Pediatric MIS Techniques: How to Do It](https://qa.library.globalcastmd.com/article/guest-editorial-pediatric-special-section-pediatric-mis-techniques-how-to-do-it-13454) — article · [machine version](https://qa.library.globalcastmd.com/article/guest-editorial-pediatric-special-section-pediatric-mis-techniques-how-to-do-it-13454.md)
- [CIRUGIA NO INVASIVA INFANTIL DR GUELFAND](https://qa.library.globalcastmd.com/watch/cirugia-no-invasiva-infantil-dr-guelfand-13497) — video · [machine version](https://qa.library.globalcastmd.com/watch/cirugia-no-invasiva-infantil-dr-guelfand-13497.md)
- [[Neonatal circumcision with local anesthesia. Results of a standardized protocol]](https://qa.library.globalcastmd.com/article/neonatal-circumcision-with-local-anesthesia-results-of-a-standardized-protocol-13642) — article · [machine version](https://qa.library.globalcastmd.com/article/neonatal-circumcision-with-local-anesthesia-results-of-a-standardized-protocol-13642.md)

### About Dr. Guelfand
- [Pediatric Surgeon Miguel Guelfand, MD](https://qa.library.globalcastmd.com/watch/pediatric-surgeon-miguel-guelfand-md-13477) — video · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-surgeon-miguel-guelfand-md-13477.md)

### More resources
- [Checking your browser](https://qa.library.globalcastmd.com/article/checking-your-browser-13646) — article · [machine version](https://qa.library.globalcastmd.com/article/checking-your-browser-13646.md)
- [Europe PMC](https://qa.library.globalcastmd.com/article/europe-pmc-13470) — article · [machine version](https://qa.library.globalcastmd.com/article/europe-pmc-13470.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) Giant omphalocele physiology and pulmonary hypertension risk (Ep 13)
- [5:00](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) Sac-preserving active reduction technique for giant omphalocele (Ep 13)
- [9:16](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556) Ladd procedure consideration at definitive omphalocele closure (Ep 13)
- [15:48](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=948) Management of massive abdominal wall defect with liver herniation (Ep 13)
- [23:21](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401) Delayed fascial closure strategies for giant ventral hernia (Ep 13)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=0) Giant omphalocele: pulmonary hypertension and management options (Ep 12)
- [3:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=226) Hydrocolloid dressing technique and Ladd procedure considerations (Ep 12)
- [6:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=402) Large abdominal wall defect management: mesh scaffolding and delayed reconstruction (Ep 12)
- [12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745) Gastroschisis management: sutureless closure and antibiotic stewardship (Ep 12)
- [0:45](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=45) Introduction and speaker presentations (Ep 11)
- [7:31](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=451) Non-surgical silo technique: rationale, protocol, and outcomes (Ep 11)
- [19:39](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1179) European multi-center evaluation study design (Ep 11)
- [24:30](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1470) Omphalocele guideline development within ERNICA (Ep 11)
- [27:43](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1663) Rotterdam case presentation: challenges and conversion (Ep 11)
- [39:21](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2361) Technical discussion and Q&A (Ep 11)
- [0:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=7) Introduction and First Case: Contained Leak Management (Ep 9)
- [1:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=96) Case 1 Management: Antisialagogue Therapy and Retrograde Endoscopy (Ep 9)
- [3:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=196) Case 2: Endoscopic Vacuum Therapy for Cervical Leak (Ep 9)
- [5:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=356) Case 3: Surgical Re-anastomosis for Large Unexplained Leak (Ep 9)
- [7:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=440) Summary and Key Takeaways (Ep 9)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 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 13 · 23:21](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401)
- 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 13 · 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 13 · 26:33](https://qa.library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- Giant omphalocele is typically defined as five centimeters or greater or liver in the sac (clinical) [Ep 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 9:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- 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 12 · 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 12 · 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 12 · 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 12 · 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 12 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- The non-surgical Duoderm silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and adopted by Dr. Guelfund's team seven years ago. — Miguel Guelfand (clinical) [Ep 11 · 8:27](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=507)
- In Dr. Guelfund's series of approximately 60 patients treated over seven years, 98% required only one surgery. — Miguel Guelfand (clinical) [Ep 11 · 10:56](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=656)
- The median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days. — Miguel Guelfand (clinical) [Ep 11 · 17:37](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1057)
- 95% of patients in the series achieved anatomical closure. — Miguel Guelfand (clinical) [Ep 11 · 17:45](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1065)
- Complications included one hemoperitoneum (due to delayed silo placement on day 3–4 with dry amnion), three local infections treated with antibiotics, one high intraabdominal pressure episode (resolved by retrieving reduction 1 cm), and one central line infection. — Miguel Guelfand (clinical) [Ep 11 · 17:50](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1070)
- There was no mortality related to the silo technique; four deaths were related to other malformations. — Miguel Guelfand (clinical) [Ep 11 · 18:24](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1104)
- The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction. — Miguel Guelfand (clinical) [Ep 11 · 12:34](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=754)
- The technique uses a 20 × 20 cm (8 × 8 inch) thick hydrocolloid dressing (Duoderm GRF) shaped into a T, with the stem attached to the skin and the flaps wrapped around the omphalocele. — Miguel Guelfand (clinical) [Ep 11 · 13:00](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=780)
- The apex of the omphalocele (not always the umbilical cord) should be positioned at the apex of the silo; plastic cord clamps should be replaced with suture or elastic band. — Miguel Guelfand (clinical) [Ep 11 · 13:52](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=832)
- Reduction is performed every 1–2 days by 0.5 inch (1 cm), depending on the baby's respiratory tolerance. — Miguel Guelfand (clinical) [Ep 11 · 14:53](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=893)
- In the first 2–3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4–5 years, only sedation is used with paralysis reserved for silo reduction, resulting in less edema and better respiratory management. — Miguel Guelfand (clinical) [Ep 11 · 15:07](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=907)
- After the silo is completely flat (typically 1–10 days), amnion inversion is performed by depressing the amnion into the cavity and securing the amniocutaneous edges with Duoderm for 1–2 days to assess tolerance before proceeding to OR closure. — Miguel Guelfand (clinical) [Ep 11 · 16:00](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=960)
- In 2–3 patients, a mesh was used as reinforcement or for closure; component separation was performed in some cases, but 95% achieved primary anatomical closure. — Miguel Guelfand (clinical) [Ep 11 · 16:48](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1008)
- Dr. Guelfund does not measure intraabdominal pressure directly, instead relying on clinical signs (leg color, hemodynamics, respiratory status) to guide reduction pace. — Miguel Guelfand (clinical) [Ep 11 · 39:41](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2381)
- When progression stalls, complete paralysis for 7 days (24 hours/day) is used to facilitate reduction. — Miguel Guelfand (clinical) [Ep 11 · 40:43](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2443)
- The Duoderm is changed every 4–5 days because it loses traction when wet; the skin is cleaned at each change, but the amnion itself is not cleaned. — Miguel Guelfand (clinical) [Ep 11 · 41:14](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2474)
- Patients are not fed during silo reduction to avoid bowel distention; amnion inversion is not attempted until the silo is completely flat. — Miguel Guelfand (clinical) [Ep 11 · 42:14](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2534)
- Dr. Guelfund's team is developing a protocol to use Botox from day one and is exploring in-utero Botox administration in collaboration with Dr. Avello; one patient has been treated in utero with good results. — Miguel Guelfand (clinical) [Ep 11 · 42:38](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2558)
- The technique is primarily pushing (applying force into the abdomen) rather than traction to the ceiling; lateral strings stabilize the silo but do not pull. — Miguel Guelfand (clinical) [Ep 11 · 43:51](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2631)
- Three patients with ruptured amnion at birth were treated by suturing the amnion and then applying the silo on top. — Miguel Guelfand (clinical) [Ep 11 · 48:12](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2892)
- For narrow-neck (mushroom-shaped) defects, the technique can be trialed; if no progression occurs within 7–10 days, the approach should be changed. — Miguel Guelfand (clinical) [Ep 11 · 48:53](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2933)
- Three patients underwent component separation at 2–4 weeks of age with good outcomes and no lateral hernias; the first two cases were performed with a plastic surgeon experienced in the technique. — Miguel Guelfand (clinical) [Ep 11 · 50:11](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3011)
- In patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for several days until the patient stabilizes, then progression is very slow and gentle based on patient response. — Miguel Guelfand (clinical) [Ep 11 · 52:24](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3144)
- Rotterdam's first Duoderm case was a 35-week, 2400 g female with an 8 cm giant omphalocele containing liver, stomach, and small bowel, plus a cardiac defect. — Hester Langenfeld (clinical) [Ep 11 · 29:30](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1770)
- The Rotterdam team encountered challenges including umbilical cord positioning, spatula migration despite tape reinforcement, uncertainty about reduction pace, and difficulty assessing bowel position through the opaque Duoderm. — Hester Langenfeld (clinical) [Ep 11 · 30:24](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1824)
- Initial bladder pressure was 17 mmHg with some urine leakage; the team accepted this as acceptable pressure. — Hester Langenfeld (clinical) [Ep 11 · 31:42](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1902)
- On day 5, the Duoderm was changed; the omphalocele had a yellow appearance but did not appear infected, and cultures were negative. — Hester Langenfeld (clinical) [Ep 11 · 33:08](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1988)
- Enteral feeding via nasogastric tube was started on day 12 due to pressure from the team to begin feeding, despite the defect still being large. — Hester Langenfeld (clinical) [Ep 11 · 35:20](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2120)
- Botox was administered on day 15 to facilitate closure. — Hester Langenfeld (clinical) [Ep 11 · 35:43](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2143)
- The patient was ventilated but not paralyzed throughout treatment; CO₂ levels were consistently high (8–10 mmHg). — Hester Langenfeld (clinical) [Ep 11 · 35:59](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2159)
- A Serratia infection developed on the skin/sac but the patient was not systemically ill; no antibiotics were started and the infection resolved. — Hester Langenfeld (clinical) [Ep 11 · 36:18](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2178)
- Amnion inversion was attempted on days 23–30, but the patient developed leg cyanosis, tachycardia, and CO₂ rise to 12 mmHg, prompting abandonment of closure attempts. — Hester Langenfeld (clinical) [Ep 11 · 36:44](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2204)
- On day 30, the team switched from Duoderm to Mepitel (silicone dressing); the patient was extubated 10 days later and is progressing on day 45 with chronic hypercapnia (CO₂ = 8) and oral feeding trials (20 mL per feed, 3 times daily). — Hester Langenfeld (clinical) [Ep 11 · 37:18](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2238)
- The European multi-center study will collect data on primary outcomes (silo reduction time, amnion inversion time, surgical closure time) and secondary outcomes (hospital stay, mortality, complications, ventilation type/duration, antibiotic use, parenteral nutrition, enteral feeding start) via the CURRENTS platform. — Marlinda Van der Kamp (clinical) [Ep 11 · 22:18](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1338)
- ERNICA's omphalocele guideline development involves 11 PICO questions categorized into prenatal care, postnatal care, and abdominal wall closure, using evidence-based methods and expert panel consultation. — Marlinda Van der Kamp (guideline) [Ep 11 · 26:30](https://qa.library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1590)
- The endo-bag device is kept in place for 4 or 5 days and then reviewed in the OR. (clinical) [Ep 9 · 5:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=311)
- In the cervical leak case, the leak was completely shut down immediately after endo-bag placement and completely closed at 5 days. (clinical) [Ep 9 · 5:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=305)
- After surgical re-anastomosis for the large leak, the patient had no stenosis at 3 days and 3 weeks post-operatively and required no dilatation. (clinical) [Ep 9 · 6:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=419)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- 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. — The host summarizing the discussion [Ep 13 · 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. — The host summarizing the discussion [Ep 13 · 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 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 summarizing the discussion [Ep 12 · 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 summarizing the discussion [Ep 12 · 10:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- Every small or moderate leak that is contained can be managed by observation with no need for new intervention. — Cecilia Gigena summarizing the discussion [Ep 9 · 1:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=76)
- New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable. — Cecilia Gigena summarizing the discussion [Ep 9 · 1:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=89)
- Botulinum toxin can be used to block the secretion of saliva in patients with esophageal leaks. — Cecilia Gigena summarizing the discussion [Ep 9 · 1:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=101)
- Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva. — Cecilia Gigena summarizing the discussion [Ep 9 · 1:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=115)
- Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture. — Cecilia Gigena summarizing the discussion [Ep 9 · 2:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=170)
- Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive. — Cecilia Gigena summarizing the discussion [Ep 9 · 5:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=324)
- Endoscopic vacuum closure helps granulation tissue form by negative pressure, making the patient heal faster. — Cecilia Gigena summarizing the discussion [Ep 9 · 5:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=338)
- Most esophageal leaks can be treated by observation or chest drain. — Cecilia Gigena summarizing the discussion [Ep 9 · 7:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=442)
- If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution. — Cecilia Gigena summarizing the discussion [Ep 9 · 7:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=448)
- For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted. — Cecilia Gigena summarizing the discussion [Ep 9 · 7:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=457)
- After a leak, a stricture is more common, so patients have to be followed more thoroughly. — Cecilia Gigena summarizing the discussion [Ep 9 · 7:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-management-of-esophageal-leaks-2022-13505?t=465)

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