Miguel Guelfand

Miguel's statements about Abdominal Wall Defects 11 statements

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Gastroschisis - Clinical Practice Updates

Statement All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. Open

Quotation the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. Open

Statement Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. Open

Statement 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. Open

Statement Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. Open

Statement 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. Open

Quotation you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. Open

Quotation I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. Open

Statement Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. Open

Statement 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. Open

Statement 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. Open

Miguel's statements about Abdominal Wall Defects: Omphalocele & Gastroschisis 32 statements

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EUPSA Webinar "GIANT OMPHALOCELE II"

Quotation anytime you touch the baby, he wanted to die Open

Quotation we hate, you know, paint and wait Open

Statement 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. Open

Quotation for us it was a game changer in terms of how to manage this patient Open

Statement In Dr. Guelfund's series of approximately 60 patients treated over seven years, 98% required only one surgery. Open

Statement The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction. Open

Statement 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. Open

Statement 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. Open

Statement Reduction is performed every 1–2 days by 0.5 inch (1 cm), depending on the baby's respiratory tolerance. Open

Statement 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. Open

Statement 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. Open

Statement 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. Open

Statement The median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days. Open

Statement 95% of patients in the series achieved anatomical closure. Open

Statement 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. Open

Statement There was no mortality related to the silo technique; four deaths were related to other malformations. Open

Statement Dr. Guelfund does not measure intraabdominal pressure directly, instead relying on clinical signs (leg color, hemodynamics, respiratory status) to guide reduction pace. Open

Quotation I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything Open

Statement When progression stalls, complete paralysis for 7 days (24 hours/day) is used to facilitate reduction. Open

Quotation you need to give me a week of full paralyzation because if not, we're going to be so Open

Quotation we don't clean the amnios at all Open

Statement 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. Open

Statement Patients are not fed during silo reduction to avoid bowel distention; amnion inversion is not attempted until the silo is completely flat. Open

Quotation we don't feed them because we don't want any distention Open

Quotation we don't go to the inversion of the amnios until it's completely flat Open

Statement 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. Open

Statement 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. Open

Quotation I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed Open

Statement Three patients with ruptured amnion at birth were treated by suturing the amnion and then applying the silo on top. Open

Statement For narrow-neck (mushroom-shaped) defects, the technique can be trialed; if no progression occurs within 7–10 days, the approach should be changed. Open

Statement 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. Open

Statement 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. Open

Miguel's statements about Congenital Heart Disease 32 statements

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