# Abdominal Compartment Syndrome — GCMD Library living collection

Updated: n/a · 8 episodes · 161 cited statements

## Episodes
### Resources
- [Approach and component separation for suture closure and underlay mesh...](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430) — video · 31:03 · [machine version](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430.md)
- [Abdominal Wall Defects](https://library.globalcastmd.com/watch/abdominal-wall-defects-639) — video · 37:50 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-639.md)
- [Gastroschisis: Advanced Practice Providers](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049) — video · 43:21 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049.md)
- [Abdominal Wall Defects: Update Course 2013](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059) — video · 37:40 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059.md)
- [Staged Closure of Gastroschisis with Spring-loaded Silo](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251) — video · 27:11 · [machine version](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251.md)
- [Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819) — video · 27:50 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819.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://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://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)
- [Quick Literature Updates Episode 20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554) — video · 4:03 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=0) Introduction and first Duoderm silo technique video (Ep 1)
- [5:40](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=340) Component separation video presentation (Ep 1)
- [10:34](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=634) Faculty debate on early versus delayed closure (Ep 1)
- [17:22](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1042) Biologic patch discussion and special cases (Ep 1)
- [26:16](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1576) Dr. Abello's algorithm and decision framework (Ep 1)
- [0:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1) Prenatal management and delivery planning for gastroschisis (Ep 2)
- [5:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=316) Postnatal closure techniques for gastroschisis with minimal bowel damage (Ep 2)
- [13:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=782) Management of gastroschisis with intestinal atresia (Ep 2)
- [18:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1085) Feeding intolerance after gastroschisis repair (Ep 2)
- [21:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1272) Management of large omphalocele in term neonate (Ep 2)
- [27:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1639) Assessing abdominal compartment syndrome during closure (Ep 2)
- [32:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1922) Staged repair of giant omphalocele in a 3-year-old (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=0) Embryology and Differential Diagnosis of Abdominal Wall Defects (Ep 3)
- [3:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231) Prenatal Diagnosis and Initial Stabilization (Ep 3)
- [7:10](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430) Surgical Management Options: Primary vs Staged Closure (Ep 3)
- [11:03](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663) Silo Reduction Technique and Monitoring (Ep 3)
- [15:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906) Postoperative Monitoring and Complications (Ep 3)
- [19:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1170) Prognosis and Necrotizing Enterocolitis Risk (Ep 3)
- [21:04](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1264) Case Presentation: 36-Week Infant with Gastroschisis (Ep 3)
- [31:27](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1887) Feeding Advancement and Prolonged Ileus (Ep 3)
- [35:05](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2105) Long-Term Nutritional Outcomes and TPN Duration (Ep 3)
- [38:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310) Readmission Patterns and Future Research Needs (Ep 3)
- [0:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1) Prenatal Management and Delivery Planning for Gastroschisis (Ep 4)
- [5:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=316) Postnatal Closure Techniques for Gastroschisis (Ep 4)
- [13:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=782) Management of Gastroschisis with Intestinal Atresia (Ep 4)
- [18:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1085) Feeding Intolerance After Gastroschisis Repair (Ep 4)
- [21:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1272) Management of Large Omphalocele in Term Neonate (Ep 4)
- [27:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1639) Monitoring for Abdominal Compartment Syndrome (Ep 4)
- [32:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1922) Repair of Giant Omphalocele in Older Child (Ep 4)
- [0:26](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=26) Introduction to Gastroschisis and Spring-Loaded Silo Technique (Ep 5)
- [3:46](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=226) Patient Preparation and Silo Size Selection (Ep 5)
- [6:38](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=398) Bedside Silo Placement Technique (Ep 5)
- [12:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=720) Silo Management and Gradual Reduction (Ep 5)
- [14:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=840) Delayed Fascial Closure Technique (Ep 5)
- [23:48](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1428) Cosmetic Outcomes and Key Success Factors (Ep 5)
- [24:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1499) Alternative Applications of Spring-Loaded Silo (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=0) Introduction and Antibiotic Selection for Perforated Appendicitis (Ep 6)
- [6:37](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=397) Discussion of Appendicitis Antibiotic Trial Results (Ep 6)
- [9:08](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=548) Surgical Management of Necrotizing Enterocolitis (Ep 6)
- [14:56](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=896) Gastrostomy Tube Placement Technique Selection (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Most damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy, supported by animal and clinical studies. (clinical) [Ep 2 · 2:45](https://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 2 · 3:14](https://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 2 · 3:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=224)
- About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks. (epidemiological) [Ep 2 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=236)
- No perinatal center in Canada performs routine cesarean sections for gastroschisis. (epidemiological) [Ep 2 · 4:37](https://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 2 · 4:49](https://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 2 · 8:18](https://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 2 · 8:27](https://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 2 · 9:14](https://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 2 · 9:41](https://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 2 · 9:54](https://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 2 · 10:02](https://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 2 · 11:37](https://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 2 · 11:50](https://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 2 · 15:58](https://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 2 · 15:00](https://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 2 · 15:09](https://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 2 · 16:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1001)
- Gord Cameron first described umbilical ostomies in the 1980s. (epidemiological) [Ep 2 · 17:53](https://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 2 · 20:07](https://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 2 · 19:46](https://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 2 · 22:13](https://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 2 · 22:23](https://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 2 · 22:31](https://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 2 · 23:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1385)
- Lateral component separation can facilitate bringing fascial edges together in omphalocele closure. (clinical) [Ep 2 · 23:32](https://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 2 · 23:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1433)
- Aquacel applied to omphalocele sac is not recommended as it does not come off easily. (opinion) [Ep 2 · 26:28](https://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 2 · 26:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1618)
- Ventilatory parameters are the most reliable measure of safe abdominal closure tension. (opinion) [Ep 2 · 28:04](https://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 2 · 28:51](https://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 2 · 29:56](https://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 2 · 31:05](https://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 2 · 35:45](https://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 2 · 36:01](https://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 2 · 36:40](https://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 2 · 37:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2223)
- 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 5 · 0:49](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=49)
- 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 5 · 3:26](https://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 5 · 4:30](https://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 5 · 4:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=292)
- 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 5 · 5:37](https://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 5 · 5:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=359)
- Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction. (clinical) [Ep 5 · 7:07](https://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 5 · 8:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=489)
- Final closure is performed when the silo contents is within 2 centimeters of the abdominal wall. (clinical) [Ep 5 · 13:20](https://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 5 · 13:26](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=806)
- Stretching the abdominal wall aids in a tension-free closure and often produces some minor postoperative congestion of the abdominal wall. (clinical) [Ep 5 · 14:47](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=887)
- 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 5 · 21:07](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1267)
- 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 5 · 25:31](https://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 5 · 26:02](https://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 5 · 26:34](https://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 5 · 26:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1619)
- The Chilean Society of Pediatric Surgery screens approximately 1,200 articles each month from non-pediatric surgical journals to identify the 3% relevant to pediatric surgery. — Jose Campos (clinical) [Ep 6 · 1:38](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=98)
- One participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience. — Shawn St. Peter (clinical) [Ep 6 · 7:04](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=424)
- NSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers. — Shawn St. Peter (epidemiological) [Ep 6 · 7:45](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=465)
- In the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement. — Shawn St. Peter (clinical) [Ep 6 · 12:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=760)
- Peritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy. — Shawn St. Peter (opinion) [Ep 6 · 13:42](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=822)
- Peritoneal drainage started as a temporizing measure for NEC but morphed into a definitive management strategy in approximately 40-50% of surgeons' minds. (opinion) [Ep 6 · 14:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=850)
- The original description of percutaneous endoscopic gastrostomy (PEG) was done by Todd Ponsky Sr. — Jose Campos (clinical) [Ep 6 · 15:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=950)
- PEG tubes are difficult to change to button tubes, often requiring a second anesthetic with GI specialists to remove the PEG endoscopically before placing a button. — Meera Kotagal (clinical) [Ep 6 · 20:29](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1229)
- The article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article. — Todd Ponsky (clinical) [Ep 6 · 17:36](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1056)
- The Teen Labs Consortium has been conducting NIH-funded prospective trials on bariatric surgery in adolescents since 2007. (clinical) [Ep 6 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1450)
- Sleeve gastrectomy is a very safe operation in adolescents with good long-term data showing resolution of comorbidities, especially in pre-diabetic and diabetic patients. (clinical) [Ep 6 · 23:14](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1394)
- The average time pediatric patients spend in bariatric surgery programs before proceeding to surgery is approximately nine months. (clinical) [Ep 6 · 25:11](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1511)
- spk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles — Todd Ponsky (clinical) [Ep 1 · 0:27](https://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://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://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://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://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://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=105)
- The Duoderm compression technique requires daily adjustments and significant work — Jack (clinical) [Ep 1 · 5:02](https://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://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=302)
- 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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=802)
- Delayed closure approach: apply fatty gauzes until epithelialization, wait until 6-7 months, then perform delayed primary closure (clinical) [Ep 1 · 15:00](https://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://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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1377)
- spk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar — Todd Ponsky (clinical) [Ep 1 · 23:25](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1405)
- The abdominal wall forms around the 4th week of gestation, well before most women know they are pregnant. — Joyce (clinical) [Ep 3 · 0:31](https://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 3 · 0:40](https://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 3 · 0:50](https://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 3 · 1:24](https://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 3 · 1:32](https://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 3 · 1:52](https://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 3 · 2:14](https://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 3 · 2:40](https://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 3 · 3:06](https://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 3 · 3:16](https://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 3 · 3:37](https://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 3 · 3:51](https://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 3 · 4:48](https://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 3 · 5:01](https://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 3 · 5:35](https://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 3 · 5:51](https://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 3 · 7:10](https://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 3 · 7:22](https://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 3 · 7:47](https://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 3 · 8:14](https://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 3 · 8:40](https://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 3 · 8:52](https://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 3 · 9:37](https://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 3 · 10:22](https://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 3 · 11:03](https://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 3 · 11:53](https://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 3 · 13:06](https://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 3 · 13:22](https://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 3 · 15:06](https://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 3 · 15:38](https://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 3 · 16:54](https://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 3 · 17:24](https://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 3 · 29:22](https://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 3 · 30:13](https://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 3 · 30:59](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1859)
- Of all potential gastroschisis complications, dysmotility is the most universal. — Joyce (clinical) [Ep 3 · 19:56](https://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 3 · 20:08](https://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 3 · 20:30](https://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 3 · 33:46](https://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 3 · 34:33](https://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 3 · 36:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2191)
- 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 3 · 42:18](https://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 4 · 2:45](https://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 4 · 3:44](https://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 4 · 3:56](https://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 4 · 4:37](https://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 4 · 4:49](https://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 4 · 8:27](https://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 4 · 9:05](https://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 4 · 9:41](https://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 4 · 11:37](https://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 4 · 15:55](https://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 4 · 16:13](https://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 4 · 17:53](https://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 4 · 20:04](https://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 4 · 20:46](https://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 4 · 22:13](https://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 4 · 22:31](https://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 4 · 23:11](https://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 4 · 23:32](https://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 4 · 23:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1433)
- 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 4 · 29:56](https://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 4 · 29:00](https://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 4 · 28:04](https://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 4 · 36:14](https://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 4 · 36:40](https://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 4 · 36:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2218)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Wrapping Duoderm around an omphalocele and tightening daily can achieve gradual reduction without sutures. — The host summarizing the discussion [Ep 2 · 24:37](https://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. — The host summarizing the discussion [Ep 2 · 24:57](https://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. — The host summarizing the discussion [Ep 2 · 26:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1568)
- 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. — The host summarizing a resource [Ep 5 · 0:39](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=39)
- Traditional staged closure with sutured elastic silo involves risks of silo disruption, fascial dehiscence, and infectious complications. — The host summarizing a resource [Ep 5 · 1:11](https://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. — The host summarizing a resource [Ep 5 · 1:27](https://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. — The host summarizing a resource [Ep 5 · 2:08](https://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. — The host summarizing a resource [Ep 5 · 2:43](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=163)
- The Bentek silo is available in 7 sizes from 3 centimeters to 15 centimeters, defined by the diameter of the reinforced ring. — The host summarizing a resource [Ep 5 · 5:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=320)
- A distal colon severely distended with meconium is typical and is a good indication of the probable absence of a proximal atresia or stenosis. — The host summarizing a resource [Ep 5 · 6:56](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=416)
- If the ring has too much traction it will cause abdominal wall congestion and edema, complicating closure later on. — The host summarizing a resource [Ep 5 · 13:02](https://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. — The host summarizing a resource [Ep 5 · 13:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=789)
- The silo creates a closed system by completely containing the bowel and peritoneal fluid. — The host summarizing a resource [Ep 5 · 13:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=832)
- A 1 centimeter fascial edge is mobilized in both directions to the border of the umbilical stump. — The host summarizing a resource [Ep 5 · 17:06](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1026)
- The baby remained stable without any increase in airway pressures during the closure procedure, which was completed in under 25 minutes. — The host summarizing a resource [Ep 5 · 23:38](https://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. — The host summarizing a resource [Ep 5 · 24:25](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1465)
- A multi-institutional prospective randomized trial comparing piperacillin-tazobactam to ceftriaxone-metronidazole for perforated appendicitis was stopped at 75% enrollment when interim analysis favored the piperacillin-tazobactam group. — Jose Campos summarizing the discussion [Ep 6 · 4:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=280)
- Intra-abdominal abscess formation was significantly lower in the piperacillin-tazobactam group with an odds ratio of 4.8. — Jose Campos summarizing the discussion [Ep 6 · 5:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=330)
- The number needed to treat with piperacillin-tazobactam to prevent one intra-abdominal abscess was 5.7. — Jose Campos summarizing the discussion [Ep 6 · 5:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=350)
- Necrotizing enterocolitis treated surgically is associated with high mortality rates and poor neurodevelopmental outcomes. — Jose Campos summarizing the discussion [Ep 6 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=630)
- Two previous randomized controlled trials comparing surgical techniques for NEC both failed to enroll enough patients to answer the clinical question. — Jose Campos summarizing the discussion [Ep 6 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=650)
- A 20-center randomized controlled trial by Marty Blakely comparing initial laparotomy versus peritoneal drainage for NEC randomized 310 premature newborns. — Jose Campos summarizing the discussion [Ep 6 · 11:05](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=665)
- At 18 to 22 months of corrected age, the composite outcome of death and neurodevelopmental impairment was similar in both the laparotomy and peritoneal drainage groups in frequentist analysis. — Jose Campos summarizing the discussion [Ep 6 · 11:25](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=685)
- Bayesian analysis of the NEC trial showed a high probability of laparotomy being superior to peritoneal drainage. — Jose Campos summarizing the discussion [Ep 6 · 11:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=700)
- In the original papers by Ziggy Hein on peritoneal drainage for NEC, approximately one-third of patients died, one-third received laparotomy, and one-third were managed with drainage alone. — The host summarizing the discussion [Ep 6 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=831)
- A systematic review examining gastrostomy insertion techniques reviewed 900 publications, with 58 being used for final recommendations. — Jose Campos summarizing the discussion [Ep 6 · 18:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1100)
- Twelve studies directly compared outcomes between laparoscopic and percutaneous endoscopic gastrostomy, showing major complication rates were significantly less common with laparoscopic placement. — Jose Campos summarizing the discussion [Ep 6 · 18:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1130)
- The number needed to treat to prevent one major complication from PEG (by using laparoscopic approach instead) is 24. — Jose Campos summarizing the discussion [Ep 6 · 19:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1160)
- A database comparison of 3,000 patients with differentiated papillary thyroid cancer found no survival difference between total thyroidectomy and thyroid lobectomy. — Jose Campos summarizing the discussion [Ep 6 · 25:49](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1549)
- 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 summarizing a resource [Ep 7 · 0:14](https://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 summarizing a resource [Ep 7 · 0:24](https://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 summarizing a resource [Ep 7 · 0:29](https://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 summarizing a resource [Ep 7 · 0:36](https://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 summarizing a resource [Ep 7 · 0:39](https://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 summarizing a resource [Ep 7 · 0:39](https://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 summarizing a resource [Ep 7 · 0:46](https://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)
- 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 summarizing the discussion [Ep 1 · 3:16](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=196)
- Case presented: 28-week gestation, 1130g premature female with giant omphalocele including liver, identified by prenatal ultrasound — The host summarizing a resource [Ep 1 · 6:32](https://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 — The host summarizing a resource [Ep 1 · 8:07](https://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 — The host summarizing a resource [Ep 1 · 9:30](https://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 — The host summarizing a resource [Ep 1 · 10:19](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=619)
- 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 — The host summarizing the discussion [Ep 1 · 14:00](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=840)
- Cardiac surgeons report biologic patches in VSD closure turn into cardiac muscle — Todd Ponsky summarizing the discussion [Ep 1 · 23:10](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1390)
- Dr. Abello's algorithm: first perform relaxation test under sedation to assess how much stretching is needed and determine silo size requirements — The host summarizing the discussion [Ep 1 · 27:04](https://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 — The host summarizing the discussion [Ep 1 · 29:03](https://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 — The host summarizing the discussion [Ep 1 · 30:33](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1833)
- 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 summarizing the discussion [Ep 3 · 37:24](https://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 summarizing the discussion [Ep 3 · 38:06](https://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 summarizing the discussion [Ep 3 · 38:30](https://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 summarizing the discussion [Ep 3 · 39:25](https://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 summarizing the discussion [Ep 3 · 40:07](https://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 summarizing the discussion [Ep 3 · 40:50](https://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 summarizing the discussion [Ep 3 · 41:19](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2479)
- Dr. Abello uses Duoderm wrapped around omphalocele and tightens it daily to achieve gradual reduction — The host summarizing the discussion [Ep 4 · 24:37](https://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 — The host summarizing the discussion [Ep 4 · 24:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1497)
- 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 summarizes what Dr. Alex Halpern said [Ep 8 · 1:03](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 1:18](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 1:18](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 1:25](https://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 summarizing a resource [Ep 8 · 1:58](https://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 summarizing a resource [Ep 8 · 2:13](https://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 summarizing a resource [Ep 8 · 2:13](https://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 summarizing a resource [Ep 8 · 2:23](https://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 summarizing a resource [Ep 8 · 2:23](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 3:01](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 3:23](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 3:23](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 3:23](https://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 summarizes what Dr. Alex Halpern said [Ep 8 · 3:38](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=218)

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