# Abdominal Wall Defects: Omphalocele & Gastroschisis — GCMD Library living collection

Updated: n/a · 5 episodes · 83 cited statements

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

### Gastroschisis Management
- [Gastroschisis - Clinical Practice Updates](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996.md)
- [Gastroschisis](https://library.globalcastmd.com/watch/gastroschisis-13502) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-13502.md)

### Case Discussions & Updates
- [Update Course Rewind: Omphalocele & Gastroschisis 2020](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507) — podcast · 15:18 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) Giant omphalocele physiology and pulmonary hypertension risk (Ep 3)
- [5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) Sac-preserving active reduction technique for giant omphalocele (Ep 3)
- [9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556) Ladd procedure consideration at definitive omphalocele closure (Ep 3)
- [15:48](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=948) Management of massive abdominal wall defect with liver herniation (Ep 3)
- [23:21](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401) Delayed fascial closure strategies for giant ventral hernia (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=0) Giant omphalocele: pulmonary hypertension and management options (Ep 5)
- [3:46](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=226) Hydrocolloid dressing technique and Ladd procedure considerations (Ep 5)
- [6:42](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=402) Large abdominal wall defect management: mesh scaffolding and delayed reconstruction (Ep 5)
- [12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745) Gastroschisis management: sutureless closure and antibiotic stewardship (Ep 5)
- [0:45](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=45) Introduction and speaker presentations (Ep 2)
- [7:31](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=451) Non-surgical silo technique presentation by Dr. Guelfund (Ep 2)
- [19:39](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1179) European multicenter research proposal (Ep 2)
- [24:30](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1470) ERNICA guideline development overview (Ep 2)
- [27:43](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1663) Rotterdam case presentation by Dr. Langenfeld (Ep 2)
- [39:21](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2361) Technical discussion and Q&A (Ep 2)

## 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 3 · 0:00](https://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 3 · 0:00](https://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 3 · 0:00](https://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 3 · 0:00](https://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 3 · 5:00](https://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 3 · 5:00](https://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 3 · 5:00](https://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 3 · 6:47](https://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 3 · 6:47](https://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 3 · 8:01](https://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 3 · 9:16](https://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 3 · 9:16](https://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 3 · 10:31](https://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 3 · 13:10](https://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 3 · 14:33](https://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 3 · 17:52](https://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 3 · 19:10](https://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 3 · 20:24](https://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 3 · 21:23](https://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 3 · 23:21](https://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 3 · 26:33](https://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 3 · 26:33](https://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 5 · 0:36](https://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 5 · 0:36](https://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 5 · 1:14](https://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 5 · 1:14](https://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 5 · 1:14](https://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 5 · 3:46](https://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 5 · 4:26](https://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 5 · 4:20](https://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 5 · 4:45](https://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 5 · 5:17](https://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 5 · 5:17](https://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 5 · 8:18](https://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 5 · 8:49](https://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 5 · 9:14](https://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 5 · 12:25](https://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 5 · 12:25](https://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 5 · 12:25](https://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 5 · 12:25](https://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 5 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago — Miguel Guelfand (clinical) [Ep 2 · 8:27](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=507)
- In the series of 50 patients, 98% required only one surgery for closure — Miguel Guelfand (clinical) [Ep 2 · 11:20](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=680)
- The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele — Miguel Guelfand (clinical) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=780)
- The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction — Miguel Guelfand (clinical) [Ep 2 · 12:34](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=754)
- Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele — Miguel Guelfand (clinical) [Ep 2 · 13:59](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=839)
- The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition — Miguel Guelfand (clinical) [Ep 2 · 14:53](https://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, the protocol changed to sedation only with paralysis used only during silo reduction — Miguel Guelfand (clinical) [Ep 2 · 15:07](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=907)
- Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure — Miguel Guelfand (clinical) [Ep 2 · 16:07](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=967)
- In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days — Miguel Guelfand (clinical) [Ep 2 · 17:18](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1038)
- 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure — Miguel Guelfand (clinical) [Ep 2 · 16:48](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1008)
- Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection — Miguel Guelfand (clinical) [Ep 2 · 17:50](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1070)
- There was no mortality related to the silo technique; four mortalities occurred related to other malformations — Miguel Guelfand (clinical) [Ep 2 · 18:24](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1104)
- The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling — Miguel Guelfand (clinical) [Ep 2 · 43:51](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2631)
- Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction — Miguel Guelfand (clinical) [Ep 2 · 39:41](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2381)
- When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction — Miguel Guelfand (clinical) [Ep 2 · 40:46](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2446)
- The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm — Miguel Guelfand (clinical) [Ep 2 · 41:29](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2489)
- The silo is changed every 4-5 weeks because it loses traction as it gets wet — Miguel Guelfand (clinical) [Ep 2 · 41:29](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2489)
- Patients are not fed during the reduction phase to avoid bowel distention — Miguel Guelfand (clinical) [Ep 2 · 42:14](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2534)
- Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated — Miguel Guelfand (clinical) [Ep 2 · 42:20](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2540)
- A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia — Miguel Guelfand (clinical) [Ep 2 · 42:38](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2558)
- Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top — Miguel Guelfand (clinical) [Ep 2 · 48:12](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2892)
- For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed — Miguel Guelfand (clinical) [Ep 2 · 48:53](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2933)
- Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias — Miguel Guelfand (clinical) [Ep 2 · 50:11](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3011)
- The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients — Miguel Guelfand (clinical) [Ep 2 · 50:48](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3048)
- For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle — Miguel Guelfand (clinical) [Ep 2 · 52:24](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3144)
- Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension — Miguel Guelfand (clinical) [Ep 2 · 54:28](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3268)
- Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks — Miguel Guelfand (clinical) [Ep 2 · 58:49](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3529)
- The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed — Miguel Guelfand (clinical) [Ep 2 · 47:20](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2840)
- Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases — Miguel Guelfand (clinical) [Ep 2 · 62:51](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3771)
- The Rotterdam case was a 35-week, 2400g female with giant omphalocele (8cm) containing liver, stomach, and small bowel, plus cardiac defect — Hester Langenfeld (clinical) [Ep 2 · 29:30](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1770)
- In the Rotterdam case, bladder pressure was 17 with some urination beside the catheter, and there was bulging of the Duoderm on the side — Hester Langenfeld (clinical) [Ep 2 · 31:42](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1902)
- The spatula moved upward on the liver side because tape at the ends caused the middle to distend when pressed — Hester Langenfeld (clinical) [Ep 2 · 32:13](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1933)
- On day 5, the omphalocele had yellow appearance but did not look infected; cultures were negative initially — Hester Langenfeld (clinical) [Ep 2 · 33:08](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1988)
- The amnion leaked fluid, but cultures remained negative until later in the course — Hester Langenfeld (clinical) [Ep 2 · 34:00](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2040)
- Enteral feeding via nasogastric tube was started on day 12 while the defect was still large — Hester Langenfeld (clinical) [Ep 2 · 35:20](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2120)
- Botox was administered on day 15 due to concerns about achieving primary closure — Hester Langenfeld (clinical) [Ep 2 · 35:43](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2143)
- The patient was ventilated but not paralyzed throughout treatment, with CO2 consistently high at 8-10 — Hester Langenfeld (clinical) [Ep 2 · 35:59](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2159)
- Serratia infection occurred on the skin/sac but the patient was not systemically ill and did not receive antibiotics — Hester Langenfeld (clinical) [Ep 2 · 36:18](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2178)
- Attempted amnion inversion on days 23-30 resulted in blue legs, tachycardia, and CO2 rising to 12, requiring abandonment of closure attempt — Hester Langenfeld (clinical) [Ep 2 · 36:44](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2204)
- The patient had lung hypoplasia contributing to inability to tolerate closure — Hester Langenfeld (clinical) [Ep 2 · 37:08](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2228)
- On day 30, treatment was switched to Mepitel (silicone dressing), after which the patient was extubated 10 days later (day 40) — Hester Langenfeld (clinical) [Ep 2 · 37:18](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2238)
- By day 45, the patient was on Optiflow, drinking 20mL per feeding three times daily, with chronic hypercapnia (CO2 of 8) — Hester Langenfeld (clinical) [Ep 2 · 37:47](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2267)

## 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 3 · 26:33](https://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 3 · 26:33](https://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 5 · 10:26](https://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 5 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- According to literature, patients with giant omphalocele and lung hypoplasia requiring long-term ventilation have a median ventilation time of 100 days — Martin summarizing the discussion [Ep 2 · 53:43](https://library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3223)

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