# Abdominal Wall Defects — GCMD Library living collection

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

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

Updated: n/a · 49 episodes · 1170 cited statements

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

### Acute Management
- [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)

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

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

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

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

### Evidence & Research
- [91% Decrease in Mortality with Gastroschisis Bundle!](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816) — video · 3:12 · [machine version](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816.md)
- [Immediate vs Silo Closure for Gastroschisis](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022) — video · 0:26 · [machine version](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022.md)
- [Gastroschisis and sutureless abdominal wall closure](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557) — podcast · 12:17 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557.md)
- [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md)
- [Quick Literature Updates Episode 6](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636.md)
- [Quick Literature Updates Episode 11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954.md)
- [Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037) — video · 0:56 · [machine version](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154) — podcast · 17:03 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154.md)
- [Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308) — podcast · 19:28 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308.md)
- [Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626.md)
- [Quick Literature Updates Episode 16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732) — video · 4:21 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732.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)
- [Quick Literature Updates Ep 22](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118) — video · 4:23 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118.md)
- [A multi-institutional comparison of management techniques for infants with giant omphalocele](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385.md)
- [A multi-institutional comparison of management techniques for infants with giant omphalocele](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457.md)
- [Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554.md)

### Case-Based Learning
- [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)
- [Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669.md)
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.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)
- [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)

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

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

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

## Chapters
- [0:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=4) Introduction and Program Context (Ep 24)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining Intestinal Failure (Ep 24)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290) Three Categories of Intestinal Failure (Ep 24)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=499) Timing of Diagnosis and Referral (Ep 24)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=604) Multidisciplinary Team Approach (Ep 24)
- [12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754) Outcomes and Future Challenges (Ep 24)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Expansion (Ep 23)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=106) Defining Intestinal Failure (Ep 23)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 23)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=499) Timing of Diagnosis and Referral (Ep 23)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=604) Team Approach and Long-term Outcomes (Ep 23)
- [13:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=794) Series Goals and Closing (Ep 23)
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Definition of Intestinal Failure (Ep 18)
- [1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102) Prognostic Factors and Bowel Length Criteria (Ep 18)
- [7:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=427) Medical Management and TPN Strategy (Ep 18)
- [12:55](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=775) Lipid Formulations and Cholestasis Management (Ep 18)
- [17:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Adaptation (Ep 18)
- [26:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Interventions: Lengthening Procedures (Ep 18)
- [38:10](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2290) Bacterial Overgrowth and Microbiome (Ep 18)
- [43:35](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 18)
- [46:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2792) Intestinal Transplantation and Multidisciplinary Care (Ep 18)
- [0:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=0) Introduction (Ep 21)
- [2:03](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=123) Timing of Umbilical Hernia Repair (Ep 21)
- [7:01](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=421) Incarcerated Umbilical Hernias and Technical Considerations (Ep 21)
- [9:57](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=597) Gastroschisis and Omphalocele-Associated Hernias (Ep 21)
- [16:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=991) Umbilical Drainage in Infants (Ep 21)
- [21:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1291) Surgical Management of Urachal Remnants (Ep 21)
- [26:11](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1571) Patent Omphalomesenteric Duct and Epigastric Hernias (Ep 21)
- [29:11](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1751) Closing Remarks (Ep 21)
- [0:00](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=0) Comparison of Giant Omphalocele Management Techniques (Ep 46)
- [0:00](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=0) Surgeon Volume and Inguinal Hernia Recurrence (Ep 47)
- [0:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=6) Study Background and Rationale (Ep 5)
- [0:50](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=50) Protocol Components (Ep 5)
- [1:40](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=100) Results and Commentary (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=0) Breast Milk vs Formula in Uncomplicated Gastroschisis (Ep 35)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=0) Introduction and Hirschsprung Disease Study (Ep 37)
- [6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=407) Gastroschisis Management Systematic Review (Ep 37)
- [13:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=836) Clavien-Madadi Classification Validation (Ep 37)
- [18:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1092) Summary and Conclusion (Ep 37)
- [0:00](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=0) Systematic Review Findings on Gastroschisis Management (Ep 40)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 24 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=125)
- "For a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days" — Rod Gerardo (guideline) [Ep 24 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 24 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 24 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 24 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis can cause short bowel syndrome" — Paul Wales (clinical) [Ep 24 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=318)
- "Motility disorders occur when the bowel is unable to push contents through in a coordinated way due to abnormalities of the muscle itself or the nerves that control that muscle" — Paul Wales (clinical) [Ep 24 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Congenital enteropathies are conditions where the patient has all of their bowel but the mucosa does not work, leading to hypersecretion and profuse fluid losses" — Paul Wales (clinical) [Ep 24 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or three categories of intestinal failure in the way they present" — Paul Wales (clinical) [Ep 24 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen Encisco (clinical) [Ep 24 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=442)
- "Older pediatric patients can develop intestinal failure from inflammatory bowel disease or Crohn's disease where they have lost gut as a result of complications" — Paul Wales (clinical) [Ep 24 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 24 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=484)
- "There are three time points where families reach intestinal rehabilitation programs: prenatal diagnosis, postnatal acquired problems, and later presentations after discharge" — Michael Helmrath (clinical) [Ep 24 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Prenatal diagnoses that lead to intestinal rehabilitation typically include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 24 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=555)
- "Postnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis" — Ellen Encisco (clinical) [Ep 24 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=569)
- "Dietitians play a key role in understanding the nutritional needs of children in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 24 · 11:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Social work is a key component of the intestinal rehabilitation team" — Michael Helmrath (opinion) [Ep 24 · 12:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=721)
- "The survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 24 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Children with intestinal failure who survive long-term now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 24 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Earlier recognition and taking advantage of the biology of the gut to adapt are time dependent" — Michael Helmrath (clinical) [Ep 24 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "Intestinal rehabilitation streamlines care and improves communication with families and between care providers and team members" — Paul Wales (opinion) [Ep 24 · 3:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=235)
- "Intestinal rehabilitation comes down to key factors that drive the process: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 24 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple eyes on a baby who have seen them over time is important in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 24 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 23 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=125)
- "New guidelines define intestinal failure as requiring parental support for at least 60 days" — Rod Gerardo (guideline) [Ep 23 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm providing coordinated care for children with intestinal failure through comprehensive management of specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 23 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 23 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 23 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis cause short bowel syndrome" — Paul Wales (clinical) [Ep 23 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=318)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves that control that muscle prevent coordinated movement of food and stool" — Paul Wales (clinical) [Ep 23 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Children with motility disorders are dependent on intravenous support" — Paul Wales (clinical) [Ep 23 · 6:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=370)
- "Enteropathies or congenital diarrheas are conditions where the patient has all of their bowel but the mucosal lining that digests and absorbs does not work" — Paul Wales (clinical) [Ep 23 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects lead to hypersecretion and profuse fluid losses such that the bowel is unable to tolerate or absorb nutrients" — Ellen (clinical) [Ep 23 · 6:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients will have elements of one, two, or all three categories of intestinal failure" — Paul Wales (clinical) [Ep 23 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen (clinical) [Ep 23 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- "Most intestinal failure patients are infants or babies, but some older kids develop intestinal failure" — Paul Wales (epidemiological) [Ep 23 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Inflammatory bowel disease or Crohn's disease can lead to gut loss and intestinal failure in older patients" — Paul Wales (clinical) [Ep 23 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 23 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=484)
- "There are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge" — Rod Gerardo (clinical) [Ep 23 · 8:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=531)
- "Prenatal diagnoses that lead to intestinal rehab referral include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 23 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=555)
- "Postnatal acquired problems leading to intestinal rehab referral include volvulus and necrotizing enterocolitis" — Ellen (clinical) [Ep 23 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=569)
- "The intestinal rehab team includes surgeons, GI doctors, neonatologists, dietitians, social work, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology" — Michael Helmrath (clinical) [Ep 23 · 11:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=703)
- "Survival overall in big intestinal rehab programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 23 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 23 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent" — Michael Helmrath (opinion) [Ep 23 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "Intestinal rehabilitation comes down to key factors: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 23 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced providers seeing patients over time is essential in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 23 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Families living within the region can benefit from understanding that delivery at an intestinal rehab center from the beginning is probably beneficial" — Michael Helmrath (opinion) [Ep 23 · 8:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=510)
- "Access and availability to an intestinal rehab program is still very rare" — Rod Gerardo (epidemiological) [Ep 23 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Innovation comes from multiple approaches to the problem and different visions, with more expertise bringing better outcomes" — Michael Helmrath (opinion) [Ep 23 · 10:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=625)
- "Transitioning older children with intestinal failure into their late teen years and later is a major obstacle that needs to be addressed" — Michael Helmrath (clinical) [Ep 23 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 18 · 1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 18 · 3:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine is a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 18 · 4:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15 to 20 centimeters would be a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 18 · 4:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years" — Brad Warner (epidemiological) [Ep 18 · 4:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "For a patient with 15 centimeters of bowel and ileocecal valve, long term 50% should be able to wean from TPN, 25% would require transplant, and 25% would die" — Brad Warner (epidemiological) [Ep 18 · 5:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=356)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 18 · 7:49](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "Stool outputs of up to 40 ccs per kilo per day are acceptable when advancing enteral feeding" — Brad Warner (guideline) [Ep 18 · 8:30](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=510)
- "For TPN, shoot for about 100 to 120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (guideline) [Ep 18 · 10:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Generally shoot for about 2 to 3 g of protein per kilo per day and about 2 to 3 g of fat per kilo per day in TPN" — Brad Warner (guideline) [Ep 18 · 10:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "A baby should gain about 20 to 30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 18 · 12:05](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes patients from 2 to 3 g per kilo per day of fat delivered daily down to about 1 g per kilo per day delivered twice or 3 times a week to reduce cholestasis" — Brad Warner (guideline) [Ep 18 · 12:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat primarily containing omega 3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega 6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 18 · 14:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "SMOF lipid contains soybean (essential fatty acids), medium chain triglycerides (easily digested), olive oil, and fish oil, and has become the most commonly used lipid in Canada" — Brad Warner (clinical) [Ep 18 · 15:08](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains growth factors like EGF and IGF, milk oligosaccharides that enhance adaptation, and other beneficial components" — Brad Warner (opinion) [Ep 18 · 18:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (clinical) [Ep 18 · 19:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, though the exact number is unknown" — Brad Warner (clinical) [Ep 18 · 21:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when patient hits a plateau enterally and starts backing away, or if going backward rather than forward in enteral tolerance" — Brad Warner (guideline) [Ep 18 · 22:33](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Multiple episodes of sepsis along with abdominal distention and dilated bowel loops is an indication for surgical intervention" — Brad Warner (guideline) [Ep 18 · 23:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1381)
- "If child is starting to get jaundiced, there is a role to evaluate the gut for subclinical portal bacteremia arising from dilated bowel loops" — Brad Warner (clinical) [Ep 18 · 23:18](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1398)
- "Dilated bowel loops cause bacterial overgrowth leading to secretory diarrhea that is not related to digestion-absorption capacity but to enzyme dysfunction" — Brad Warner (clinical) [Ep 18 · 23:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1433)
- "More than 4 to 5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (guideline) [Ep 18 · 25:43](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "In a child who is completely stable after 3 years but not progressing, would interrogate bowel and if dilated would proceed with lengthening" — Brad Warner (opinion) [Ep 18 · 26:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1567)
- "If a child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 18 · 27:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "With less than 50 centimeters of intestine and bowel at least 4 to 5 centimeters dilated, there is an option for either Bianchi or STEP procedure" — Brad Warner (guideline) [Ep 18 · 28:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP procedure has emerged to be the most commonly performed lengthening operation because it is easier to do with less risk of injuring mesenteric blood supply" — Brad Warner (clinical) [Ep 18 · 29:31](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "STEP procedures can redilate requiring redo procedures, and outcomes are not as good if a redo STEP is needed compared to never needing a redo" — Brad Warner (clinical) [Ep 18 · 32:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 18 · 33:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "STEP procedures can cause dysmotility acting as a brake on intestinal transit" — Brad Warner (clinical) [Ep 18 · 35:04](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90 to 100 centimeters of intestinal length rather than performing a lengthening procedure" — Brad Warner (opinion) [Ep 18 · 38:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2301)
- "Chenodeoxycholic acid bile salts can be used to improve bile flow in TPN cholestasis" — Brad Warner (clinical) [Ep 18 · 39:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Cholecystokinin administration to promote bile flow and mitigate TPN cholestasis did not work in clinical trials" — Brad Warner (clinical) [Ep 18 · 39:23](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Gut bacteria in short gut syndrome become more efficient and help adapt by encouraging greater absorption and digestion, similar to an obesogenic microbiome" — Brad Warner (clinical) [Ep 18 · 41:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse models, oral vancomycin to knock out gram positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 18 · 42:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide, a GLP-2 analog, has been demonstrated in randomized trials to reduce TPN requirements by about 1-2 liters per week in adults with short gut syndrome" — Brad Warner (clinical) [Ep 18 · 43:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2625)
- "Teduglutide is not yet approved for children in the United States due to concerns about malignancy risk from promoting proliferation" — Brad Warner (clinical) [Ep 18 · 44:34](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth hormone and glutamine combinations have shown primarily mixed results and have not been a huge advance in TPN weaning" — Brad Warner (clinical) [Ep 18 · 45:40](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2740)
- "Survival for small bowel transplant is about 50 to 60% at 5 years, with one year survivals now above 70 to 80%" — Brad Warner (epidemiological) [Ep 18 · 46:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is an immunogenic organ filled with white cells and macrophages that mount a huge graft versus host response requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 18 · 47:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have reduced significantly the number of sepsis episodes in patients with short gut syndrome" — Brad Warner (clinical) [Ep 18 · 49:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID, radiology, and interventional radiology improve survival of intestinal failure patients" — Brad Warner (clinical) [Ep 18 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3076)
- "Most umbilical hernias will close on their own in the first year and then some in the second year" — Kenneth Azarow (clinical) [Ep 21 · 2:58](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=178)
- "Age 2 is the earliest to consider umbilical hernia repair, with a 2 centimeter proboscis and at least 1 centimeter opening to the abdominal wall" — Kenneth Azarow (clinical) [Ep 21 · 3:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=185)
- "Typically before school entry is the optimal time for umbilical hernia repair" — Kenneth Azarow (opinion) [Ep 21 · 3:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=199)
- "Large proboscis length does not affect the decision to operate early on umbilical hernias" — Kenneth Azarow (clinical) [Ep 21 · 3:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=227)
- "Larger umbilical hernia defects (greater than 1 cm) are less likely to close spontaneously, but this should not affect timing of repair" — Kenneth Azarow (clinical) [Ep 21 · 4:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=252)
- "Race or ethnicity of the child does not affect the decision on timing of umbilical hernia repair" — Kenneth Azarow (clinical) [Ep 21 · 4:40](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=280)
- "Anesthesia data regarding operating before 2-3 years of age supports waiting for umbilical hernia repair" — Todd Ponsky (guideline) [Ep 21 · 4:54](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=294)
- "True incarcerated umbilical hernias present with bowel obstruction symptoms; if the child is eating well, it is not an emergent incarcerated hernia" — Kenneth Azarow (clinical) [Ep 21 · 5:38](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=338)
- "Red, tender umbilical lumps in children are usually incarcerated omentum, preperitoneal fat, or infected urachal cysts, not incarcerated bowel" — Kenneth Azarow (clinical) [Ep 21 · 5:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=342)
- "Incarcerated fat at the umbilicus can be treated with NSAIDs and urachal infections with antibiotics" — Kenneth Azarow (clinical) [Ep 21 · 6:09](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=369)
- "LMA can be used for umbilical hernia repair if adequate abdominal wall relaxation is achieved" — Kenneth Azarow (clinical) [Ep 21 · 7:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=467)
- "PDS or Maxon suture is preferred for umbilical hernia repair because it lasts twice as long as Vicryl and is non-braided" — Kenneth Azarow (clinical) [Ep 21 · 8:26](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=506)
- "Umbilicoplasty should be performed to excise excess skin at the time of umbilical hernia repair to achieve a flat, cosmetic result" — Kenneth Azarow (opinion) [Ep 21 · 10:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=624)
- "The undersurface of umbilical skin should be tacked down to the fascia using braided suture (Vicryl) to create an inflammatory response" — Kenneth Azarow (clinical) [Ep 21 · 11:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=702)
- "A pressure dressing should be applied for 3 days after umbilical hernia repair" — Kenneth Azarow (clinical) [Ep 21 · 12:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=744)
- "Gastroschisis is actually an umbilical ring defect because the natural history is for the hole to close on its own" — Kenneth Azarow (clinical) [Ep 21 · 13:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=780)
- "Over half of gastroschisis patients closed with sutureless technique will have large umbilical hernias, but most will close spontaneously over 2-3 years" — Kenneth Azarow (clinical) [Ep 21 · 13:28](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=808)
- "Suturing gastroschisis defects makes the umbilical ring edge ischemic and destroys ring integrity, leading to more hernias that won't close" — Kenneth Azarow (clinical) [Ep 21 · 14:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=853)
- "Omphalocele repair should be delayed as long as possible; children will grow and thrive with the defect covered" — Kenneth Azarow (clinical) [Ep 21 · 15:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=900)
- "For omphalocele, when the child lies flat and the flanks start bulging out, this indicates the abdominal girth is increasing and primary closure may be possible" — Kenneth Azarow (clinical) [Ep 21 · 15:34](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=934)
- "Operating too early on omphalocele is a mistake" — Kenneth Azarow (opinion) [Ep 21 · 16:15](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=975)
- "For umbilical drainage in infants, no ultrasound or VCUG is needed, only physical examination" — Kenneth Azarow (clinical) [Ep 21 · 18:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1136)
- "Operating on umbilical drainage in the first 3 months increases complication rates; many resolve spontaneously after 6 months" — Kenneth Azarow (clinical) [Ep 21 · 19:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1163)
- "Silver nitrate can be used to treat umbilical granulomas in the first few weeks" — Kenneth Azarow (clinical) [Ep 21 · 20:59](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1259)
- "Triamcinolone (Kenalog) cream is more effective than silver nitrate for treating umbilical granulomas" — Todd Ponsky (clinical) [Ep 21 · 21:33](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1293)
- "Steroid cream works better than silver nitrate for granulation tissue at gastrostomy sites" — Kenneth Azarow (clinical) [Ep 21 · 21:53](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1313)
- "Urachal remnant exploration is done through an umbilical incision, similar to umbilical hernia repair, with the track found inferiorly" — Kenneth Azarow (clinical) [Ep 21 · 22:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1332)
- "The urachal track bluntly dissects away from the preperitoneal space and the dome of the bladder can be pulled up to the umbilicus" — Kenneth Azarow (clinical) [Ep 21 · 23:27](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1407)
- "No preoperative VCUG or ultrasound findings changed management of urachal remnants in a 10-15 year study" — Kenneth Azarow (clinical) [Ep 21 · 24:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1445)
- "Infected urachal cysts can usually be treated with antibiotics alone; true abscesses require drainage and antibiotics" — Kenneth Azarow (clinical) [Ep 21 · 24:52](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1492)
- "Elective urachal remnant excision after infection prevents recurrent abscess" — Kenneth Azarow (clinical) [Ep 21 · 25:06](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1506)
- "Infected urachal cysts can be drained percutaneously by interventional radiology" — Kenneth Azarow (clinical) [Ep 21 · 25:20](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1520)
- "Elective urachal remnant excision can be done laparoscopically with stapling at the dome of the bladder and extraction through the umbilicus" — Kenneth Azarow (clinical) [Ep 21 · 25:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1537)
- "Patent omphalomesenteric duct (omphalocutaneous fistula with stool from umbilicus) will not close spontaneously and requires operation before hospital discharge" — Kenneth Azarow (clinical) [Ep 21 · 26:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1583)
- "Patent omphalomesenteric duct has risk of volvulus from small bowel wrapping around the fistula" — Kenneth Azarow (clinical) [Ep 21 · 26:36](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1596)
- "Patent omphalomesenteric duct can be approached through umbilical exploration with laparoscopic assistance if needed to reduce wrapped bowel" — Kenneth Azarow (clinical) [Ep 21 · 26:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1616)
- "Epigastric hernias (epiploceles) are purely elective repairs, will not cause intestinal obstruction, and are always preperitoneal fat through a pinhole defect" — Kenneth Azarow (clinical) [Ep 21 · 28:20](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1700)
- "PHIS hospital data shows the mean age of umbilical hernia repair nationally is 4 years" — Todd Ponsky (epidemiological) [Ep 21 · 29:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1762)
- "The study examined 117 infants with giant omphalocele" — Lizzie Lee (epidemiological) [Ep 46 · 0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Four treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo" — Lizzie Lee (clinical) [Ep 46 · 0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=7)
- "Babies treated with Duoderm silo were most likely to have their abdomen closed in one surgery" — Lizzie Lee (clinical) [Ep 46 · 0:19](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=19)
- "Approximately 80% of infants treated with Duoderm silo achieved single-surgery abdominal closure" — Lizzie Lee (clinical) [Ep 46 · 0:24](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=24)
- "Some babies treated with operative silos achieved closure sooner than other methods" — Lizzie Lee (clinical) [Ep 46 · 0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Complication rates were similar across all four management methods" — Lizzie Lee (clinical) [Ep 46 · 0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=25)
- "Almost half of infants required 6 months or more before complete abdominal closure could be achieved" — Lizzie Lee (clinical) [Ep 46 · 0:32](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=32)
- "There is no universal best treatment approach for giant omphalocele" — Lizzie Lee (opinion) [Ep 46 · 0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)
- "Duoderm silos may be particularly beneficial when the goal is single-stage abdominal closure" — Lizzie Lee (opinion) [Ep 46 · 0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11457?t=38)
- "Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025" — Jill Knepprath (epidemiological) [Ep 47 · 0:10](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=10)
- "Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 47 · 0:22](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=22)
- "There was no difference in recurrence rates for open repairs based on surgeon volume" — Jill Knepprath (epidemiological) [Ep 47 · 0:30](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=30)
- "Laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 47 · 0:35](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=35)
- "The authors recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon" — Jill Knepprath (guideline) [Ep 47 · 0:44](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=44)
- "The study was carried out by Hospital Infantil de Mexico Federico Gomez with Christian Zayas Vidal as first author and Jamie Nietos Armenio as senior author" — Alex (clinical) [Ep 5 · 0:14](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=14)
- "In Latin American countries, mortality from gastroschisis can exceed 15%" — Alex (epidemiological) [Ep 5 · 0:23](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=23)
- "The study compared outcomes in the first 42 patients treated after protocol implementation to the last 42 patients treated before the protocol" — Alex (clinical) [Ep 5 · 0:41](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=41)
- "Prior to the protocol, pre-transfer communication was incredibly limited" — Alex (clinical) [Ep 5 · 0:50](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=50)
- "After protocol implementation, the accepting hospital was in much closer communication" — Alex (clinical) [Ep 5 · 0:55](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=55)
- "Prior to the protocol, every patient got a central line" — Alex (clinical) [Ep 5 · 0:59](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=59)
- "After the protocol, every patient had a PICC line" — Alex (clinical) [Ep 5 · 1:03](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=63)
- "Prior to the protocol, all patients were taken to the operating room for primary reduction after extension of the defect" — Alex (clinical) [Ep 5 · 1:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=66)
- "Pre-protocol OR approach was limited by OR availability and required general anesthesia" — Alex (clinical) [Ep 5 · 1:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=66)
- "After the protocol, bedside reduction was attempted in most patients" — Alex (clinical) [Ep 5 · 1:19](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=79)
- "Prior to the protocol, all patients were mechanically ventilated and paralyzed" — Alex (clinical) [Ep 5 · 1:22](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=82)
- "Prior to the protocol, feeding advancement was totally at the discretion of the surgeon" — Alex (clinical) [Ep 5 · 1:22](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=82)
- "After the protocol, only patients with respiratory distress were intubated" — Alex (clinical) [Ep 5 · 1:31](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=91)
- "After the protocol, no patients were paralyzed" — Alex (clinical) [Ep 5 · 1:35](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "After the protocol, the authors followed a regimented feeding advancement schedule" — Alex (clinical) [Ep 5 · 1:35](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "The protocol resulted in shorter time to arrival at the accepting hospital" — Alex (clinical) [Ep 5 · 1:42](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=102)
- "The protocol resulted in less general anesthesia use" — Alex (clinical) [Ep 5 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in fewer central lines placed" — Alex (clinical) [Ep 5 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in fewer patients who needed to be intubated" — Alex (clinical) [Ep 5 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The protocol resulted in less time on the ventilator for those who were intubated" — Alex (clinical) [Ep 5 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "Mortality rate was reduced from 22% to 2% after protocol implementation" — Alex (clinical) [Ep 5 · 1:53](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=113)
- "The institution had a 22% mortality with gastroschisis before the protocol, which was higher than most" (epidemiological) [Ep 5 · 2:11](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=131)
- "Moving from surgical central lines to PICC lines reduced mortality" (clinical) [Ep 5 · 2:27](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=147)
- "Bedside reduction with silo was performed instead of mandated operating room repair" (clinical) [Ep 5 · 2:34](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=154)
- "Bedside reduction was performed without intubation when possible" (clinical) [Ep 5 · 2:59](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=179)
- "McMaster University performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis" — Alex Halpern (epidemiological) [Ep 35 · 0:13](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=13)
- "Infants with exclusive breast milk intake and those with supplemental or exclusive formula intake had similar outcomes" — Alex Halpern (clinical) [Ep 35 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in time to reach full enteral feeds" — Alex Halpern (clinical) [Ep 35 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in duration of parenteral nutrition" — Alex Halpern (clinical) [Ep 35 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in rates of necrotizing enterocolitis" — Alex Halpern (clinical) [Ep 35 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "No significant differences were found between feeding groups in length of hospital stay" — Alex Halpern (clinical) [Ep 35 · 0:24](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=24)
- "Formula intake versus exclusive breast milk intake does not affect outcomes in uncomplicated gastroschisis" — Alex Halpern (opinion) [Ep 35 · 0:44](https://library.globalcastmd.com/watch/association-of-exclusive-breast-milk-intake-and-outcomes-in-infants-with-uncomplicated-gastroschisis-a-national-cohort-study-9037?t=44)
- "85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age" — Em Gootee (epidemiological) [Ep 37 · 3:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=200)
- "Kids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age" — Em Gootee (clinical) [Ep 37 · 3:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=225)
- "Children with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium" — Em Gootee (clinical) [Ep 37 · 3:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=237)
- "Delayed diagnosis of Hirschsprung disease does not impact postoperative outcomes nor the need for revision surgery of the pull-through" — Colin Martin (clinical) [Ep 37 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=252)
- "Delayed diagnosis is associated with increased need for fecal diversion after pull-through" — Colin Martin (clinical) [Ep 37 · 4:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=252)
- "Approximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through" — Em Gootee (epidemiological) [Ep 37 · 4:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=266)
- "There was no difference in overall rates of redo pull-throughs across age groups" — Em Gootee (clinical) [Ep 37 · 5:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=301)
- "Older children were more likely to need a redo pull-through due to an anastomotic leak" — Em Gootee (clinical) [Ep 37 · 5:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=307)
- "Higher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak" — Em Gootee (clinical) [Ep 37 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=313)
- "The only functional outcome that was different was nighttime soiling or incontinence in the older patient population" — Em Gootee (clinical) [Ep 37 · 5:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=324)
- "Neonates with gastroschisis consume a disproportionate amount of resources compared to other children in the NICU" — Mark Slidell (epidemiological) [Ep 37 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=463)
- "The gastroschisis systematic review included 28 high quality manuscripts" — Em Gootee (clinical) [Ep 37 · 8:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=489)
- "Two randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered" — Em Gootee (clinical) [Ep 37 · 8:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=495)
- "There is no evidence to suggest that earlier delivery prior to 37 weeks for gastroschisis is justified" — Casey Culkins (clinical) [Ep 37 · 9:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=579)
- "Planned delivery before 37 weeks gestational age for gastroschisis is probably not beneficial and may in fact be harmful" — Mark Slidell (clinical) [Ep 37 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=596)
- "Early delivery may promote some of the complications of prematurity" — Mark Slidell (clinical) [Ep 37 · 10:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Delivery of infants with gastroschisis after 37 weeks post-conception seems to be preferable" — Mark Slidell (clinical) [Ep 37 · 10:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=604)
- "Skin organisms are most commonly identified in infections among infants with gastroschisis" — Em Gootee (clinical) [Ep 37 · 10:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=637)
- "Gastroschisis infants have a fairly high rate of wound infection" — Em Gootee (epidemiological) [Ep 37 · 10:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=644)
- "Silo closures have a higher rate of infection than other closure methods" — Em Gootee (clinical) [Ep 37 · 10:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "Sutureless closure has the lowest rate of infection in gastroschisis" — Em Gootee (clinical) [Ep 37 · 10:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=650)
- "Recommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter" — Em Gootee (guideline) [Ep 37 · 10:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=657)
- "Once the gastroschisis defect is closed, antibiotics can be safely stopped unless there is some other reason to continue" — Casey Culkins (guideline) [Ep 37 · 11:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=671)
- "Stable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes" — Em Gootee (clinical) [Ep 37 · 12:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=742)
- "Minimizing fluids and paralytics in gastroschisis infants improves their results" — Em Gootee (clinical) [Ep 37 · 12:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=749)
- "Sutureless repair for gastroschisis is associated with a clear decrease in the need for mechanical ventilation" — Casey Culkins (clinical) [Ep 37 · 13:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=785)
- "The literature on gastroschisis suffers from a lack of level 1 randomized controlled trials or high level comparative studies" — Mark Slidell (opinion) [Ep 37 · 13:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=797)
- "The Clavien-Madadi classification showed improved agreement rates of respondents at 85% versus 76% for the Clavien-Dindo classification" — Whit Holcomb (clinical) [Ep 37 · 16:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=999)
- "The Clavien-Madadi classification was less frequently considered inaccurate for rating in the pediatric population compared to the Clavien-Dindo classification" — Whit Holcomb (clinical) [Ep 37 · 16:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1013)
- "43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification" — Em Gootee (epidemiological) [Ep 37 · 17:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1024)
- "Advantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons" — Em Gootee (epidemiological) [Ep 37 · 17:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1036)
- "The ABSA Outcomes and Evidence-based Practice Committee performed a systematic review on optimal initial management of infants with gastroschisis." — Alex Halpern (guideline) [Ep 40 · 0:10](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=10)
- "Delivery after 37 weeks is optimal for infants with gastroschisis." — Alex Halpern (guideline) [Ep 40 · 0:17](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=17)
- "Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis." — Alex Halpern (guideline) [Ep 40 · 0:21](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=21)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit." — Alex Halpern (guideline) [Ep 40 · 0:27](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair for gastroschisis is safe and effective." — Alex Halpern (clinical) [Ep 40 · 0:27](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=27)
- "Sutureless repair does not delay feeding or increase length of stay in gastroschisis patients." — Alex Halpern (clinical) [Ep 40 · 0:37](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=37)
- "There is a need for high quality randomized controlled trials to provide evidence-based care for infants with gastroschisis." — Alex Halpern (opinion) [Ep 40 · 0:41](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=41)
- "The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly" — Em Gootee (clinical) [Ep 39 · 0:34](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=34)
- "Umbilical cords usually fall off at 2 to 3 weeks" — Em Gootee (clinical) [Ep 39 · 0:50](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Delayed umbilical cord separation can be a manifestation of immune deficiency" — Em Gootee (clinical) [Ep 39 · 0:50](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=50)
- "Omphalitis is bacterial colonization of the umbilical stump" — Rebecca Brown (clinical) [Ep 39 · 1:12](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=72)
- "Omphalitis is most commonly due to staph and strep from skin flora" — Em Gootee (clinical) [Ep 39 · 1:16](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=76)
- "Mild omphalitis cases may be treated with alcohol, drying, ampicillin, or amoxicillin with follow-up every 24 hours" — Em Gootee (clinical) [Ep 39 · 1:20](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=80)
- "Advanced omphalitis cases require hospital admission and pediatric surgery consultation" — Rebecca Brown (clinical) [Ep 39 · 1:30](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=90)
- "16% of patients admitted with omphalitis develop necrotizing fasciitis" — Em Gootee (epidemiological) [Ep 39 · 1:40](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=100)
- "Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants" — Rebecca Brown (epidemiological) [Ep 39 · 2:17](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=137)
- "Umbilical hernias can be associated with trisomy 13, 18, and 21" — Em Gootee (clinical) [Ep 39 · 2:27](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=147)
- "Most umbilical hernias heal by the time the child is 3 to 5 years old" — Em Gootee (clinical) [Ep 39 · 2:38](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=158)
- "If the fascial opening is larger than 1.5 centimeters, the hernia may not close by itself" — Em Gootee (clinical) [Ep 39 · 2:47](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=167)
- "In Walker's study, 96% of umbilical hernias less than 0.5 centimeters closed by six years, but no hernia greater than 1.5 centimeters closed by six years" — Em Gootee (epidemiological) [Ep 39 · 2:55](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=175)
- "Incarceration with umbilical hernias is rare, less than 0.2%, and more common with smaller defects" — Rebecca Brown (epidemiological) [Ep 39 · 3:21](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=201)
- "In a study of 308 umbilical hernia repairs by Tiffany Zinz, there was higher incidence of complications if patients were less than 4 years of age versus greater than 4 years" — Rebecca Brown (epidemiological) [Ep 39 · 3:42](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=222)
- "For asymptomatic umbilical hernias in children around 4 years old, that is when surgery should be considered" — Em Gootee (guideline) [Ep 39 · 4:20](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=260)
- "Early surgical repair before age 4 was not indicated regardless of the size of the defect" — Rebecca Brown (guideline) [Ep 39 · 4:26](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=266)
- "In a 2020 study of 9,809 patients, the 3-year recurrence rate for umbilical hernia repair was twice as high in children less than 4 years versus greater than 4 years" — Rebecca Brown (epidemiological) [Ep 39 · 4:40](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=280)
- "Unplanned emergency department returns within 30 days occurred at 2.5% and were twice as high for patients younger than 4 years old" — Em Gootee (epidemiological) [Ep 39 · 4:54](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=294)
- "Asymptomatic umbilical hernia repair should be delayed until greater than 4 years of age" — Em Gootee (guideline) [Ep 39 · 5:10](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=310)
- "In Rangel's study of 167,000 patients, 4,486 had umbilical hernia diagnosis at median age of 1.6 months" — Em Gootee (epidemiological) [Ep 39 · 5:18](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=318)
- "Spontaneous closure of umbilical hernias occurred in 89% by age 5" — Em Gootee (epidemiological) [Ep 39 · 5:53](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=353)
- "Closure rates for smaller hernias (less than 1 cm) were nearly 90%, while for larger hernias they were around 80%" — Em Gootee (epidemiological) [Ep 39 · 5:53](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=353)
- "If umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years" — Rebecca Brown (epidemiological) [Ep 39 · 6:03](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=363)
- "Umbilical hernia repair should be delayed until age 5 years based on high spontaneous closure rates" — Em Gootee (guideline) [Ep 39 · 6:12](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=372)
- "A large hernia may have a very small defect, and those seen early are more likely to close" — Rebecca Brown (opinion) [Ep 39 · 6:22](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=382)
- "If a hernia has a huge defect and is proboscoid, it is probably not going to close" — Rebecca Brown (opinion) [Ep 39 · 6:34](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=394)
- "Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and large proboscoid hernias in children about to start school" — Rebecca Brown (guideline) [Ep 39 · 6:43](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=403)
- "Proboscoid hernia should be corrected before school age to avoid psychological issues" — Em Gootee (guideline) [Ep 39 · 7:00](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=420)
- "General guideline is 5 years regardless of size; if it hasn't closed, fix it; until then leave it alone unless symptomatic" — Rebecca Brown (guideline) [Ep 39 · 7:11](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=431)
- "Umbilical hernia repair involves interrupted closure using vicryl or absorbable suture" — Em Gootee (clinical) [Ep 39 · 7:22](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=442)
- "Umbilical granulomas are the most common umbilical masses of a newborn" — Rebecca Brown (epidemiological) [Ep 39 · 8:52](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=532)
- "Umbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time" — Em Gootee (clinical) [Ep 39 · 8:55](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=535)
- "Umbilical granulomas often respond to silver nitrate treatment" — Em Gootee (clinical) [Ep 39 · 9:00](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=540)
- "Silver nitrate application can cause burnt skin around the belly button if not properly applied" — Em Gootee (clinical) [Ep 39 · 9:07](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=547)
- "Applying water after silver nitrate application helps neutralize the burn and prevent it from spreading" — Rebecca Brown (clinical) [Ep 39 · 9:17](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=557)
- "Bright red, pedunculated umbilical granulomas that bleed easily are more difficult to manage" — Em Gootee (clinical) [Ep 39 · 9:37](https://library.globalcastmd.com/watch/umbilical-disorders-with-dr-rebeccah-brown-9616?t=577)
- "A large multi-center study compared silo versus immediate closure for gastroschisis" (clinical) [Ep 12 · 0:06](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=6)
- "Hawkins et al. published the study in the August issue of GPS" (clinical) [Ep 12 · 0:13](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study showed no difference between silo and immediate closure for gastroschisis" (clinical) [Ep 12 · 0:13](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=13)
- "The study examined mortality, sepsis, readmission rate, and time to full feeds as outcomes" (clinical) [Ep 12 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in mortality between silo and immediate closure" (clinical) [Ep 12 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in sepsis rates between silo and immediate closure" (clinical) [Ep 12 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in readmission rates between silo and immediate closure" (clinical) [Ep 12 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "No difference was found in time to full feeds between silo and immediate closure" (clinical) [Ep 12 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "Either silo or immediate closure is an acceptable choice for gastroschisis management" (opinion) [Ep 12 · 0:24](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=24)
- "Gastroschisis is a full thickness abdominal wall defect that typically occurs to the right of the umbilicus" (clinical) [Ep 14 · 0:32](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=32)
- "Gastroschisis has a reported incidence of 1 in 6000 to 1 in 10,000" (epidemiological) [Ep 14 · 0:39](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=39)
- "At UC Irvine's two neonatal intensive care units, they care for 30 to 40 patients per year with gastroschisis" (epidemiological) [Ep 14 · 0:49](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=49)
- "Gastroschisis is second only to inguinal hernias as a congenital anomaly requiring surgical correction at their institution" (epidemiological) [Ep 14 · 0:57](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=57)
- "Traditional staged closure with sutured elastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications" (clinical) [Ep 14 · 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" (clinical) [Ep 14 · 1:27](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=87)
- "Dr. James Fisher and colleagues from Loma Linda University were the first to publish a series of patients undergoing routine bedside silo placement" (clinical) [Ep 14 · 2:08](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=128)
- "A prospective randomized study comparing primary to staged closure of gastroschisis is in progress but results are not yet available" (clinical) [Ep 14 · 2:33](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=153)
- "Several retrospective studies from large US centers reported favorable results with spring-loaded silo staged closure compared to primary closure controls" (clinical) [Ep 14 · 2:43](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=163)
- "Advantages of routine silo placement with delayed closure include 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" (clinical) [Ep 14 · 2:57](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=177)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed nor is early labor induced" (clinical) [Ep 14 · 4:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=270)
- "The Bentek silo is available in 7 sizes from 3 centimeters to 15 centimeters diameter" (clinical) [Ep 14 · 5:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=320)
- "A ring that is 2 centimeters larger than the diameter of the defect is typically chosen" (clinical) [Ep 14 · 5:37](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=337)
- "Most gastroschisis defects are 2 to 3 centimeters in diameter, making 4 and 5 centimeter silos the most commonly used" (clinical) [Ep 14 · 5:42](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=342)
- "Gastroschisis cases involving atresia typically contain severely distended bowel and often require a 7.5 centimeter silo" (clinical) [Ep 14 · 5:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=359)
- "A distal colon severely distended with meconium is a good indication of the probable absence of a proximal atresia or stenosis" (clinical) [Ep 14 · 6:56](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=416)
- "If an obstruction exists without perforation, their policy is to proceed with silo placement and closure, followed by exploration 4 to 6 weeks later" (clinical) [Ep 14 · 8:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=489)
- "Too much traction on the ring will cause abdominal wall congestion and edema, complicating closure later" (clinical) [Ep 14 · 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 abdominal contents, most notably the duodenum, with risk of pressure necrosis" (clinical) [Ep 14 · 13:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=789)
- "Final closure is performed when the silo contents are within 2 centimeters of the abdominal wall" (clinical) [Ep 14 · 13:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=800)
- "Unnecessary prolongation of silo duration has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications" (clinical) [Ep 14 · 13:34](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=814)
- "The silo essentially creates a closed system by completely containing the bowel and peritoneal fluid" (clinical) [Ep 14 · 13:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=832)
- "Skin edge bites exactly at the edge are likely to cause skin necrosis and possible wound infection; bites should be approximately 3 millimeters from the skin edge" (clinical) [Ep 14 · 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 gradual reduction of liver along with bowel" (clinical) [Ep 14 · 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 abdominal wall prevent premature dislodgement" (clinical) [Ep 14 · 26:10](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1570)
- "The silo can be used in cases of neonatal abdominal compartment syndrome such as severe diffuse necrotizing enterocolitis" (clinical) [Ep 14 · 26:34](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1594)
- "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes" — Em Gootee (clinical) [Ep 36 · 1:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85)
- "MMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (clinical) [Ep 36 · 1:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=97)
- "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (clinical) [Ep 36 · 1:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103)
- "Out of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (epidemiological) [Ep 36 · 1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=116)
- "Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin" — Em Gootee (clinical) [Ep 36 · 2:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=156)
- "GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain" — Em Gootee (clinical) [Ep 36 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182)
- "GGT blood test levels are used to detect diseases of the liver and bile ducts" — Em Gootee (clinical) [Ep 36 · 3:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=192)
- "Biliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion" — Em Gootee (clinical) [Ep 36 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=207)
- "Lower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes" — Em Gootee (clinical) [Ep 36 · 4:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249)
- "The reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown" — Em Gootee (clinical) [Ep 36 · 4:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281)
- "The gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants" — Em Gootee (epidemiological) [Ep 36 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422)
- "78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula" — Em Gootee (epidemiological) [Ep 36 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463)
- "Patients with gastroschisis who had some exposure to formula in the first 28 days of life did not have increased risk of necrotizing enterocolitis or major differences in reaching full enteral feeds" — Mike Livingston (clinical) [Ep 36 · 8:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=492)
- "There were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay" — Em Gootee (clinical) [Ep 36 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507)
- "Gastroschisis patients exposed to formula seemed to have a slightly faster time getting to full feeds, likely related to timing of closure rather than feeding" — Mike Livingston (clinical) [Ep 36 · 8:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514)
- "Gastroschisis patients who received exclusive breast milk in first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Mike Livingston (clinical) [Ep 36 · 8:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533)
- "The transition systematic review found 8 studies that included patient and parent responses and clinician perspectives" — Whit Holcomb (epidemiological) [Ep 36 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766)
- "The transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (epidemiological) [Ep 36 · 12:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=775)
- "There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)" — Em Gootee (clinical) [Ep 36 · 13:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=796)
- "The life course progression of anorectal malformation and Hirschsprung disease is not well understood" — Em Gootee (clinical) [Ep 36 · 13:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=810)
- "Barriers and enablers of successful transition for surgical patients showed agreement with those for medical patients that guidelines were based on" — Sebastian King (clinical) [Ep 36 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "Patients felt clinicians did not always understand the need for transitioning their child's care from pediatric to adult settings, including the reasons, processes, and how to make processes smooth" — Sebastian King (opinion) [Ep 36 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "There was little evidence that transfer of colorectal patients happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 36 · 14:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862)
- "Patients felt clinicians did not always understand the significance of transfer to an adult service" — Whit Holcomb (opinion) [Ep 36 · 14:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=871)
- "No models of transfer of care for colorectal conditions were identified" — Whit Holcomb (clinical) [Ep 36 · 14:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878)
- "Ziegler et al. performed a prospective study in 10 patients with giant omphalocele and 6 with complicated gastroschisis" — Alex Halpern (clinical) [Ep 38 · 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 (clinical) [Ep 38 · 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 (clinical) [Ep 38 · 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 (clinical) [Ep 38 · 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" — Alex Halpern (clinical) [Ep 38 · 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 (clinical) [Ep 38 · 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 (opinion) [Ep 38 · 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)
- "Connecticut Children's Medical Center implemented an algorithm for managing esophageal button batteries in 2019 that includes activating the critical airway response team" — Eleanor Cisco (clinical) [Ep 41 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=60)
- "The study compared patients presenting with esophageal button batteries before algorithm implementation (2015-2019) with those after implementation (2019-2022)" — Eleanor Cisco (clinical) [Ep 41 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=72)
- "There was a significant reduction in time from chest X-ray to OR for button battery removal after algorithm implementation" — Eleanor Cisco (clinical) [Ep 41 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=85)
- "The algorithm implementation helped children receive needed care faster for esophageal button batteries" — Eleanor Cisco (opinion) [Ep 41 · 1:34](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=94)
- "McMaster University performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=128)
- "Infants with exclusive breast milk intake and those with supplemental or exclusive formula intake had similar outcomes in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in time to reach full enteral feeds in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in duration of parenteral nutrition in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in rates of necrotizing enterocolitis in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "No significant differences were found between breast milk and formula groups in length of hospital stay in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "Formula intake versus exclusive breast milk intake does not affect outcomes in uncomplicated gastroschisis" — Alex Halpern (clinical) [Ep 41 · 2:38](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=158)
- "A retrospective single institution study in Phoenix from 2017 to 2021 examined cryoablation in Nuss procedures" — Cecilia Jenna (clinical) [Ep 41 · 3:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "The study compared patients undergoing Nuss procedure with cryoanalgesia in the first quarter of experience with the fourth quarter" — Cecilia Jenna (clinical) [Ep 41 · 3:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "350 patients underwent Nuss procedure with cryoanalgesia in the study period" — Cecilia Jenna (epidemiological) [Ep 41 · 3:27](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=207)
- "Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter for Nuss procedures with cryoanalgesia" — Cecilia Jenna (clinical) [Ep 41 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Patients in the last quarter required 74% less opioids compared to the first quarter for Nuss procedures with cryoanalgesia" — Cecilia Jenna (clinical) [Ep 41 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Experience plays a role in outcomes for cryoanalgesia in Nuss procedures" — Cecilia Jenna (opinion) [Ep 41 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=224)
- "The Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries" — Lizzie Lee (clinical) [Ep 44 · 1:03](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=63)
- "Primary outcomes examined were anastomotic complications, enterocolitis, and constipation" — Lizzie Lee (clinical) [Ep 44 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=80)
- "There was no significant difference in anastomotic complications between dilation and non-dilation groups" — Lizzie Lee (clinical) [Ep 44 · 1:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "The non-dilation group had less enterocolitis and less constipation compared to traditional dilation group" — Lizzie Lee (clinical) [Ep 44 · 1:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "Choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis" — Lizzie Lee (opinion) [Ep 44 · 1:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=96)
- "For gastroschisis, delivery after 37 weeks is optimal" — Alex Halpern (guideline) [Ep 44 · 2:18](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=138)
- "Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis" — Alex Halpern (guideline) [Ep 44 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=141)
- "Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit" — Alex Halpern (guideline) [Ep 44 · 2:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "Sutureless repair for gastroschisis is safe, effective, and does not delay feeding or increase length of stay" — Alex Halpern (clinical) [Ep 44 · 2:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "There is a need for high quality randomized controlled trials to help provide evidence-based care for gastroschisis infants" — Alex Halpern (opinion) [Ep 44 · 2:42](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=162)
- "The CDH study was retrospective, done in Texas using a state hospital database" — Cecilia Gigena (clinical) [Ep 44 · 3:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=196)
- "The CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers" — Cecilia Gigena (epidemiological) [Ep 44 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=212)
- "High volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients" — Cecilia Gigena (clinical) [Ep 44 · 3:46](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had significantly shorter length of stay for CDH patients" — Cecilia Gigena (clinical) [Ep 44 · 3:46](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=226)
- "High volume centers had better outcomes for patients with CDH" — Cecilia Gigena (opinion) [Ep 44 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=240)
- "The study examined 117 infants with giant omphalocele." — Lizzie Lee (epidemiological) [Ep 45 · 0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=7)
- "Four treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo." — Lizzie Lee (clinical) [Ep 45 · 0:07](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=7)
- "Babies treated with Duoderm silo were most likely to have their abdomen closed in one surgery." — Lizzie Lee (clinical) [Ep 45 · 0:19](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=19)
- "Approximately 80% of infants treated with Duoderm silo achieved single-stage abdominal closure." — Lizzie Lee (clinical) [Ep 45 · 0:24](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=24)
- "Some babies treated with operative silos achieved closure sooner than other methods." — Lizzie Lee (clinical) [Ep 45 · 0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=25)
- "The overall chance of complications was similar across all four treatment methods." — Lizzie Lee (clinical) [Ep 45 · 0:25](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=25)
- "Almost half of the infants required six months or more before complete abdominal closure could be achieved." — Lizzie Lee (clinical) [Ep 45 · 0:32](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=32)
- "There is no one-size-fits-all treatment for giant omphalocele." — Lizzie Lee (opinion) [Ep 45 · 0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=38)
- "Duoderm silos may be a particularly good option when the goal is single-stage abdominal closure." — Lizzie Lee (opinion) [Ep 45 · 0:38](https://library.globalcastmd.com/watch/a-multi-institutional-comparison-of-management-techniques-for-infants-with-giant-omphalocele-11385?t=38)
- "97% of bilateral kidney tumors in children are Wilms tumor" — Tony Sandler (epidemiological) [Ep 4 · 9:12](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=552)
- "Current protocol for bilateral Wilms is to start chemotherapy without biopsy, typically 2 cycles, and stop when tumor shrinkage plateaus (defined as less than 50% volume reduction)" — Tony Sandler (guideline) [Ep 4 · 1:32](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=92)
- "When bilateral Wilms tumors stop shrinking after chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 4 · 4:30](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=270)
- "Bilateral nephron-sparing surgery for Wilms can be performed using on-ice technique with vascular clamping and sharp dissection" — Tony Sandler (clinical) [Ep 4 · 4:53](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=293)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 4 · 3:27](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=207)
- "Anaplastic Wilms tumor recurrence portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 4 · 6:48](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=408)
- "Multifocal Wilms tumors raise concern about underlying embryologic kidney abnormalities and risk for developing additional tumors" — Dan (clinical) [Ep 4 · 8:15](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=495)
- "If gastroschisis fascia is not cut during closure, umbilical hernias will typically close spontaneously and do not require repair" — Tony Sandler (clinical) [Ep 4 · 13:05](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=785)
- "Gastroschisis with atresia typically presents with pristine bowel at the atresia site, unlike inflamed gastroschisis bowel" — Tony Sandler (clinical) [Ep 4 · 19:14](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1154)
- "Ambient intra-abdominal pressure is lower when gastroschisis fascia is not closed compared to fascial closure" — Tony Sandler (clinical) [Ep 4 · 19:26](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1166)
- "Gastroschisis bowel can transform from inflamed appearance to normal intestine within 2 weeks, earlier than the traditional 4-6 week teaching" — Tony Sandler (clinical) [Ep 4 · 22:23](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1343)
- "STEP registry data discourages performing STEP procedures in the perinatal period due to poor outcomes" — Greg (guideline) [Ep 4 · 26:24](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1584)
- "Patients with gastroschisis have motility disorders that make STEP procedures less beneficial" — Greg (clinical) [Ep 4 · 26:33](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1593)
- "Bianchi procedure is preferred over STEP because it allows subsequent STEP if needed, whereas STEP limits future lengthening options" — Greg (opinion) [Ep 4 · 26:46](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1606)
- "In neonates with questionable short gut, plication is preferred over tapering to preserve bowel for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 4 · 28:12](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1692)
- "Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from ring compression exceed the reduction forces" — Todd (opinion) [Ep 4 · 14:27](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=867)
- "Tegaderm dressing for gastroschisis is typically left in place for 3 days, then converted to dry dressing when bowel is adherent" — Tony Sandler (clinical) [Ep 4 · 15:06](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=906)
- "Feeding can be started in gastroschisis when bowel function returns, without waiting for complete fascial closure" — Tony Sandler (clinical) [Ep 4 · 16:08](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=968)
- "Umbilical ostomy technique involves sewing dilated atretic bowel to the fascial ring at the umbilicus with downstream bowel tacked adjacent, waiting 2-4 weeks, then coring out and anastomosing" (clinical) [Ep 4 · 16:42](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1002)
- "Primary anastomosis of gastroschisis-associated atresia is risky because the bowel size discrepancy creates a tenuous anastomosis in air-exposed bowel" (clinical) [Ep 4 · 18:36](https://library.globalcastmd.com/watch/bilateral-wilm-s-tumor-complex-gastroschisis-complex-ileal-atresia-669?t=1116)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 20 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0)
- "With gastroschisis, the main issue is that the bowel gets damaged through fetal life" — Jacob Langer (clinical) [Ep 20 · 4:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=276)
- "Most gastroschisis patients don't have any other associated anomalies" — Jacob Langer (clinical) [Ep 20 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "It's pretty rare to have other anomalies or abnormal chromosomes with gastroschisis" — Jacob Langer (clinical) [Ep 20 · 4:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=292)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis" — Jacob Langer (clinical) [Ep 20 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "Most people nowadays would not do routine cesarean section for gastroschisis" — Jacob Langer (opinion) [Ep 20 · 6:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=378)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 20 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 20 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly due to inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 20 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor induction at 37 weeks is usually successful, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 20 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=461)
- "Most evidence from the CapsNet database suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 20 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 20 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (clinical) [Ep 20 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Using forceps at the bedside to push bowel back in can damage the bowel" — Jacob Langer (clinical) [Ep 20 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "Intraabdominal pressure should be kept below 20 during gastroschisis reduction" — Jacob Langer (clinical) [Ep 20 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=734)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 20 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two different kinds of intestinal atresia in gastroschisis: early-onset atresia and late-onset atresia associated with vanishing gastroschisis" — Jacob Langer (clinical) [Ep 20 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect gets very small as the baby grows, causing ischemia and necrosis of the exteriorized bowel" — Jacob Langer (clinical) [Ep 20 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN, and improved sepsis control" — Jacob Langer (clinical) [Ep 20 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "There is no good evidence for how to manage atresia in gastroschisis—whether to repair at initial closure, create stomas, or delay repair" — Jacob Langer (opinion) [Ep 20 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "Neonatal stomas prolapse no matter what technique is used" — Jacob Langer (clinical) [Ep 20 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average for gastroschisis patients to start having bowel movements" — Jacob Langer (clinical) [Ep 20 · 24:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1470)
- "A UK study showed that cisapride shortened the period of intestinal dysmotility in gastroschisis, but cisapride is no longer available" — Jacob Langer (clinical) [Ep 20 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "Metoclopramide can be given intravenously, ensuring the patient receives the medication even with poor intestinal absorption" — Jacob Langer (clinical) [Ep 20 · 25:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1520)
- "Going in too early to explore for mechanical obstruction in gastroschisis with prolonged dysmotility is a mistake" — Jacob Langer (opinion) [Ep 20 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, the exteriorized testis is usually the right testis" — Jacob Langer (clinical) [Ep 20 · 28:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 20 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 20 · 28:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 20 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "There is no rationale for routine cesarean section or preterm delivery for small omphaloceles" — Jacob Langer (opinion) [Ep 20 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair from a surgical point of view" — Jacob Langer (clinical) [Ep 20 · 30:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1829)
- "Giant omphaloceles are associated with pulmonary hypoplasia, which is difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 20 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "The pressure guideline of 20 for abdominal wall defect closure was established by Stuart Lacy in the 1980s based on rabbit studies and then validated in children" — Jacob Langer (clinical) [Ep 20 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jacob Langer (clinical) [Ep 20 · 34:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of intraabdominal pressure is more important than the absolute number during reduction" — Jacob Langer (clinical) [Ep 20 · 34:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days" — Jacob Langer (clinical) [Ep 20 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Spring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time" — Todd Ponsky (clinical) [Ep 20 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "A larger abdominal wall defect after silo use takes longer to close on its own after bowel reduction" — Jacob Langer (clinical) [Ep 20 · 18:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1121)
- "Using Duoderm to gradually reduce giant omphaloceles appears to achieve reduction more quickly than other methods" — Jacob Langer (clinical) [Ep 20 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or extremely large size" — Jacob Langer (clinical) [Ep 20 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles with a small abdominal wall defect but large external component will never reduce spontaneously" — Jacob Langer (clinical) [Ep 20 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "In mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 20 · 41:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "In delayed omphalocele repair, the defect often extends to the costal margin, requiring patch closure of the upper portion" — Jacob Langer (clinical) [Ep 20 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails to provide adequate closure in approximately 50% of omphalocele repairs" — Jacob Langer (clinical) [Ep 20 · 44:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2644)
- "Omphalocele may be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jacob Langer (clinical) [Ep 20 · 44:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 20 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiology can usually place a G-tube lateral to a giant omphalocele defect under fluoroscopy" — Jacob Langer (clinical) [Ep 20 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "Performing fundoplication in a child with an unreduced giant omphalocele is extremely difficult because the liver is midline and blocks access to the hiatus" — Jacob Langer (clinical) [Ep 20 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "In giant omphaloceles, the midline liver can compress the duodenum or pylorus, causing mechanical gastric outlet obstruction" — Jacob Langer (clinical) [Ep 20 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus" — Jacob Langer (clinical) [Ep 20 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Children with omphalocele who develop appendicitis may have delayed diagnosis due to abnormal appendix location" — Jacob Langer (clinical) [Ep 20 · 49:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2954)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not carefully identified" — Jacob Langer (clinical) [Ep 20 · 50:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=0)
- "Most gastroschisis patients don't have any other associated anomalies and it's rare to have abnormal chromosomes" — Jacob Langer (clinical) [Ep 6 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=286)
- "Early papers showed benefit to cesarean section for gastroschisis, but those cesarean sections were usually done early at 36-37 weeks, raising the question of whether timing rather than mode of delivery gave the benefit" — Jacob Langer (clinical) [Ep 6 · 5:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=346)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis and most people nowadays would not do routine cesarean section" — Jacob Langer (clinical) [Ep 6 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 6 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 6 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 6 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=427)
- "Labor can usually be successfully induced at 37 weeks in gastroschisis pregnancies, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 6 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=461)
- "Most evidence suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 6 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 6 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (opinion) [Ep 6 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jacob Langer (clinical) [Ep 6 · 11:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jacob Langer (clinical) [Ep 6 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=689)
- "Intra-abdominal pressure should be kept below 20 mmHg during gastroschisis reduction" — Jacob Langer (clinical) [Ep 6 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=734)
- "The sutureless closure technique using the umbilical cord stump to cover the defect is based on Anthony Sandler's experience, who trained in Toronto" — Jacob Langer (clinical) [Ep 6 · 13:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=820)
- "A study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (clinical) [Ep 6 · 14:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=859)
- "Spring-loaded silos create outward pressure as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 6 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 6 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia with dilated but not thick-walled bowel, and late atresia from progressive constriction causing ischemia" — Jacob Langer (clinical) [Ep 6 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect becomes very small and the majority of small bowel becomes necrotic and disappears" — Jacob Langer (clinical) [Ep 6 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN that doesn't damage the liver, and control of sepsis" — Jacob Langer (clinical) [Ep 6 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1215)
- "Three management options for atresia in gastroschisis: repair at time of closure, bring out stomas, or reduce everything and repair atresia later" — Jacob Langer (clinical) [Ep 6 · 20:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1254)
- "There is no good evidence for management of atresia in gastroschisis because it's rare, so treatment should be individualized" — Jacob Langer (opinion) [Ep 6 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1275)
- "The umbilicus is the preferred site for neonatal stomas because it leaves a scar that would have been there anyway and is convenient for appliance placement" — Jacob Langer (opinion) [Ep 6 · 22:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jacob Langer (clinical) [Ep 6 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jacob Langer (clinical) [Ep 6 · 24:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1467)
- "Metoclopramide can be given intravenously, which is advantageous over oral prokinetics in patients with motility problems" — Jacob Langer (clinical) [Ep 6 · 25:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1517)
- "A randomized prospective trial is underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 6 · 25:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1537)
- "Contrast enema and upper GI studies at 4 weeks may not give clear answers about mechanical obstruction versus hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 6 · 25:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1557)
- "Laparotomy for persistent ileus in gastroschisis is usually performed around 6 weeks if the patient hasn't opened up" — Jacob Langer (clinical) [Ep 6 · 26:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1604)
- "Going in too early for persistent ileus in gastroschisis is a mistake" — Jacob Langer (opinion) [Ep 6 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1641)
- "The exteriorized testis in gastroschisis is usually the right testis" — Jacob Langer (clinical) [Ep 6 · 28:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1680)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 6 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 6 · 28:38](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1718)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 6 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1787)
- "There is no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery for small omphaloceles" — Jacob Langer (clinical) [Ep 6 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1805)
- "Most surgeons recommend cesarean section for giant omphaloceles, although this is not evidence-based" — Jacob Langer (opinion) [Ep 6 · 31:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1881)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 6 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1915)
- "Intra-abdominal pressure monitoring is very helpful in omphalocele reduction, with a target pressure below 20 mmHg" — Jacob Langer (clinical) [Ep 6 · 33:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1994)
- "Stuart Lacy established the pressure guideline of 20 mmHg in the 1980s based on rabbit studies and then prospectively validated it in children with abdominal wall defects" — Jacob Langer (clinical) [Ep 6 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2008)
- "The Montreal group first described using the omphalocele sac as a silo with sequential ligation" — Jacob Langer (clinical) [Ep 6 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2107)
- "Using Duoderm to gradually reduce omphalocele appears to achieve reduction more quickly than sac ligation" — Jacob Langer (clinical) [Ep 6 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, bad cardiac disease, pulmonary hypoplasia, multiple anomalies, abnormal chromosomes, or giant size" — Jacob Langer (clinical) [Ep 6 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2292)
- "Mushroom-shaped omphaloceles with small abdominal wall defects but large external contents will never reduce spontaneously" — Jacob Langer (clinical) [Ep 6 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2470)
- "For mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 6 · 41:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2479)
- "Component separation in pediatric patients is controversial, with concerns about devascularization and worsening the situation" — Jacob Langer (opinion) [Ep 6 · 43:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2586)
- "In omphalocele repair, the defect often extends to the costal margin where closure is impossible, requiring patch placement in the upper portion" — Jacob Langer (clinical) [Ep 6 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2615)
- "Surgisis patch fails about 50% of the time in omphalocele repair, requiring replacement with non-absorbable mesh" — Jacob Langer (clinical) [Ep 6 · 44:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2641)
- "Pentalogy of Cantrell may include missing pericardium or Morgagni hernia associated with omphalocele" — Jacob Langer (clinical) [Ep 6 · 44:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2692)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 6 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2768)
- "GJ tubes placed by interventional radiology lateral to the omphalocele defect allow feeding despite severe reflux" — Jacob Langer (clinical) [Ep 6 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2790)
- "Fundoplication in a child with a large omphalocele defect is extremely difficult because the midline liver makes hiatus access almost impossible" — Jacob Langer (clinical) [Ep 6 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2835)
- "In omphalocele babies, the midline liver can put pressure on the duodenum or pylorus, causing mechanical gastric outlet obstruction that worsens reflux" — Jacob Langer (clinical) [Ep 6 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus, so Ladd's procedure is not needed" — Jacob Langer (clinical) [Ep 6 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if performing Ladd's procedure, but appendix should be preserved if renal abnormality exists that might require Mitrofanoff" — Jacob Langer (clinical) [Ep 6 · 49:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2946)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not careful" — Jacob Langer (clinical) [Ep 6 · 50:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3010)
- "97% of bilateral large kidney tumors in children are Wilms tumor" — Tony Sandler (epidemiological) [Ep 8 · 9:12](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- "For bilateral Wilms tumors, chemotherapy is started without biopsy and continued until tumor shrinkage stops, typically defined as less than 50% volume reduction" — Tony Sandler (guideline) [Ep 8 · 1:32](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- "When bilateral Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 8 · 4:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- "Bilateral nephron-sparing surgery is achievable in most cases of large bilateral Wilms tumors using on-table renal hypothermia with ice and vascular clamping" — Tony Sandler (clinical) [Ep 8 · 4:44](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 8 · 3:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- "Anaplastic Wilms tumor recurrence portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 8 · 6:48](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- "Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy" — Tony Sandler (opinion) [Ep 8 · 7:56](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- "Multifocal renal tumors raise concern about underlying embryologic abnormalities and risk of developing additional tumors" — Dan (clinical) [Ep 8 · 8:15](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- "For gastroschisis with inflamed bowel, bedside reduction without intubation is possible in approximately 80% of cases" — Todd (clinical) [Ep 8 · 10:29](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=629)
- "Early delivery of gastroschisis cases results in less thick and matted bowel" (clinical) [Ep 8 · 11:11](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- "For gastroschisis closure without fascial incision, umbilical hernias that develop will typically close spontaneously over 3-5 years" — Tony Sandler (clinical) [Ep 8 · 12:54](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- "Spring-loaded Bianchi silos may enlarge the fascial defect due to outward radial forces from the compression ring" — Todd (opinion) [Ep 8 · 14:20](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=860)
- "Tegaderm dressing is left in place for approximately 3 days on gastroschisis closures, then converted to dry dressing when adherent" — Tony Sandler (clinical) [Ep 8 · 15:06](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=906)
- "Feeding can be started when bowel function returns in gastroschisis cases, without waiting for complete fascial closure" — Tony Sandler (clinical) [Ep 8 · 16:08](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=968)
- "For gastroschisis with atresia and pristine bowel, bringing an ostomy out through the umbilical fascial ring is technically advantageous" (clinical) [Ep 8 · 17:49](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- "Anastomosis in gastroschisis with atresia is technically difficult due to size mismatch between dilated proximal and decompressed distal bowel" (clinical) [Ep 8 · 18:36](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- "In gastroschisis with unclear atresia and inflamed bowel, reduction without anastomosis is preferred, with re-exploration at 4-6 weeks" — Tony Sandler (clinical) [Ep 8 · 19:14](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1154)
- "Closing fascia in gastroschisis increases intra-abdominal pressure compared to leaving it open with Tegaderm coverage" — Tony Sandler (clinical) [Ep 8 · 19:26](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1166)
- "Re-exploration at 2 weeks in complex gastroschisis can show transformation of inflamed bowel into viable intestine suitable for anastomosis" — Tony Sandler (clinical) [Ep 8 · 22:07](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- "For apple peel ileal atresia with ischemic distal bowel, resection is indicated rather than waiting for reperfusion if bowel does not pink up on the operating table" — Tony Sandler (clinical) [Ep 8 · 25:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1519)
- "Plication of dilated proximal bowel in neonatal atresia is preferred over tapering to preserve bowel length for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 8 · 28:10](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- "The STEP registry discourages performing STEP procedures in the perinatal period due to poor outcomes" — Greg (guideline) [Ep 8 · 26:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1587)
- "STEP procedures in gastroschisis patients have limited benefit due to underlying motility disorders" — Greg (clinical) [Ep 8 · 26:33](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- "Bianchi procedure is preferred over STEP for initial bowel lengthening because it preserves the option for subsequent STEP, whereas STEP limits future lengthening options" — Greg (opinion) [Ep 8 · 26:46](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- "Abdominal wall forms around 4th week of gestation, before most women know they are pregnant" — Joyce (clinical) [Ep 9 · 0:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=31)
- "During 6th week, rapid intestinal growth and liver expansion causes herniation of midgut into umbilical cord" — Joyce (clinical) [Ep 9 · 0:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=40)
- "Around 10th week, herniated bowel loops return to abdominal cavity and assume fixed position" — Joyce (clinical) [Ep 9 · 0:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=50)
- "Gastroschisis is more common than omphalocele" — Joyce (epidemiological) [Ep 9 · 1:20](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=80)
- "In gastroschisis, umbilical cord is located to the left of the defect; in omphalocele it is in the center" — Joyce (clinical) [Ep 9 · 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" — Joyce (clinical) [Ep 9 · 1:32](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=92)
- "Associated anomalies occur in 10% of gastroschisis cases but 60-75% of omphalocele cases" — Joyce (epidemiological) [Ep 9 · 1:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=112)
- "Gastroschisis defect is usually found lateral to umbilicus on the right more than left, approximately 4 cm in size" — Joyce (clinical) [Ep 9 · 2:21](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=141)
- "Etiology of gastroschisis remains unknown; theories propose vascular event involving right umbilical vein or right omphalomesenteric artery causing necrosis and abdominal wall weakening" — Joyce (clinical) [Ep 9 · 2:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=160)
- "Incidence of gastroschisis has risen over last 20 years to approximately 5 per 10,000 live births" — Joyce (epidemiological) [Ep 9 · 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 9 · 3:16](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=196)
- "Risk factors include young age (<20 years), smoking, and use of vasoconstrictive medications" — Joyce (epidemiological) [Ep 9 · 3:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=217)
- "Approximately 90% of gastroschisis cases are diagnosed prenatally on routine ultrasound" — Joyce (epidemiological) [Ep 9 · 3:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231)
- "There is no evidence in literature to support either C-section or vaginal delivery in regards to outcome" — Joyce (guideline) [Ep 9 · 4:48](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=288)
- "Gastroschisis patients may require as much as 140-150 mL/kg/day of fluids to deal with losses" — Joyce (clinical) [Ep 9 · 16:54](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1014)
- "There is approximately 10% associated occurrence of intestinal atresia with gastroschisis" — Joyce (epidemiological) [Ep 9 · 7:10](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430)
- "Atresia can be treated at time of abdominal wall closure with resection and primary anastomosis, or bowel can be reduced with atresia intact and repaired 4-12 weeks later" — Joyce (clinical) [Ep 9 · 7:17](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=437)
- "At Cincinnati Children's, almost exclusively perform staged closures with silos - only handful of small defects closed primarily out of 41 patients in last 3 years" — Joyce (clinical) [Ep 9 · 8:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=532)
- "Lucille Packard Children's Hospital uses sutureless technique with silo reduction followed by Mepilex and Tegaderm dressings until fully healed in about 6 weeks" — Joyce (clinical) [Ep 9 · 9:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=577)
- "With non-sutured repair, have never had a ventral hernia; 10-20% get umbilical hernia which usually resolves by 3-5 years of age" — Todd (clinical) [Ep 9 · 10:38](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=638)
- "Approximately 75% of pediatric surgeons who participated in survey do non-sutured (Tegaderm) closure" — Todd (epidemiological) [Ep 9 · 11:03](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663)
- "For non-sutured closure: place silo on everyone, reduce at bedside if possible, tie umbilical cord with suture and lay in circle over hole, apply gauze and Tegaderm, change dressing every 4 days" — Todd (clinical) [Ep 9 · 12:01](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=721)
- "Complications of primary closure stem mainly from increased abdominal pressure leading to decreased venous return and possible abdominal compartment syndrome with ischemic injury" — Joyce (clinical) [Ep 9 · 13:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=786)
- "Literature shows debate about closure method - some report earlier feeding and decreased length of stay with primary closure, others report decreased ventilator time, shorter stay, and lower cost for silo reduction" — Joyce (clinical) [Ep 9 · 15:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906)
- "Overall survival rate is good at greater than 95% regardless of closure type" — Joyce (epidemiological) [Ep 9 · 15:28](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=928)
- "Dysmotility is the most universal complication of gastroschisis" — Joyce (clinical) [Ep 9 · 19:56](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1196)
- "Prognosis mainly dependent on severity of associated problems like prematurity, complications during initial post-op period, and degree of motility dysfunction" — Joyce (clinical) [Ep 9 · 20:08](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1208)
- "NEC is reported in about 5-10% of patients with gastroschisis, tends to occur later in course" — Joyce (epidemiological) [Ep 9 · 20:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1230)
- "No correlation between development of NEC and type of closure performed" — Joyce (clinical) [Ep 9 · 20:44](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1244)
- "Do not use bladder pressures - not terribly accurate in this size patient. Use peak airway pressures as primary assessment if intubated" — Todd (opinion) [Ep 9 · 29:25](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1765)
- "If baby not peeing or not acting right, there's never downside to releasing silo and letting things back out" — Todd (opinion) [Ep 9 · 29:57](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1797)
- "Do not routinely look at bladder pressures. Peak airway pressures are very good, or if pressure control ventilation, watch for significant changes in tidal volume" — Dean (opinion) [Ep 9 · 30:15](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1815)
- "Majority of gastroschisis care is done by advanced practitioners - fluid management, advancement of feeds, wound care" — Jenny (clinical) [Ep 9 · 30:59](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1859)
- "Typical feeding protocol: start enteral feeds 24 hours after NG removal at 1 mL/hour, increase by 1 mL/hour daily until day 5, then BID increases, then every 8 hour increases by day 8 if tolerating" — Joyce (clinical) [Ep 9 · 33:46](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2026)
- "From 2010 to present, 36 patients required long-term TPN (>30 days): 22 simple gastroschisis averaged 35 days TPN with 3 still on TPN at 1 year; 4 with atresia averaged 146 days TPN but all off within 10 months" — Joyce (epidemiological) [Ep 9 · 36:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2191)
- "About 1/3 of children with gastroschisis are below 10th percentile for weight at one year but without neurodevelopmental delays" — Joyce (epidemiological) [Ep 9 · 37:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2244)
- "Gestational age <37 weeks and development of cholestasis independently linked to poor growth; small for gestational age or low birth weight was not" — Joyce (clinical) [Ep 9 · 38:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2286)
- "In Cincinnati series of 71 infants (2006-2009), enteral feedings started around day 16, median length of stay 42 days, 6 patients discharged on TPN and 24% on tube feedings" — Joyce (epidemiological) [Ep 9 · 38:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310)
- "In Cincinnati series of 58 infants (2006-2008), 40% readmitted at least once within first year; most common reason was bowel obstruction and abdominal pain/distention" — Joyce (epidemiological) [Ep 9 · 39:35](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2375)
- "67% of patients with primary closures were readmitted vs 20% with silo reductions (did not reach statistical significance)" — Joyce (epidemiological) [Ep 9 · 40:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2450)
- "Volume of NG output less critical than color - can have large volume of spit but still be ready to feed if not bilious" — Todd (clinical) [Ep 9 · 43:01](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2581)
- "Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not capture other academic strengths" — Gail Besner (opinion) [Ep 26 · 1:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101)
- "The concept of academic RVUs was first described 12-13 years ago but without a clear incentivization framework" — Gail Besner (clinical) [Ep 26 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175)
- "Nationwide Children's Hospital implemented a point-based academic RVU system for publications, presentations, and other academic pursuits" — Gail Besner (clinical) [Ep 26 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "External federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system" — Rod Gerardo (clinical) [Ep 26 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "The academic RVU system at Nationwide resulted in increased presentations, peer-reviewed publications, and external federal research funding" (clinical) [Ep 26 · 3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "At Akron, the bonus structure required the entire group to reach a certain RVU threshold for 50% of bonus, eliminating competition for individual cases" — Todd (clinical) [Ep 26 · 5:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303)
- "The BC Children's Hospital gastroschisis study compared outcomes before and after implementation of a protocol in 2012, using data from 2008-2019" (clinical) [Ep 26 · 5:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine, gastroschisis treatment differed from other institutions with very low silo use and attempts at immediate bedside sutureless closure for nearly every patient" — Charza Jaharifard (clinical) [Ep 26 · 7:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=432)
- "Approximately 75% of gastroschisis babies can be closed immediately, either in the OR with fascial closure pre-protocol or at bedside post-protocol" — Charza Jaharifard (clinical) [Ep 26 · 7:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo reduction, parents cannot hold their baby for 5-6 days while looking at intestines through the silo" — Charza Jaharifard (clinical) [Ep 26 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure, parents can hold their baby within 48 hours if intubated, or immediately if managed without intubation" — Charza Jaharifard (clinical) [Ep 26 · 8:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "Prior myelomeningocele studies used two separate in utero surgeries: one to create the defect and one to repair it with PMSCs" (clinical) [Ep 26 · 10:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=626)
- "The current study performed a single operation at approximately 100 days gestational age, creating and repairing the defect simultaneously with PMSCs placed directly on the spinal cord" (clinical) [Ep 26 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "PMSCs did not persist in placentas, uteri, or lambs at 3 months post-treatment" (clinical) [Ep 26 · 11:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683)
- "There was no histological evidence of abnormal growth or tumor development from PMSC treatment" (clinical) [Ep 26 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690)
- "Human trials using PMSCs for myelomeningocele repair have begun with the first two patients" (clinical) [Ep 26 · 11:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "The front of a baby's belly does not form properly during early pregnancy in omphalocele" (clinical) [Ep 33 · 0:06](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=6)
- "In omphalocele, the baby has an opening in their belly button through which organs pass and are covered by a thin sac" (clinical) [Ep 33 · 0:11](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=11)
- "Omphalocele is classed as a rare birth defect" (epidemiological) [Ep 33 · 0:21](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=21)
- "Sometimes only a portion of the small intestine passes through the opening in omphalocele" (clinical) [Ep 33 · 0:26](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=26)
- "In other cases, more organs including some or most of the liver pass through the opening" (clinical) [Ep 33 · 0:30](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=30)
- "When the liver is involved, it is called large or giant omphalocele" (clinical) [Ep 33 · 0:30](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=30)
- "The cause of omphalocele is unknown" (clinical) [Ep 33 · 0:40](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=40)
- "Omphalocele can be a feature of many genetic syndromes" (clinical) [Ep 33 · 0:43](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "Many babies with omphalocele have other birth defects" (epidemiological) [Ep 33 · 0:43](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "A diagnosis of omphalocele can be made before birth using ultrasound" (clinical) [Ep 33 · 0:51](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=51)
- "Prenatal tests should be carried out to identify any associated anomalies in omphalocele" (guideline) [Ep 33 · 1:00](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=60)
- "Ongoing care for babies with omphalocele should be provided at a specialist center by a dedicated team with knowledge and experience" (guideline) [Ep 33 · 1:06](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=66)
- "Omphalocele is a serious condition and can be life threatening for the baby before birth and as a newborn" (clinical) [Ep 33 · 1:17](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=77)
- "Most babies with omphalocele do survive" (epidemiological) [Ep 33 · 1:24](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=84)
- "Some babies with giant omphalocele may be transferred to a dedicated intensive care unit after birth" (clinical) [Ep 33 · 1:32](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=92)
- "The contents of the belly that have passed through the opening are wrapped in a sterile bag to avoid damage" (clinical) [Ep 33 · 1:39](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=99)
- "When the baby is stable, surgery can be performed to place the organs back in the belly and close the opening" (clinical) [Ep 33 · 1:46](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=106)
- "Small omphaloceles can be repaired in one operation called a primary repair" (clinical) [Ep 33 · 1:54](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=114)
- "For babies with giant omphalocele, repair is done in several steps called a staged repair" (clinical) [Ep 33 · 2:01](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=121)
- "In some giant omphalocele cases, there may not be enough room in the newborn baby's belly for the organs to fit back inside" (clinical) [Ep 33 · 2:08](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=128)
- "When there is insufficient abdominal domain, surgery may be postponed for weeks or months to allow the lungs and body to grow" (clinical) [Ep 33 · 2:17](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=137)
- "Babies may be able to return home during the period of delayed surgery with appropriate nursing care in place" (clinical) [Ep 33 · 2:27](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=147)
- "Hospital stay duration differs depending on the severity of the omphalocele, any associated anomalies or complications, and response to treatment" (clinical) [Ep 33 · 2:33](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=153)
- "Follow up care by a multidisciplinary team (MDT) of different clinical specialists is required" (guideline) [Ep 33 · 2:45](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=165)
- "Some babies may experience ongoing difficulties that require different types and levels of care, such as feeding or breathing difficulties" (clinical) [Ep 33 · 2:55](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=175)
- "Identifying any complications or difficulties early is very important" (guideline) [Ep 33 · 3:05](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=185)
- "Babies with giant omphaloceles need to be monitored more closely" (guideline) [Ep 33 · 3:10](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=190)
- "Peer support can be accessed through patient and family support groups" (clinical) [Ep 33 · 3:15](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=195)
- "The front of a baby's belly does not form properly during early pregnancy in gastroschisis" (clinical) [Ep 34 · 0:06](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=6)
- "Gastroschisis presents as an opening on the right side of the belly button" (clinical) [Ep 34 · 0:11](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=11)
- "The baby's intestines pass through the abdominal opening in gastroschisis" (clinical) [Ep 34 · 0:16](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=16)
- "Gastroschisis is classed as a rare birth defect" (epidemiological) [Ep 34 · 0:19](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=19)
- "The cause of gastroschisis is unknown" (clinical) [Ep 34 · 0:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=24)
- "Gastroschisis may mean that the intestines are not able to work properly" (clinical) [Ep 34 · 0:27](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=27)
- "Gastroschisis is not usually associated with other malformations" (clinical) [Ep 34 · 0:32](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=32)
- "A diagnosis of gastroschisis can be made before birth using ultrasound" (clinical) [Ep 34 · 0:36](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=36)
- "Many babies with gastroschisis are born prematurely (before 37 weeks)" (epidemiological) [Ep 34 · 0:45](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=45)
- "Care should be provided at a specialist center by a dedicated team with knowledge and experience of gastroschisis" (guideline) [Ep 34 · 0:51](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=51)
- "Gastroschisis is a serious condition and can be life threatening before and after birth" (clinical) [Ep 34 · 1:03](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=63)
- "Most babies with gastroschisis do survive" (epidemiological) [Ep 34 · 1:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=70)
- "Some babies may be transferred to a dedicated intensive care unit if they are born prematurely" (guideline) [Ep 34 · 1:18](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=78)
- "The baby's intestines are wrapped in a sterile bag to avoid damage" (clinical) [Ep 34 · 1:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "Babies with gastroschisis receive fluid via a tube that delivers it through a vein" (clinical) [Ep 34 · 1:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "When the baby is stable, surgery is performed to place the intestines back in the belly and close the opening" (clinical) [Ep 34 · 1:33](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=93)
- "Primary repair is a single operation to close gastroschisis" (clinical) [Ep 34 · 1:41](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=101)
- "Staged repair involves several steps to close gastroschisis" (clinical) [Ep 34 · 1:49](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=109)
- "Further surgery may be needed if other malformations are also present" (clinical) [Ep 34 · 1:54](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=114)
- "While the intestines recover, the baby receives feed through a tube that delivers it through a vein (parenteral nutrition)" (clinical) [Ep 34 · 1:59](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=119)
- "Hospital stay duration depends on the severity of gastroschisis, complications, and response to treatment" (clinical) [Ep 34 · 2:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=130)
- "Hospital stay often ranges between 2 to 10 weeks but may be longer if needed" (epidemiological) [Ep 34 · 2:20](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=140)
- "Follow-up care by a multidisciplinary team is required to monitor growth and development" (guideline) [Ep 34 · 2:25](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=145)
- "Some babies may experience ongoing difficulties that require different types and levels of care" (clinical) [Ep 34 · 2:37](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=157)
- "Identifying any complications or difficulties early is very important" (opinion) [Ep 34 · 2:43](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=163)
- "Some babies may require parenteral nutrition for a longer period to promote continued growth" (clinical) [Ep 34 · 2:49](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=169)
- "Peer support can be accessed through patient and family support groups" (guideline) [Ep 34 · 2:55](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=175)
- "This is a retrospective study using educational data from children born between 1991 and 2022" — Lizzie Lee (clinical) [Ep 42 · 0:11](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=11)
- "The study compared 208 children with gastroschisis and over 2000 age-matched controls" — Lizzie Lee (clinical) [Ep 42 · 0:18](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=18)
- "Researchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments" — Lizzie Lee (clinical) [Ep 42 · 0:18](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=18)
- "Children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments" — Lizzie Lee (clinical) [Ep 42 · 0:33](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=33)
- "Children with gastroschisis may face long-term learning challenges and could benefit from early educational support" — Lizzie Lee (opinion) [Ep 42 · 0:41](https://library.globalcastmd.com/watch/educational-outcomes-in-school-aged-children-with-a-history-of-simple-and-complex-gastroschisis-are-poor-compared-to-controls-10437?t=41)
- "The meta-analysis included 709 patients from 15 research studies across multiple international centers" — Lizzie Lee (epidemiological) [Ep 43 · 1:03](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=63)
- "Thoracoscopic repair has higher recurrence rates compared to open repair for congenital diaphragmatic hernia" — Lizzie Lee (clinical) [Ep 43 · 1:18](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- "Thoracoscopic repair has longer operative times compared to open repair for congenital diaphragmatic hernia" — Lizzie Lee (clinical) [Ep 43 · 1:18](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78)
- "Thoracoscopic repair has a lower incidence of postoperative bowel obstruction compared to open repair" — Lizzie Lee (clinical) [Ep 43 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=85)
- "The Ziegler study included 10 patients with giant omphalocele and 6 with complicated gastroschisis" — Alex Halpern (epidemiological) [Ep 43 · 1:59](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=119)
- "Complete fascial closure was achieved after a median of 7 days in children with giant omphalocele using the fascia tense pediatric device" — Alex Halpern (clinical) [Ep 43 · 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 (clinical) [Ep 43 · 2:13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133)
- "No patients developed abdominal compartment syndrome when using the fascia tense pediatric device" — Alex Halpern (clinical) [Ep 43 · 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 treated with the fascia tense pediatric device" — Alex Halpern (clinical) [Ep 43 · 2:23](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143)
- "The Italian study included 83 patients in the laparoscopic cholecystectomy without ICG group" — Cecilia Gigena (epidemiological) [Ep 43 · 3:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=190)
- "The Italian study included 90 patients in the laparoscopic cholecystectomy with ICG group" — Cecilia Gigena (epidemiological) [Ep 43 · 3:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=190)
- "The ICG group had no complications compared to 12% in the non-ICG group" — Cecilia Gigena (clinical) [Ep 43 · 3:23](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- "The ICG group had shorter surgery time compared to the non-ICG group" — Cecilia Gigena (clinical) [Ep 43 · 3:23](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203)
- "The ICG group had better visualization of the biliary tree compared to the non-ICG group" — Cecilia Gigena (clinical) [Ep 43 · 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 (opinion) [Ep 43 · 3:38](https://library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=218)
- "Cloacal exstrophy affects the gastrointestinal/colorectal area, urogenital tract, spine and cord, and sometimes motion of lower extremities" — Alberto Peña (clinical) [Ep 19 · 1:31](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=91)
- "Babies are born with omphalocele, bladder exstrophy with two hemibladders, open cecum between the hemibladders, and separated pubic bones" — Alberto Peña (clinical) [Ep 19 · 2:09](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=129)
- "The small bowel can become exstrophic through the ileocecal valve creating an 'elephant trunk' appearance" — Alberto Peña (clinical) [Ep 19 · 3:08](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=188)
- "Males have two separated hemiphalluses with normal gonads; females have two hemivaginas below the exstrophic bladder leading to two hemi-uteri" — Alberto Peña (clinical) [Ep 19 · 3:32](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=212)
- "Colonic anatomy exists on a spectrum from normal colon to almost absent colon or no colon at all, sometimes with two ceca or two appendices and bizarre blood supply" — Alberto Peña (clinical) [Ep 19 · 4:20](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=260)
- "The amount of colon present at birth has very important implications for the patient and surgeon" — Alberto Peña (clinical) [Ep 19 · 4:57](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=297)
- "A variant exists where babies have intact abdominal skin without omphalocele or bladder exstrophy externally, but have completely open bladder and all internal malformations" — Alberto Peña (clinical) [Ep 19 · 5:44](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=344)
- "We have progressed in safer surgical techniques, intensive care, and parenteral nutrition, but cannot claim much progress in functional sequelae" — Alberto Peña (opinion) [Ep 19 · 7:02](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=422)
- "Patients suffer lifelong serious limitations in bowel control, urinary control, sexual function, and spinal abnormalities that can be managed but not made normal" — Alberto Peña (clinical) [Ep 19 · 7:34](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=454)
- "Historical practice was bilateral gonadectomy, hemiphallus removal, vaginal creation with bowel, and female gender assignment for XY patients" — Alberto Peña (clinical) [Ep 19 · 8:31](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=511)
- "Patients raised as females despite XY chromosomes showed male attitudes and behavior, and became upset when learning of their chromosomal sex and surgical reassignment" — Alberto Peña (clinical) [Ep 19 · 9:16](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=556)
- "Patients argued that sex is not the most important thing, they wanted their gonads back, and with modern techniques can fertilize and have children" — Alberto Peña (clinical) [Ep 19 · 9:59](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=599)
- "Current consensus is that XY patients should be raised as male, with urologists and plastic surgeons working on phallic reconstruction" — Alberto Peña (guideline) [Ep 19 · 10:34](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=634)
- "When prominent pediatric urologists dominated surgical departments, patients received good urologic attention but poor gastrointestinal attention, and vice versa when pediatric surgeons led" — Alberto Peña (clinical) [Ep 19 · 12:13](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=733)
- "The pediatric surgeon must separate the urothelium of the bladder from intestinal mucosa by placing multiple stitches at the edges and making an incision" — Alberto Peña (clinical) [Ep 19 · 13:31](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=811)
- "It is very common and very bad for pediatric surgeons to simply create an ileostomy, leaving all colon distally attached to the urinary tract" — Alberto Peña (opinion) [Ep 19 · 14:55](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=895)
- "Leaving colon attached to the urinary tract creates a natural congenital bladder augmentation that urologists may appreciate" — Alberto Peña (clinical) [Ep 19 · 15:31](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=931)
- "Babies with ileostomy and colon left attached to bladder absorb urine from the newborn period causing hyperchloremic acidosis that interferes with growth and development" — Alberto Peña (clinical) [Ep 19 · 15:43](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=943)
- "Defunctionalized colon left distally will not grow and remain tiny; colon requires passing fecal matter through its lumen to grow" — Alberto Peña (clinical) [Ep 19 · 16:03](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=963)
- "The rescue operation involves taking down the ileostomy, finding colonic tissue, performing end-to-end anastomosis, and creating an end colostomy, which makes acidosis disappear the next day" — Alberto Peña (clinical) [Ep 19 · 17:03](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1023)
- "Surgeons must accept they are dealing with a spectrum and sometimes the colonic component is so complex they prefer to avoid it and simply open an ileostomy" — Alberto Peña (opinion) [Ep 19 · 19:13](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1153)
- "The surgeon must not leave gastrointestinal tract inside defunctionalized—this is the main principle" — Alberto Peña (guideline) [Ep 19 · 20:07](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1207)
- "Orthopedic surgeons in some institutions routinely perform pelvic osteotomy at initial operation, which facilitates bladder and omphalocele reconstruction" — Alberto Peña (clinical) [Ep 19 · 21:00](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1260)
- "Even technically correct colostomies sometimes don't work well due to poor motility of the incorporated colon" — Alberto Peña (clinical) [Ep 19 · 22:00](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1320)
- "Babies with poor colonic motility may have bacterial overgrowth similar to Hirschsprung disease and require colostomy irrigation" — Alberto Peña (clinical) [Ep 19 · 22:20](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1340)
- "Babies below 3 years of age are in diapers at home and don't care about them, but around age 3 when starting school is when the second phase of management begins" — Alberto Peña (clinical) [Ep 19 · 23:18](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1398)
- "Most patients require bladder augmentation using gastrointestinal tract, and the pediatric surgeon is the defender of the gastrointestinal tract" — Alberto Peña (opinion) [Ep 19 · 23:54](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1434)
- "Patients born with no colon are candidates for colostomy for life and should never have terminal ileum pulled through even if sphincter evidence exists, because they will never have bowel control" — Alberto Peña (guideline) [Ep 19 · 24:42](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1482)
- "Only patients with capacity to form solid stool should be considered for pull-through, as bowel management only works with solid stool" — Alberto Peña (guideline) [Ep 19 · 25:04](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1504)
- "Surgeons should not underestimate the capacity of tiny pieces of colon to grow and should incorporate everything rather than discarding it" — Alberto Peña (guideline) [Ep 19 · 25:47](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1547)
- "Trial of bowel management through the colostomy simulates the colostomy as the new anus; if enema keeps patient clean for 24 hours with no stool in bag, pull-through may work" — Alberto Peña (clinical) [Ep 19 · 26:41](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1601)
- "If patient has very little colon and cannot form solid stool, the urologist can freely use bowel for augmentation since pull-through is not an option" — Alberto Peña (clinical) [Ep 19 · 28:07](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1687)
- "The colon to be pulled through is the most posterior structure in the pelvis with bladder augmentation in front, so augmentation should not be done before deciding on pull-through or it becomes a nightmare to access" — Alberto Peña (clinical) [Ep 19 · 28:54](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1734)
- "Pull-through and bladder augmentation should ideally be done together in approximately a 12-hour operation" — Alberto Peña (clinical) [Ep 19 · 31:04](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1864)
- "Pediatric surgeon goes first because the colon goes in the back, and separated pubic bones make things easier" — Alberto Peña (clinical) [Ep 19 · 31:16](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1876)
- "Appendix stays up in abdomen when colon is pulled down and can be used for Malone procedure to administer enemas" — Alberto Peña (clinical) [Ep 19 · 31:28](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1888)
- "Urologists almost never use colon for augmentation because colon is needed to form solid stool" — Alberto Peña (clinical) [Ep 19 · 31:57](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1917)
- "Giant colonic pouches with poor motility are good for bowel management because lack of peristalsis means once-daily irrigation keeps patient clean" — Alberto Peña (clinical) [Ep 19 · 32:26](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1946)
- "Midline abdominal incisions are always used in colorectal pediatric surgery to keep flanks and quadrants available for potential stomas" — Alberto Peña (clinical) [Ep 19 · 33:13](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=1993)
- "The blood supply in cloacal exstrophy is very bizarre with aberrant abnormal vessels, requiring careful study to avoid ligating crucial vessels and losing the colon" — Alberto Peña (clinical) [Ep 19 · 34:20](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2060)
- "Patients don't need prone positioning because the exstrophy makes everything anterior; frog-leg supine position provides access to entire perineum" — Alberto Peña (clinical) [Ep 19 · 35:53](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2153)
- "Patients have orthopedic problems for life, and some teenagers are unhappy about persistent pubic bone separation" — Alberto Peña (clinical) [Ep 19 · 37:33](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2253)
- "Separated pubic bones cause walking with feet separated and pointing laterally, which looks ugly and patients complain about" — Alberto Peña (clinical) [Ep 19 · 37:55](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2275)
- "Patients with severe spinal problems need ongoing follow-up by pediatric orthopedics and neurosurgeon for tethered cord, sometimes requiring cord release" — Alberto Peña (clinical) [Ep 19 · 38:21](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2301)
- "During pull-through, vaginas are approximated as much as possible; degree of separation varies on the spectrum" — Alberto Peña (clinical) [Ep 19 · 38:50](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2330)
- "When vaginas run in completely different directions and cannot be brought together due to blood supply, one vagina may be removed leaving the one with better-looking cervix" — Alberto Peña (clinical) [Ep 19 · 39:20](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2360)
- "Patients with functional hemi-uterus may become pregnant but it is high-risk and should be followed by specialized pediatric gynecologist" — Alberto Peña (clinical) [Ep 19 · 39:53](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2393)
- "General advice is not to become pregnant, but some patients want to and may deliver by cesarean section" — Alberto Peña (opinion) [Ep 19 · 40:10](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2410)
- "Hemi-uterus has great tendency to produce miscarriages and premature labors" — Alberto Peña (clinical) [Ep 19 · 40:30](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2430)
- "Augmented bladder produces a lot of mucus; if mucus stays it forms stones, requiring family teaching on bladder irrigation and mucus removal" — Alberto Peña (clinical) [Ep 19 · 41:07](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2467)
- "Mitrofanoff may stop working or leak urine and need revision or valve tightening, similar to Malone" — Alberto Peña (clinical) [Ep 19 · 42:04](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2524)
- "When patients transition to adult hospitals they don't feel well because adult specialists lack experience with these malformations" — Alberto Peña (clinical) [Ep 19 · 42:29](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2549)
- "Patients with cloacal exstrophy when they grow up are particularly charming, intelligent, charismatic, and beautiful" — Alberto Peña (opinion) [Ep 19 · 42:57](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2577)
- "Colorectal and urogenital problems have been left behind in terms of scientific approach and research funds because they are not elegant problems related to stool, urine, and sex" — Alberto Peña (opinion) [Ep 19 · 44:48](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2688)
- "Prenatal diagnosis of anorectal and urogenital malformations is easier in the most complex defects because they have visible spinal problems and absent bladder" — Alberto Peña (clinical) [Ep 19 · 47:58](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2878)
- "No bladder visible on ultrasound from week 20 of pregnancy is a bad sign" — Alberto Peña (clinical) [Ep 19 · 49:00](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2940)
- "Prenatal diagnosis allows families to make decisions about pregnancy interruption or to deliver in a place with a specialized team" — Alberto Peña (clinical) [Ep 19 · 49:38](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=2978)
- "Certain malformations require centers of excellence with dedicated focused teams, otherwise after 20 years there will be many damaged children and nobody properly trained" — Alberto Peña (opinion) [Ep 19 · 50:30](https://library.globalcastmd.com/watch/cloacal-exstrophy-with-dr-alberto-pe-a-309?t=3030)
- "For patients with pulmonary hypoplasia or bad hearts or prematurity or where the omphalocele is too big, escharotic technique is used" — Jack (clinical) [Ep 1 · 0:56](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=56)
- "Silver-impregnated sponges offer the same advantage as Silvadene but are less messy and don't require painting" — Jack (clinical) [Ep 1 · 1:35](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=95)
- "Aquacel silver-impregnated material stuck to the omphalocele sac and became incorporated, failing to fall off as expected" — Todd (clinical) [Ep 1 · 1:53](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=113)
- "The problem with compression techniques is if you have a patient with pulmonary hypoplasia or a bad heart where you can't safely increase intra-abdominal pressure" — 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 case was a 28-week gestation, 1130g premature female with giant omphalocele including the liver, identified by prenatal ultrasound" (clinical) [Ep 1 · 6:32](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=392)
- "After 10 days of Duoderm silo manipulation, the peritoneal sac was still covered, thick, and manageable" (clinical) [Ep 1 · 7:02](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=422)
- "Component separation incision is made 0.5 to 1 centimeter outside the semilunar line, with dissection of lateral fascia towards the external oblique" (clinical) [Ep 1 · 7:46](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=466)
- "By dissecting the fascia to the mid-axillary line, you can gain between 2 and 4 centimeters of advancement" (clinical) [Ep 1 · 8:38](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=518)
- "This is reported as probably the smallest patient with lowest weight and giant omphalocele treated with Duoderm method and component separation for definitive anatomic closure without eventration" (clinical) [Ep 1 · 10:19](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=619)
- "Component separation in little babies is not easy, especially if it's been on a silo for a long period and it's all scarred together" — Todd (clinical) [Ep 1 · 11:07](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=667)
- "Concern about what the abdominal wall will be like when the patient is 20 years old and whether they'll be able to function normally after component separation" — Jack (opinion) [Ep 1 · 11:38](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=698)
- "Surgisis was used for a long time but had a lot of recurrences; now using Strattice with better results" — Jack (clinical) [Ep 1 · 11:51](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=711)
- "The advantage of using a patch is that you leave the abdominal wall musculature intact, and as the child grows, the patch becomes a smaller percentage of the abdominal wall area" — Jack (opinion) [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 a defect that goes right up to the costal margin, making it difficult to close that area 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)
- "Often the lower part of the defect can be closed primarily but a patch is needed 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)
- "The new six-ply Surgisis with 22 tension lines works better, with tension on the patch allowing the fascia to be brought together" — Todd (clinical) [Ep 1 · 13:23](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=803)
- "Long-term follow-up with the Duoderm technique shows all patients healed well without problems" (clinical) [Ep 1 · 14:00](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=840)
- "Putting fatty gauzes on omphaloceles until epithelialization, then waiting until 6-7 months for delayed primary closure avoids the risks of early complex surgery" (opinion) [Ep 1 · 14:45](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=885)
- "Painting technique followed by delayed primary closure when the child is older allows most closures without using a patch" (clinical) [Ep 1 · 16:27](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=987)
- "Duoderm silo technique was successful on two giant omphaloceles with liver herniation, done gradually over time with the patient on nasal cannula and morphine, 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)
- "Duoderm patches were reapplied 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)
- "In neonates, the Duoderm pulling technique works well because babies are very compliant, allowing significant reduction of the defect size" (clinical) [Ep 1 · 18:57](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1137)
- "Leaving the amnion (which is usually stuck to the liver) and placing Alloderm over it, then closing the skin, results in thick fascia over time, creating a relatively small central defect similar to rectus diastasis" (clinical) [Ep 1 · 24:14](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1454)
- "The problem with painting and waiting is that the muscle stays way out laterally and over time it's almost like they have a bigger defect" (clinical) [Ep 1 · 24:51](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1491)
- "The most challenging situation is smaller defects with the whole liver out, because those don't go back in when painting and waiting - the liver is almost locked out" — Jack (clinical) [Ep 1 · 25:15](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1515)
- "In cases where the liver is locked out, you actually have to enlarge the fascial defect to get things to go back in" — Jack (clinical) [Ep 1 · 25:39](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1539)
- "Herniated livers in omphaloceles often have a mushroom or dumbbell shape, making them very difficult to reduce" — Todd (clinical) [Ep 1 · 25:46](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1546)
- "Dr. Gabello's algorithm starts with a relaxation test to determine how much the patient can tolerate and how much silo is needed" (clinical) [Ep 1 · 27:04](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1624)
- "If primary closure cannot be achieved, the next step is separation of components" (clinical) [Ep 1 · 28:40](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1720)
- "If after component separation the intra-abdominal pressure is still too high or critical, a mesh can be placed" (clinical) [Ep 1 · 29:37](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1777)
- "If pressure is too high or pulmonary hypertension occurs at any moment, the process can be aborted and traditional painting and waiting can be used" (clinical) [Ep 1 · 30:33](https://library.globalcastmd.com/watch/approach-and-component-separation-for-suture-closure-and-underlay-mesh-430?t=1833)
- "Silver sulfadiazine (called Flamazine in Canada) has been used for many years for omphalocele escharization based on teaching from Sigy Ein" — Jack (clinical) [Ep 2 · 1:09](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=69)
- "Silver-impregnated sponges offer the same advantage as Silvadene but are less messy and don't require painting" — Jack (clinical) [Ep 2 · 1:44](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=104)
- "Aquacel silver-impregnated material stuck to the omphalocele sac and became incorporated, failing to fall off as expected" — Todd (clinical) [Ep 2 · 1:54](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=114)
- "Component separation by dissecting the lateral fascia toward the major oblique until the mid-axillary line can gain between 2 and 4 centimeters" (clinical) [Ep 2 · 8:26](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=506)
- "The case represents the probable smallest patient with lowest weight (1,130g) and giant omphalocele treated with Abello method and component separation for definitive anatomic closure without eventation" (clinical) [Ep 2 · 10:28](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=628)
- "Component separation in infants raises concerns about long-term abdominal wall function at 20 years of age" — Jack (opinion) [Ep 2 · 11:41](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=701)
- "Surgisis patch had many recurrences, while Strattice appears to have better results for omphalocele closure" — Jack (clinical) [Ep 2 · 12:08](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=728)
- "As the child grows, a patch becomes a smaller and smaller percentage of the abdominal wall area" — Jack (clinical) [Ep 2 · 12:16](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=736)
- "Many omphaloceles have defects extending right up to the costal margin, making complete closure difficult even with component separation" — Jack (clinical) [Ep 2 · 12:36](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=756)
- "Six-ply Surgisis provides 22 tension lines, allowing tension on the patch while bringing the fascia together" — Todd (clinical) [Ep 2 · 13:33](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=813)
- "Biologic dressings are not meant to be bridged and will turn into liquid as temporary materials, not muscle" — Todd (clinical) [Ep 2 · 23:04](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1384)
- "Cardiac surgeons report that biologic patches in VSD closure turn into cardiac muscle" — Todd (clinical) [Ep 2 · 23:19](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1399)
- "In babies still developing tissue, biologic patches may turn into muscle or scar tissue" — Todd (opinion) [Ep 2 · 23:35](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1415)
- "Alloderm used as a bridge with minimized patch size appears to turn into thick fascia over time, creating a relatively small central defect similar to rectus diastasis" (clinical) [Ep 2 · 24:23](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1463)
- "With painting and waiting, muscle stays way out laterally and over time patients have a bigger defect" (clinical) [Ep 2 · 25:03](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1503)
- "Smaller defects with the whole liver out are most challenging because the liver doesn't go back in when painting and waiting, as if the liver is locked out" — Jack (clinical) [Ep 2 · 25:24](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1524)
- "In cases where the liver is locked out, the fascial defect must be enlarged to get contents to reduce" — Jack (clinical) [Ep 2 · 25:48](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1548)
- "Livers in small-defect omphaloceles develop a mushroom or dumbbell shape that makes reduction difficult" — Todd (clinical) [Ep 2 · 25:55](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1555)
- "The Duoderm technique allows gradual progress over approximately 3-day intervals with only nasal cannula and morphine, avoiding intubation until repair" (clinical) [Ep 2 · 17:53](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1073)
- "Babies are very compliant in the neonatal period, allowing significant reduction with Duoderm pulling" (clinical) [Ep 2 · 19:07](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1147)
- "A relaxation test determines how much the patient will tolerate and guides the need for component separation" (clinical) [Ep 2 · 27:26](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1646)
- "If intraabdominal pressure is too high after component separation, a mesh can be placed" (clinical) [Ep 2 · 29:45](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1785)
- "If pulmonary hypertension or excessive pulmonary pressure occurs, the procedure can be aborted and traditional painting and waiting used" (clinical) [Ep 2 · 30:13](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1813)
- "Dr. Abello has never had to abort the process due to patient intolerance, including in patients with cardiomyopathy or pulmonary hypertension" (clinical) [Ep 2 · 31:32](https://library.globalcastmd.com/watch/tricks-omphalocele-approach-component-separation-for-suture-closure-635?t=1892)
- "Most damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy based on animal and clinical studies" — Jack (clinical) [Ep 3 · 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 later delivery" — Jack (clinical) [Ep 3 · 3:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=194)
- "Delivering gastroschisis too early (34-35 weeks) trades bowel problems for problems of prematurity" — Jack (clinical) [Ep 3 · 3:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=202)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" — Jack (epidemiological) [Ep 3 · 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" — Jack (epidemiological) [Ep 3 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis" — Jack (epidemiological) [Ep 3 · 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" — Jack (guideline) [Ep 3 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=289)
- "Using a pre-formed silo allows gentle reduction of bowel without trauma from forceps manipulation" — Jack (clinical) [Ep 3 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=507)
- "Approximately one-third of gastroschisis cases can be reduced at bedside using the Bianchi technique with silo assistance" — Jack (clinical) [Ep 3 · 8:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=527)
- "Waiting for 10% body weight loss before reducing gastroschisis allows bowel edema to resolve" (clinical) [Ep 3 · 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" — Jack (clinical) [Ep 3 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=581)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia without bowel thickening, and late-occurring atresia from small defect with matted bowel" — Jack (clinical) [Ep 3 · 15:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=958)
- "Bringing a stoma out through the umbilicus avoids creating an additional abdominal scar" — Jack (clinical) [Ep 3 · 17:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1039)
- "Umbilical stoma placement provides an easy location for appliance placement compared to lateral positions" — Jack (clinical) [Ep 3 · 17:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1061)
- "Silver sulfadiazine use in the first month of life can cause white blood count suppression and requires monitoring" — Jack (clinical) [Ep 3 · 26:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1618)
- "Intragastric pressure of 20 is suggested as the threshold for safe abdominal closure" — Jack (guideline) [Ep 3 · 30:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1802)
- "In older children with chronic omphalocele, the abdomen does not expand as rapidly as in newborns and requires more time for staged reduction" — Jack (clinical) [Ep 3 · 36:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2211)
- "Most intestinal damage in gastroschisis occurs in the last few weeks of pregnancy based on animal and clinical studies" (clinical) [Ep 10 · 2:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=165)
- "Neonatal outcomes are better if gastroschisis is delivered slightly early at 37 weeks" (clinical) [Ep 10 · 3:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=194)
- "Delivering gastroschisis too early at 34-35 weeks trades bowel problems for prematurity problems" (clinical) [Ep 10 · 3:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=202)
- "Age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" (epidemiological) [Ep 10 · 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 10 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis" (epidemiological) [Ep 10 · 4:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=277)
- "Routine cesarean section for gastroschisis was standard of care 15-20 years ago but has gone out of favor" (guideline) [Ep 10 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=289)
- "Using forceps and retractors for bedside reduction can harm the bowel" (clinical) [Ep 10 · 8:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=498)
- "Pre-formed silo allows bowel to be pushed back in without harming it" (clinical) [Ep 10 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=507)
- "Approximately one-third of gastroschisis cases can be reduced at bedside using silo technique without intubation" (clinical) [Ep 10 · 8:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=531)
- "Waiting for 10% body weight loss allows edema in bowel to resolve, making reduction easier" (clinical) [Ep 10 · 9:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=554)
- "Half of gastroschisis bowel goes back in spontaneously within 1-2 days if silo is suspended without tightening" (clinical) [Ep 10 · 9:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=560)
- "Leaving silo on for more than a day causes the fascial defect to get much bigger" (clinical) [Ep 10 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=581)
- "Larger fascial defect after prolonged silo use takes longer to contract and heal without surgical closure" (clinical) [Ep 10 · 9:48](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=588)
- "Plastic closure of gastroschisis produces extremely good results" (clinical) [Ep 10 · 11:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=697)
- "Plastic closure often results in small umbilical hernia, but vast majority close by age 2" (clinical) [Ep 10 · 11:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=700)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia without bowel thickening, and late-occurring atresia from small defect" (clinical) [Ep 10 · 15:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=958)
- "Bringing ostomy out through umbilicus avoids transposing defect and makes later closure easier" (clinical) [Ep 10 · 16:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=976)
- "Umbilical ostomy placement provides easy appliance application on front of abdomen" (clinical) [Ep 10 · 17:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1056)
- "Gord Cameron first described umbilical ostomies in the 1980s" (clinical) [Ep 10 · 17:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1073)
- "Abdominal compartment syndrome is difficult to assess clinically" (opinion) [Ep 10 · 28:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1702)
- "Intragastric pressure of 20 is the threshold number suggested by literature" (guideline) [Ep 10 · 30:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1804)
- "Omphaloceles with narrow opening and large contents behave differently than those with big opening" (clinical) [Ep 10 · 35:39](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2139)
- "Omphaloceles with big opening that are painted gradually reduce spontaneously over 6 months to a year" (clinical) [Ep 10 · 35:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2145)
- "In older children with omphalocele, abdomen does not expand rapidly like in newborns and requires time" (clinical) [Ep 10 · 36:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2211)
- "A culture of safety is a deliberate way of doing things to avoid complications." — Sherif Emil (clinical) [Ep 11 · 0:22](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=22)
- "Error traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well." — Sherif Emil (clinical) [Ep 11 · 1:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=60)
- "The spring loaded silo works quite well for the majority of gastroschisis patients." — Sherif Emil (clinical) [Ep 11 · 1:30](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=90)
- "The spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases." — Sherif Emil (clinical) [Ep 11 · 2:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=120)
- "Gastroschisis cases and omphalocele have really very different issues requiring separation in analysis." — Sherif Emil (clinical) [Ep 11 · 2:30](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=150)
- "There can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed." — Sherif Emil (clinical) [Ep 11 · 3:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=180)
- "One error trap in gastroschisis is to assume that there would be no reason to do a premature delivery." — Sherif Emil (clinical) [Ep 11 · 3:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=180)
- "Giant omphaloceles (5 cm or greater or liver in sac) have greater time to full feeds and require more TPN compared to routine omphaloceles" — Sean (clinical) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Giant omphaloceles have greater risk of respiratory insufficiency and higher incidence of chromosomal anomalies" — Sean (clinical) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "56 of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within first week of life" — Sean (epidemiological) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Five patients had no signs of pulmonary hypertension on first echo within first seven days but subsequently developed severe pulmonary hypertension, all associated with sepsis episodes" — Sean (clinical) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Two of the five patients with delayed pulmonary hypertension died, and one required pulmonary vasodilator for more than a year" — Sean (clinical) [Ep 17 · 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 single episode of sepsis" — Sean (clinical) [Ep 17 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "The sac-preserving hydrocolloid technique developed by Dr. Abello has been used in almost 40 patients over three years" — Miguel Gilfoyd (clinical) [Ep 17 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "97% of patients treated with sac-preserving technique achieved closure within 30 days, and 92% within 15 days" — Miguel Gilfoyd (clinical) [Ep 17 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "All patients treated with sac-preserving technique are kept in ICU, ventilated and completely paralyzed during reduction" — Miguel Gilfoyd (clinical) [Ep 17 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "The hydrocolloid dressing should be applied within first 24 hours before the sac becomes very stiff" — Miguel Gilfoyd (clinical) [Ep 17 · 6:47](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Three patients with ruptured omphalocele sacs were sutured and then had hydrocolloid dressing applied successfully" — Miguel Gilfoyd (clinical) [Ep 17 · 7:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=457)
- "Compressions can usually start within 48 hours if baby is stable" — Miguel Gilfoyd (clinical) [Ep 17 · 8:01](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=481)
- "Risk of adhesive bowel obstruction is higher with gastroschisis, but risk of midgut volvulus is higher in patients with omphalocele" — Sean (clinical) [Ep 17 · 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" — Sean (clinical) [Ep 17 · 9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "If closure technique involves exposing the intestines, Ladd procedure may be worthwhile; if sac is maintained, not worth going through sac" — Sean (opinion) [Ep 17 · 10:31](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631)
- "In diaphragmatic hernia repair, key move is to unroll bowel like a scroll to increase distance between ends of mesentery and decrease volvulus risk" — Todd (clinical) [Ep 17 · 13:10](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=790)
- "Non-rotation does not exclude possibility of unfavorable anatomy with narrow base of mesentery and two ends close together" — Sean (clinical) [Ep 17 · 14:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=873)
- "In gastroschisis, entire liver being out is not expected; when almost no abdominal domain exists, management becomes very challenging" — Saleem (clinical) [Ep 17 · 16:42](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1002)
- "Spring-loaded tech silo on giant abdominal wall defect can make defect much bigger over time as forces go outward" — Todd (clinical) [Ep 17 · 20:24](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1224)
- "Biologic mesh can be used as scaffold to allow skin epithelialization in giant defects" — Saleem (clinical) [Ep 17 · 21:23](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1283)
- "Prolene mesh can stay in place for months without removal, with 80% of giant defects closable within 2-3 months" — Miguel Gilfoyd (clinical) [Ep 17 · 24:18](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1458)
- "Tissue expanders placed subcutaneously can create redundant healthy skin, particularly important for cases initially treated with paint and wait" — Eric (clinical) [Ep 17 · 25:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1537)
- "Component separation technique involves separating tissue at external oblique about 1 cm beyond rectus sheath on both sides, creating significant space" — Sean (clinical) [Ep 17 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "UT Houston group reported component separation use in 9 children aged 7 days to 10 years, achieving fascial closure in vast majority" — Sean (clinical) [Ep 17 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "The Teodoro study examined pediatric trauma patients with gunshot wounds or MVCs presenting to a level one trauma center between 2009 and 2019" — Ellen Encisco (clinical) [Ep 30 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims" — Ellen Encisco (clinical) [Ep 30 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "Gunshot wound victims were 7.8 times more likely to die than MVC victims" — Ellen Encisco (clinical) [Ep 30 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "In California statewide data from 2006 to 2015, the case fatality rate for gunshot wound victims was higher than for motor vehicle collisions" — Ellen Encisco (epidemiological) [Ep 30 · 0:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=20)
- "The case fatality rate for pediatric gunshot wounds increased from 2006 to 2015 in California" — Ellen Encisco (epidemiological) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "The Petterson study examined 10 years of data comprising approximately 8800 pediatric trauma patients transported by helicopter or ground to pediatric trauma centers" — Britney Levy (clinical) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Children transported via helicopter had a higher injury severity score than those transported by ground" — Britney Levy (clinical) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "1.3% of children transported by helicopter required an emergency operation" — Britney Levy (clinical) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Only 0.2% of children transported by ground required an emergency operation" — Britney Levy (clinical) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "98.7% of children transported by helicopter did not require an emergency intervention" — Britney Levy (clinical) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "Helicopter transport may be over-utilized in pediatric trauma" — Britney Levy (opinion) [Ep 30 · 1:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=89)
- "The Miyata study used data from the Canadian Association of Pediatric Surgery Network for pediatric patients with gastroschisis who underwent bedside reduction and closure" — Rod Gerardo (clinical) [Ep 30 · 2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis" — Rod Gerardo (clinical) [Ep 30 · 2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=170)
- "The Philips study was a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers" — Cecilia Gigena (clinical) [Ep 30 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had shortened alpha angles on TEG analysis" — Cecilia Gigena (clinical) [Ep 30 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had lower maximum amplitude values on TEG analysis" — Cecilia Gigena (clinical) [Ep 30 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Patients with massive transfusions had lower platelet counts" — Cecilia Gigena (clinical) [Ep 30 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions" — Cecilia Gigena (clinical) [Ep 30 · 3:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-6-6636?t=213)
- "Infants with gastroschisis often require prolonged hospitalization for surgical repair and then initiation and advancement of feeds" — Em Tombash (clinical) [Ep 31 · 1:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60)
- "For babies with uncomplicated gastroschisis, feeds can be started immediately after sutureless abdominal closure, beginning with 10 to 20 milliliters per kilogram per day with advancements of 20 milliliters per kilogram per day if tolerated" — Em Tombash (guideline) [Ep 31 · 2:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150)
- "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds" — Em Tombash (clinical) [Ep 31 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=180)
- "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue with the feeding protocol even after one bout of emesis" — Em Tombash (guideline) [Ep 31 · 3:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=210)
- "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis" — Em Tombash (clinical) [Ep 31 · 5:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=300)
- "Serial dilatations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area" — Em Tombash (guideline) [Ep 31 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330)
- "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilatations are unsuccessful or there is concern for cartilaginous component" — Em Tombash (guideline) [Ep 31 · 5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330)
- "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours of intussusception were similar between inpatient and outpatient management groups after enema reduction" — Em Tombash (epidemiological) [Ep 31 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450)
- "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management of intussusception after enema reduction" — Em Tombash (epidemiological) [Ep 31 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Both inpatient and outpatient groups had similar rates of requiring operative intervention after intussusception reduction" — Em Tombash (epidemiological) [Ep 31 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Outpatient management of intussusception after air enema reduction results in a shorter hospital stay with no difference in rate of returns to emergency department, recurrence, need for operation, or mortality" — Em Tombash (clinical) [Ep 31 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=510)
- "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation for reducing surgical site infections in colorectal surgery" — Em Tombash (epidemiological) [Ep 31 · 9:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=570)
- "Recent adult studies have shown no benefit from mechanical bowel preparation in terms of reducing surgical site infections, and some studies showed an increase in wound infections" — Em Tombash (epidemiological) [Ep 31 · 10:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600)
- "Case appropriate pre-operative IV antibiotics may reduce surgical site infection incidents in colorectal operations" — Em Tombash (guideline) [Ep 31 · 10:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=630)
- "Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019" — Em Tombash (epidemiological) [Ep 31 · 11:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=690)
- "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies" — Em Tombash (clinical) [Ep 31 · 14:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840)
- "CT bronchoscopy can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure" — Em Tombash (clinical) [Ep 31 · 14:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=870)
- "Death or neurodevelopmental impairment occurred in 69% of patients with necrotizing enterocolitis who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage" — Em Tombash (epidemiological) [Ep 31 · 16:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960)
- "A prospective randomized cohort study showed no difference in overall survival between laparotomy and peritoneal drainage for necrotizing enterocolitis, but did show improved long-term neurodevelopmental outcomes with laparotomy" — Em Tombash (epidemiological) [Ep 31 · 16:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=990)
- "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups in medical settings" — Em Tombash (opinion) [Ep 31 · 18:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1080)
- "Microaggressions can harm trainees's performance and sense of belonging" — Em Tombash (opinion) [Ep 31 · 18:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1110)
- "In a 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings, 77% of patients were admitted for observation but none needed neurosurgical intervention or additional imaging during the index admission" — Em Tombash (epidemiological) [Ep 31 · 20:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200)
- "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications and can be discharged safely from the emergency department without inpatient observation" — Em Tombash (clinical) [Ep 31 · 20:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230)
- "In the IMPACT trial, patients with perforated appendicitis taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to ceftriaxone and metronidazole combination therapy" — Em Tombash (epidemiological) [Ep 31 · 22:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1320)
- "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic related complications compared to combination therapy" — Em Tombash (epidemiological) [Ep 31 · 22:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1350)
- "The CDC Wonder database was used to examine data between 1999 and 2020 for pediatric firearm and automobile fatalities." — Ellen Encisco (epidemiological) [Ep 32 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "The Gifford's Law Center annual gun law scorecard between 2014 and 2020 was used to assess state gun law scores." — Ellen Encisco (epidemiological) [Ep 32 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "In recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children." — Ellen Encisco (epidemiological) [Ep 32 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Stronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws." — Ellen Encisco (epidemiological) [Ep 32 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Gabapentin is an anticonvulsant that is often used off label as part of multimodal pain control after major surgery." — Alex Halpern (clinical) [Ep 32 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "The Children's Hospital of LA study was a retrospective cohort study looking at kids age 2 to 18 who underwent appendectomy for perforated appendicitis between 2014 and 2019." — Alex Halpern (clinical) [Ep 32 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Kids who received gabapentin had decreased postoperative opioid use after appendectomy for perforated appendicitis." — Alex Halpern (clinical) [Ep 32 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Kids who received gabapentin had a decreased postoperative length of stay after appendectomy for perforated appendicitis." — Alex Halpern (clinical) [Ep 32 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "The Midwest Pediatric Surgery Consortium study followed 375 patients with gastroschisis who underwent closure between 2013 and 2016." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "The overall rate for periumbilical hernias after gastroschisis closure was 22.7%." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Patients who underwent sutureless closures had 50% rates of persistent hernia." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 16.4% of patients who underwent sutured closure had a persistent hernia." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Spontaneous closure of periumbilical hernias after gastroschisis repair was seen in 38.8% of cases." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 31.8% of periumbilical hernias after gastroschisis closure needed surgery." — Cecilia Gigena (clinical) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Sutureless closures lead to more periumbilical hernias but they can be managed as any other congenital umbilical hernia and have no additional risk." — Cecilia Gigena (opinion) [Ep 32 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Gastroschisis has a reported incidence of 1 in 6,000 to 1 in 10,000" (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Gastroschisis is much more common in many parts of the U.S., including Southern California" (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "At two neonatal intensive care units, the practice treats 30 to 40 patients a year with gastroschisis" (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Gastroschisis is second only to inguinal hernias as a congenital anomaly requiring surgical correction at their institution" (epidemiological) [Ep 13 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "Traditional staged closure with sutured silastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications" (clinical) [Ep 13 · 1:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=60)
- "The spring-loaded silo allows for fast, pain-free, suture-less silo placement without need for a formal operation" (clinical) [Ep 13 · 2:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=120)
- "Dr. 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" (clinical) [Ep 13 · 3:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=180)
- "A prospective randomized study comparing primary to stage closure of gastroschisis is in progress but results are not yet available" (clinical) [Ep 13 · 4:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Several retrospective studies from large centers in the U.S. have reported favorable results with spring-loaded silo staged closure compared to primary closure controls" (clinical) [Ep 13 · 4:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Routine silo placement with delayed closure showed decreased airway pressures compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed earlier extubation compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased incidence of necrotizing enterocolitis compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased infectious complications compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed more rapid return of bowel function compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased length of stay compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Routine silo placement with delayed closure showed decreased hospital charges compared to primary closure" (clinical) [Ep 13 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor at their institution" (clinical) [Ep 13 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "They do not perform routine cesarean section for gastroschisis" (clinical) [Ep 13 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "They do not induce early labor for gastroschisis" (clinical) [Ep 13 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "The baby is sedated with fentanyl and midazolam drips for silo placement" (clinical) [Ep 13 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "A single dose of Vecuronium is given for the silo placement procedure" (clinical) [Ep 13 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "Placement of the silo is feasible without sedation, intubation, or paralysis, but these interventions create optimal conditions" (opinion) [Ep 13 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "The Bentec silo is available in seven sizes, from 3 cm to 15 cm diameter" (clinical) [Ep 13 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "They typically choose a ring that is 2 cm larger than the diameter of the defect" (clinical) [Ep 13 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "Most gastroschisis defects are 2 to 3 cm in diameter, making 4 and 5 cm silos the most commonly used" (clinical) [Ep 13 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "Gastroschisis that involve an atresia typically contain severely distended bowel and often require a 7.5 cm silo" (clinical) [Ep 13 · 10:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=600)
- "A distal colon severely distended with meconium is a good indication of the probable absence of a proximal atresia or stenosis" (clinical) [Ep 13 · 11:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction" (clinical) [Ep 13 · 11:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "If an obstruction exists without perforation, their policy is to proceed with silo placement and closure, followed by exploration four to six weeks later" (clinical) [Ep 13 · 12:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=720)
- "If the ring is too lax and allowed to sink in the abdomen, it may cause necrosis of the underlying duodenum or small bowel, especially if the silo is left in position for a prolonged period" (clinical) [Ep 13 · 15:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "If the ring elevates the abdominal wall, it would lead to abdominal wall congestion and complicate the final closure" (clinical) [Ep 13 · 15:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "The baby is maintained on sedation and mechanical ventilation but not paralyzed during the silo reduction period" (clinical) [Ep 13 · 16:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=960)
- "Resolution of bowel edema, accommodation by the abdominal cavity, and gravity result in gradual spontaneous reduction" (clinical) [Ep 13 · 16:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=960)
- "Active reduction is performed once or twice daily using umbilical tape to slowly ligate the silo with simultaneous reduction of contents" (clinical) [Ep 13 · 17:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1020)
- "Final closure is performed when the silo contents is within 2 cm of the abdominal wall" (clinical) [Ep 13 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "They leave the silo in place for the shortest time possible" (clinical) [Ep 13 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "Unnecessary prolongation of the silo duration has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications" (opinion) [Ep 13 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "The abdominal wall is stretched during closure to aid in a tension-free closure, which often produces some minor post-operative congestion of the abdominal wall" (clinical) [Ep 13 · 20:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1200)
- "The umbilical stump is preserved during closure" (clinical) [Ep 13 · 21:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1260)
- "The skin edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection" (clinical) [Ep 13 · 23:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1380)
- "Complications are similar between sutureless and standard sutured gastroschisis repair" — Salim (clinical) [Ep 15 · 2:27](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147)
- "Tony Sandler at Iowa originated sutureless repair when a large gastroschisis wound closed spontaneously after covering with umbilical cord and tachyderm" — Salim (clinical) [Ep 15 · 3:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=180)
- "Multiple retrospective studies reported sutureless repair patients eat quicker, go home faster, and are cheaper to manage" — Salim (clinical) [Ep 15 · 4:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=260)
- "The Brisoni randomized study from Stanford found sutureless repair patients took longer to eat and had longer hospital length of stay" — Salim (clinical) [Ep 15 · 4:50](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=290)
- "A subsequent 98-patient study from UCSF showed benefit for sutureless repair, conflicting with the Brisoni randomized trial" — Salim (clinical) [Ep 15 · 5:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=330)
- "Approximately 13% of sutureless repair patients require umbilical hernia repair at 4-5 years of age, higher than fascial closure patients" — Salim (clinical) [Ep 15 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Robert Baird's study from McGill showed everything was better about tape closure and had a lower umbilical hernia rate" — Todd (clinical) [Ep 15 · 6:19](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379)
- "Fear of feeding after sutureless closure may drive increased length of stay due to hesitation about bowel distension and evisceration" — Todd (opinion) [Ep 15 · 7:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=440)
- "Natural selection bias may favor sutureless closure for easier cases, confounding outcome comparisons" — Salim (opinion) [Ep 15 · 7:58](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=478)
- "The UCSF study with 98 patients and 5-year follow-up found 13% required hernia repair when compared to historical sutured controls" — Salim (clinical) [Ep 15 · 9:45](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=585)
- "Patients with attempted fascial closure without silo have higher incidence of umbilical or ventral hernias requiring repair" — Salim (clinical) [Ep 15 · 10:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=640)
- "All general anesthetic agents in every class cause increased apoptosis and developmental issues in animal studies (rats, mice, sheep)" — Salim (clinical) [Ep 15 · 11:47](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=707)
- "The GAS trial and PANDA study with 5-year data show no difference in neurodevelopmental outcome between spinal and general anesthesia in human infants" — Salim (clinical) [Ep 15 · 12:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=750)
- "Tony Sandler no longer uses the umbilical cord for sutureless closure; it is not as important as once thought" — Salim (clinical) [Ep 15 · 15:06](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906)
- "A silo can be placed, reduced, then followed by tape closure even if immediate reduction is not possible" — Salim (clinical) [Ep 15 · 15:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=940)
- "UCLA's UC fetal consortium standardized gastroschisis care without general anesthesia or intubation significantly decreased antibiotic use, intubation days, and opioid use, but did not decrease length of stay" (clinical) [Ep 15 · 16:02](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=962)
- "Gastroschisis patients should be delivered vaginally unless there is an obstetric indication for C-section" — Salim (guideline) [Ep 15 · 17:34](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1054)
- "The gastroschisis prognostic score (GPS) based on peel degree, bowel distension, and matting did not ultimately matter as much as hoped" — Salim (clinical) [Ep 15 · 18:10](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1090)
- "Gastroschisis with very thick peel, very distended bowel, and many loops should not undergo immediate closure; silo reduction is preferred" — Salim (clinical) [Ep 15 · 19:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1140)
- "There is no real need for fascial closure regardless of gastroschisis defect size; skin closure alone is adequate" — Salim (opinion) [Ep 15 · 19:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1180)
- "Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality" — Alex Gibbons (clinical) [Ep 16 · 0:26](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=26)
- "Exception to hemoglobin 7 transfusion threshold is sickle cell disease, where hematocrit needs to be around 30 or HbSS below 50%" (clinical) [Ep 16 · 1:45](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=105)
- "Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality" (clinical) [Ep 16 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and is equally tolerated" (clinical) [Ep 16 · 2:20](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=140)
- "In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still have recovery and it helps preserve fertility" (clinical) [Ep 16 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "Ultrasound is not a great tool for diagnosis of ovarian torsion" (clinical) [Ep 16 · 3:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=209)
- "For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin" (guideline) [Ep 16 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7" (guideline) [Ep 16 · 4:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=245)
- "Institutional policy is to use VTE prophylaxis (SCDs and low molecular weight heparin if high risk) in trauma patients 12 years and older" (clinical) [Ep 16 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "High risk for VTE includes femur fractures, cervical spine fracture, and intubated patients" (clinical) [Ep 16 · 4:53](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=293)
- "Children with IBD are probably the most at-risk group for deep venous thromboses" (clinical) [Ep 16 · 5:50](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=350)
- "Burnout directly impacts patient care and outcomes" (clinical) [Ep 16 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Support systems for physician wellness need to be established proactively during education and practice because burnt-out surgeons are unlikely to seek help" (opinion) [Ep 16 · 6:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=362)
- "Physicians should ask patients whether there's a firearm in the home and if so, whether it's safely stored" (guideline) [Ep 16 · 8:23](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=503)
- "Safe firearm storage means keeping guns under lock and key, unloaded, with ammunition stored separately, and controlling who has access" — Salim (guideline) [Ep 16 · 10:27](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=627)
- "Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic fluids for maintenance, which decreases risk of hyponatremia" (clinical) [Ep 16 · 11:27](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=687)
- "Isotonic fluid continuation applies to pyloric stenosis patients as well" (clinical) [Ep 16 · 13:07](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=787)
- "Pediatric nephrology division at Indiana did not want universal switch to isotonic fluids for all patients, preferring a more tailored measured approach" — Fred Rescorla (opinion) [Ep 16 · 14:05](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=845)
- "In Wilms tumor surgery, failure to remove lymph nodes automatically upstages the patient" (clinical) [Ep 16 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "Wilms tumor has both local and systemic staging, and pulmonary metastasis does not preclude doing a primary nephrectomy" (clinical) [Ep 16 · 14:30](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=870)
- "Even in Wilms tumor with stage 4 disease (lung mets), it is important to take nodes because you treat the local disease and it impacts treatment for abdominal disease" — Dan (clinical) [Ep 16 · 15:37](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=937)
- "For Wilms tumor, take nodes from both sides of the cava and the aorta, but do not need to dissect into renal hilum on contralateral side or open Gerota's fascia" (clinical) [Ep 16 · 23:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1381)
- "Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures" (clinical) [Ep 16 · 16:41](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1001)
- "In the APAC trial of adults, 41% of the non-operative appendicitis group underwent appendectomy at 5 years" — Todd Ponsky (epidemiological) [Ep 16 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "Parents surveyed for PCORI study said they would accept 50% success rate for non-operative appendicitis management" — Todd Ponsky (epidemiological) [Ep 16 · 17:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1036)
- "Opioid crisis recommendations include reducing total opioids prescribed, using non-opioid analgesia, non-pharmacological approaches, and educating on disposal of unused opioids" (guideline) [Ep 16 · 23:29](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1409)
- "For well-appearing full-term infant with intact omphalocele and no maternal fever or chorioamnionitis, preoperative antibiotic given one hour before incision and discontinued within 72 hours is most appropriate" — Liz Byerly (guideline) [Ep 16 · 26:19](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1579)
- "Babies with ruptured omphalocele or gastroschisis have an open abdomen and should receive antibiotics, but intact omphalocele does not require antibiotics until OR" (clinical) [Ep 16 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "Children with duodenal atresia going to OR within 24-48 hours probably don't need antibiotics if well-appearing" (clinical) [Ep 16 · 28:02](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1682)
- "In pediatric sepsis, give 20 mL/kg boluses of isotonic fluid up to 60 mL/kg total, with goal of perfusion improvement" — Salim Islam (guideline) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Stop fluid boluses if seeing over-perfusion such as rales on auscultation or hepatomegaly" — Salim Islam (guideline) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Must start broad-spectrum antibiotics in sepsis within first hour; waiting over 3 hours decreases survival" — Salim Islam (clinical) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "If hemoglobin less than 10 in septic patient, transfusion may be indicated" — Salim Islam (clinical) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "For pediatric sepsis vasopressor choice, epinephrine is preferred over dopamine based on two randomized trials showing better mortality and more rapid sustained blood pressure improvement" — Salim Islam (clinical) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Hydrocortisone is indicated for vasopressor-refractory hypotension in sepsis" — Salim Islam (guideline) [Ep 16 · 33:01](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=1981)
- "Broad-spectrum antibiotics for sepsis means extended-spectrum penicillin like piperacillin-tazobactam or ampicillin-sulbactam to cover everything empirically" — Salim Islam (clinical) [Ep 16 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Draw blood for lactate and cultures just prior to starting antibiotics in sepsis, but don't delay antibiotics waiting for cultures" — Salim Islam (guideline) [Ep 16 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Odds ratio for not starting antibiotics within 3 hours in pediatric sepsis is 3.92 for mortality - almost 4 times more likely to die" — Salim Islam (epidemiological) [Ep 16 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Source control is key in sepsis management - if abscess or perforated appendicitis, must address surgical source" — Salim Islam (clinical) [Ep 16 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "ECMO survival for severe sepsis with recalcitrant hypotension is about 46% overall, which is better than zero" — Salim Islam (epidemiological) [Ep 16 · 36:49](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2209)
- "Updated APSA blunt liver-spleen injury guidelines recommend treating based on patient's hemodynamic status, not injury grade" — Stephen Lee (guideline) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Modified pediatric shock index (heart rate over systolic blood pressure) can determine if patient is still bleeding" — Stephen Lee (clinical) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Hemodynamically stable liver-spleen injury patients admitted to ward need only one repeat hemoglobin check at 6 hours, can have regular diet, and have no activity restrictions" — Stephen Lee (guideline) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "After first 20 mL/kg normal saline bolus in trauma, if patient still requires fluids, give blood (10 mL/kg packed red blood cells)" — Stephen Lee (guideline) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Angioembolization in stable patients with contrast blush does not need to be done, particularly in splenic injuries which do not continue to bleed" — Stephen Lee (clinical) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Operative threshold for blunt liver-spleen injury is greater than 40 mL/kg of packed red blood cells transfused" — Stephen Lee (guideline) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "ATOMAC (Arkansas, Texas, Oklahoma, Memphis, Arizona) is a consortium of level 1 pediatric trauma centers studying trauma questions prospectively since 2010" — Stephen Lee (epidemiological) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=2596)
- "Cervical spine injury occurs in about 1-2% of all pediatric traumas" — Meera Kotagal (epidemiological) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In children 8 years and younger, 50% of cervical spine injuries are bony fractures and 50% are ligamentous injuries, dislocations, or SCIWORA" — Meera Kotagal (epidemiological) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "In older children, 70-80% of cervical spine injuries are bony injuries, following adult patterns" — Meera Kotagal (epidemiological) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "60-80% of vertebral injuries in children are in the cervical spine, compared to 30-40% in adults" — Meera Kotagal (epidemiological) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "AAST cervical spine injury score for children under 3 years uses GCS less than 14, motor vehicle crash involvement, and age greater than or equal to 2 years as predictors; score 0-1 has negative predictive value over 99%" — Meera Kotagal (clinical) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "46% of institutions do not have a protocol for cervical spine clearance in children" — Meera Kotagal (epidemiological) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Patients with abnormal neurological exam cannot be clinically cleared and need MRI for cervical spine evaluation" — Meera Kotagal (guideline) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "CT is not commonly used for pediatric cervical spine injury because most injuries are ligamentous not bony, so move towards MRI for cross-sectional imaging" — Meera Kotagal (clinical) [Ep 16 · 59:25](https://library.globalcastmd.com/watch/7th-annual-pediatric-surgery-update-course-2019-full-show-2797?t=3565)
- "Tony Sandler published the first manuscript about sutureless closures utilizing natural umbilical properties to close the gastroschisis defect by itself in 2004" — Rod Gerardo (clinical) [Ep 22 · 1:44](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=104)
- "The study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The study included a total of 315 patients" — Rod Gerardo (epidemiological) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients were divided into sutured versus sutureless abdominal wall closure groups with subgroup analysis for those who received silos" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in days on TPN compared to sutured closure" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in time to goal feeds compared to sutured closure" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in time to initial feeds compared to sutured closure" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure showed no difference in length of stay compared to sutured closure" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less antibiotic use than sutured closure patients" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer surgical site and deep space infections than sutured closure patients" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer episodes of general anesthetics than sutured closure patients" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less ventilator use than sutured closure patients" — Rod Gerardo (clinical) [Ep 22 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients able to undergo primary repair probably had more favorable bowel" — Jason Frischer (opinion) [Ep 22 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Patients with more favorable bowel theoretically would have less hospital stay and feed faster" — Jason Frischer (opinion) [Ep 22 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Many sutureless repair patients were done in more recent cohorts and tended towards less interventions" — Jason Frischer (opinion) [Ep 22 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "In sutured repair, mobilizing flaps from skin and fascia causes redness and bruising around the incision" — Jason Frischer (clinical) [Ep 22 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "Tissue manipulation in sutured repair puts patients at higher risk for potential infection or erythema" — Jason Frischer (clinical) [Ep 22 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The finding of increased antibiotics needed after sutured repair was expected" — Jason Frischer (opinion) [Ep 22 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "Several small studies show that some sutureless patients had a high umbilical hernia repair rate or at least a high umbilical hernia rate" — Jason Frischer (epidemiological) [Ep 22 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Long-term follow-up data on the same patients examining growth and umbilical hernia repair rates has been completed and will be analyzed soon" — Jason Frischer (clinical) [Ep 22 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Gastroschisis is now more like a safe bedside procedure rather than necessitating a trip to the OR" — Rod Gerardo (opinion) [Ep 22 · 11:22](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=682)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover" — Foong-Yen Lim (clinical) [Ep 25 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover" — Foong-Yen Lim (clinical) [Ep 25 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development" — Foong-Yen Lim (clinical) [Ep 25 · 0:55](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=55)
- "Very high level of alpha fetal protein is associated with gastroschisis or omphalocele" — Foong-Yen Lim (clinical) [Ep 25 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Ultrasound imaging is needed to definitively diagnose abdominal wall defects" — Foong-Yen Lim (clinical) [Ep 25 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies" — Foong-Yen Lim (guideline) [Ep 25 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Fetal growth is tracked monthly because there is concern for significant growth restriction" — Foong-Yen Lim (guideline) [Ep 25 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise can occur in these patients" — Foong-Yen Lim (clinical) [Ep 25 · 2:56](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=176)
- "Gastroschisis affects approximately one in every 2,200 live births" — Todd Ponsky (epidemiological) [Ep 25 · 3:15](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=195)
- "Gastroschisis is most common among babies born to young mother of low gravity and usually first pregnancy, with 75% being first born" — Foong-Yen Lim (epidemiological) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Nearly 60% of gastroschisis cases are premature" — Foong-Yen Lim (epidemiological) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "More than 90% of gastroschisis infants are born less than 2,500 grams in weight" — Foong-Yen Lim (epidemiological) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Pseudoephedrine and acetaminophen have an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7" — Foong-Yen Lim (epidemiological) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions" — Foong-Yen Lim (epidemiological) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Mothers with omphalocele are usually advanced in their age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3" — Foong-Yen Lim (epidemiological) [Ep 25 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Trisomy 13, 18, and 21 occur in anywhere between 35 and 90% of patients with omphalocele" — Foong-Yen Lim (epidemiological) [Ep 25 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Minimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated and cold" — Foong-Yen Lim (clinical) [Ep 25 · 5:02](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "These babies can have significant acidosis and pulmonary hypertension" — Foong-Yen Lim (clinical) [Ep 25 · 5:02](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "Primary closure is considered if bowel looks pristine, non-thickened, non-inflammatory, with only small amount on the outside and enough abdominal domain" — Foong-Yen Lim (guideline) [Ep 25 · 5:34](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=334)
- "Staged closure is favored if the defect is large or there's issue with the bowel" — Foong-Yen Lim (guideline) [Ep 25 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Some patients can have atresia, compromised bowel, or perforation" — Foong-Yen Lim (clinical) [Ep 25 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Patients can develop intestinal perforation after only two days to four days of enteral feeding" — Foong-Yen Lim (clinical) [Ep 25 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Majority of babies in the last four and a half years at Cincinnati Children's are being managed using a sutureless closure" — Todd Ponsky (clinical) [Ep 25 · 6:34](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=394)
- "In sutureless closure, after pushing the bowel back in, the umbilical cord is put over and then dressing over, without taking babies to the operating room to close with suture" — Foong-Yen Lim (clinical) [Ep 25 · 6:58](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "With sutureless closure, skin will grow over and the umbilical defect can close spontaneously over time" — Foong-Yen Lim (clinical) [Ep 25 · 6:58](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "For small bowel atresia, management options include tapering the dilated portion of bowel or resecting the bowel before tapering" — Foong-Yen Lim (opinion) [Ep 25 · 7:29](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=449)
- "For omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option" — Foong-Yen Lim (guideline) [Ep 25 · 7:57](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=477)
- "Meshes are sewn to the edges of the fascia without interrupting the membrane" — Foong-Yen Lim (clinical) [Ep 25 · 7:57](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=477)
- "At Cincinnati Children's, Duoderm silo is done on top of the skin using plastic clips to sequentially clip it down until it's flush to the abdominal skin" — Foong-Yen Lim (clinical) [Ep 25 · 8:17](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=497)
- "After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin" — Foong-Yen Lim (clinical) [Ep 25 · 8:17](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=497)
- "Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover" — Fung Lim (clinical) [Ep 27 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is right through the middle of the umbilicus and has a membranous cover" — Fung Lim (clinical) [Ep 27 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development" — Fung Lim (clinical) [Ep 27 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "Very high level of alpha fetal protein is associated with gastroschisis or omphalocele" — Fung Lim (clinical) [Ep 27 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "Ultrasound imaging is needed to definitively diagnose abdominal wall defects" — Fung Lim (clinical) [Ep 27 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because patients may have other associated anomalies" — Todd Ponsky (guideline) [Ep 27 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "Fetal growth is tracked monthly in these cases because there is concern for significant growth restriction" — Todd Ponsky (guideline) [Ep 27 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "In utero growth restriction as well as in utero fetal demise can occur in these patients" — Fung Lim (clinical) [Ep 27 · 2:51](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "Gastroschisis affects approximately one in every 2200 live births" — Todd Ponsky (epidemiological) [Ep 27 · 3:15](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=195)
- "Gastroschisis is most common among babies born to young mother of low gravity and usually first pregnancy, with 75% being first born" — Fung Lim (epidemiological) [Ep 27 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis cases are premature" — Fung Lim (epidemiological) [Ep 27 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "More than 90% of gastroschisis infants are born less than 2500 grams in weight" — Fung Lim (epidemiological) [Ep 27 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7" — Fung Lim (epidemiological) [Ep 27 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "For omphalocele, mothers are usually advanced in their age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3" — Fung Lim (epidemiological) [Ep 27 · 4:21](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele" — Fung Lim (epidemiological) [Ep 27 · 4:21](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "Minimizing heat loss and fluid loss are crucial immediately after birth, otherwise babies can show up extremely dehydrated and cold" — Fung Lim (clinical) [Ep 27 · 5:02](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "These babies can have significant acidosis and pulmonary hypertension" — Fung Lim (clinical) [Ep 27 · 5:02](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "Primary closure is considered if bowel looks pristine, non-thickened, non-inflammatory, with only small amount on the outside and enough abdominal domain" — Fung Lim (clinical) [Ep 27 · 5:32](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=332)
- "Staged closure is favored if the defect is large or there's issue with the bowel, including atresia, compromised bowel, or perforation" — Fung Lim (clinical) [Ep 27 · 6:03](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "Some patients develop intestinal perforation after only two to four days of enteral feeding" — Fung Lim (clinical) [Ep 27 · 6:03](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "Majority of babies at Cincinnati Children's in the last four and a half years are managed using sutureless closure" — Fung Lim (clinical) [Ep 27 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "In sutureless closure, after pushing bowel back in, umbilical cord is put over with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time" — Fung Lim (clinical) [Ep 27 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "For omphalocele without significant respiratory issues, sequential reduction using meshes is the best option" — Fung Lim (clinical) [Ep 27 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "At Cincinnati Children's, Duoderm silo is placed on top of the skin and sequentially clipped down with plastic clips until flush to abdominal skin" — Fung Lim (clinical) [Ep 27 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "The Update Course has approximately 2000 people signed up" (epidemiological) [Ep 28 · 0:00](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=0)
- "MMP7 could be used to distinguish biliary atresia from other cholestatic diseases" — Rod Gerardo (clinical) [Ep 28 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "Intraoperative ICG can be used to determine biliary flow or identify a transaction" — Rod Gerardo (clinical) [Ep 28 · 3:47](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=227)
- "26% of respondents use ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it" (epidemiological) [Ep 28 · 4:45](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=285)
- "MMP7 testing is often a send-out test at non-freestanding children's hospitals" — Rod Gerardo (clinical) [Ep 28 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "Children with biliary atresia presenting at five weeks have limited time to achieve best outcomes" — Rod Gerardo (clinical) [Ep 28 · 5:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=348)
- "For pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading" — Rod Gerardo (guideline) [Ep 28 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "There is currently no great definition of what constitutes massive transfusion protocol in pediatric patients" — Rod Gerardo (clinical) [Ep 28 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "Balanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion" — Rod Gerardo (clinical) [Ep 28 · 8:30](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=510)
- "Hypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each" — Rod Gerardo (epidemiological) [Ep 28 · 10:35](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=635)
- "Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions" (clinical) [Ep 28 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "There are case reports showing mucosal sloughing with phenol use" (clinical) [Ep 28 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "Deflux, used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse" (clinical) [Ep 28 · 10:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=650)
- "3% sotradecol is used as an alternative sclerotherapy agent" — Rod Gerardo (clinical) [Ep 28 · 11:48](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=708)
- "D50 from the code cart is easier to acquire than 3% saline in some operating rooms" — Rod Gerardo (clinical) [Ep 28 · 11:56](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=716)
- "50% of respondents always use sutureless closure for large abdominal wall defects, 39% use it in select patients, and only 11% do not use it" (epidemiological) [Ep 28 · 12:23](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=743)
- "ERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics" — Rod Gerardo (clinical) [Ep 28 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "ERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols" — Rod Gerardo (clinical) [Ep 28 · 16:14](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=974)
- "ERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice" — Rod Gerardo (opinion) [Ep 28 · 16:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1002)
- "ERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy" — Rod Gerardo (opinion) [Ep 28 · 17:55](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1075)
- "Surgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways" — Rod Gerardo (clinical) [Ep 28 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "Surgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay" — Rod Gerardo (clinical) [Ep 28 · 19:09](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1149)
- "Starting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation" — Rod Gerardo (opinion) [Ep 28 · 19:42](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1182)
- "For pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system" — Rod Gerardo (clinical) [Ep 28 · 21:18](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1278)
- "Multiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding" — Rod Gerardo (clinical) [Ep 28 · 21:38](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1298)
- "Most institutions are either addressing social determinants of health or working on it, with few saying no" (epidemiological) [Ep 28 · 21:50](https://library.globalcastmd.com/watch/update-course-2021-update-course-2020-review-of-last-year-s-important-t-opics-5405?t=1310)
- "Several hospitals have changed their gastroschisis protocols based on recent publications" — Todd (clinical) [Ep 29 · 0:00](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=0)
- "Some protocols say to start feeding when NG output is 20 mL/kg/day" — Justin (clinical) [Ep 29 · 1:45](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=105)
- "Some published protocols say to start feeding when the baby has had a bowel movement" — Jason Frischer (clinical) [Ep 29 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "Some protocols say to start feeding when NG output is clear" — Jason Frischer (clinical) [Ep 29 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "Some protocols say to start feeding when you clamp the NG and there is no output" — Jason Frischer (clinical) [Ep 29 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "One institution does not intubate gastroschisis babies at all for dressing placement" — Jason Frischer (clinical) [Ep 29 · 3:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=190)
- "If you empty the stomach, squish out the colon, go slow, give the baby sweeties, and have nurses help relax the baby, you can reduce gastroschisis without sedation" — Jason Frischer (clinical) [Ep 29 · 5:13](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=313)
- "Some institutions use full general anesthesia for gastroschisis reduction" — Bindi (clinical) [Ep 29 · 5:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=352)
- "In parts of the world without TPN access, they must feed gastroschisis babies immediately" — Jason Frischer (clinical) [Ep 29 · 6:19](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=379)
- "Cincinnati introduced sham feeding into their gastroschisis protocol because babies had poor oral feeding skills from delayed access to feeding" — Beth Rymeski (clinical) [Ep 29 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Cincinnati tried ad-lib feeding for gastroschisis for about a year but abandoned it after reviewing results" — Beth Rymeski (clinical) [Ep 29 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Cincinnati's gastroschisis feeding protocol has been in place for approximately four years" — Beth Rymeski (clinical) [Ep 29 · 6:52](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=412)
- "Feeding protocols are important because they reduce care variation and allow nurses and residents to advance feeds without calling a doctor every time" — Todd (opinion) [Ep 29 · 9:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=550)
- "In the multi-institutional study, roughly two-thirds of patients were fed by protocol and one-third were not" — Beth Rymeski (epidemiological) [Ep 29 · 10:01](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=601)
- "Protocol-fed infants had fewer surgical site infections" — Beth Rymeski (epidemiological) [Ep 29 · 10:01](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=601)
- "The study was inconclusive due to lots of different feeding protocols used across member institutions" — Jason Frischer (epidemiological) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "The SSI reduction was probably because protocol-fed patients had less variability and fewer changes in care" — Jason Frischer (opinion) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati's average length of stay for gastroschisis was 49 days, astronomically higher than other NICUs in their cooperative network" — Jason Frischer (epidemiological) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "After instituting a feeding protocol, Cincinnati dropped gastroschisis length of stay by 10 days over two years" — Jason Frischer (epidemiological) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati is starting to see a decrease in time from first feed to full feeds" — Jason Frischer (clinical) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Cincinnati has not seen a change in days from admission to first feed, although 2020 showed improvement before bouncing back" — Jason Frischer (epidemiological) [Ep 29 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=630)
- "Some neonatologists prefer continuous feeds, which can lead to babies not taking anything orally and developing oral aversion, prolonging length of stay" — Justin (clinical) [Ep 29 · 13:06](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=786)
- "Cincinnati tries to do intermittent feeds to start, though the protocol does not specifically mandate it" — Beth Rymeski (clinical) [Ep 29 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Approximately two-thirds of Cincinnati's gastroschisis babies go home with an NG or G-tube" — Beth Rymeski (epidemiological) [Ep 29 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Cincinnati has only been doing sham feeds for about a year, too early to see if it makes a difference" — Beth Rymeski (clinical) [Ep 29 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=831)
- "Some people will ignore bilious emesis completely in gastroschisis patients" — Jason Frischer (clinical) [Ep 29 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Some people check residuals which will be bilious and some will completely ignore that" — Jason Frischer (clinical) [Ep 29 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "A study from New Zealand discusses attitudes towards feeding in gastroschisis" — Jason Frischer (clinical) [Ep 29 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Institutions need to define their own tolerance thresholds and stay on protocol while continually evaluating patient condition" — Jason Frischer (opinion) [Ep 29 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "If a patient has significant issues and complete intolerance, one approach is to stop feeds for six hours" — Jason Frischer (clinical) [Ep 29 · 15:05](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=905)
- "Cincinnati's written protocol states that emesis is expected to set family and nursing expectations" — Beth Rymeski (clinical) [Ep 29 · 16:58](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1018)
- "One recent patient who was primarily reduced on day of life zero was out of hospital in about two weeks" — Jason Frischer (clinical) [Ep 29 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "Current gastroschisis length of stay is about 30 to 34 days at one institution" — Jason Frischer (epidemiological) [Ep 29 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "The institution tries to push oral feeds quickly to avoid oral aversion" — Jason Frischer (clinical) [Ep 29 · 17:15](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1035)
- "One institution has not seen any aspirations with early aggressive feeding yet" — Jason Frischer (clinical) [Ep 29 · 18:00](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1080)
- "Much of the early feeding data came from low-resource countries without TPN access" — Justin (epidemiological) [Ep 29 · 18:28](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1108)
- "It is very hard for gastroschisis babies in Africa to tolerate early aggressive feeding" — Justin (clinical) [Ep 29 · 18:28](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1108)
- "At least two-thirds of gastroschisis cases at one institution cannot be reduced right away and are placed in a silo" — Jason Frischer (epidemiological) [Ep 29 · 18:56](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1136)
- "Giant omphalocele is typically defined as five centimeters or greater or liver in the sac" (clinical) [Ep 49 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "In a two-center retrospective study of 97 giant omphalocele survivors over 20 years, patients had greater time to full feeds, required more TPN, had more chromosomal anomalies, and higher incidence of respiratory insufficiency" (clinical) [Ep 49 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "56 of 97 giant omphalocele patients were identified as having pulmonary hypertension, most diagnosed within the first week of life" (clinical) [Ep 49 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Five patients with giant omphalocele had no signs of pulmonary hypertension in first echo within seven days but subsequently developed severe pulmonary hypertension, all associated with sepsis episodes" (clinical) [Ep 49 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Two of the five patients who developed late pulmonary hypertension died, and one required pulmonary vasodilator for more than a year" (clinical) [Ep 49 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Treatment options for giant omphalocele include painting the sac, removing sac and placing silo with passive or active reduction, keeping sac with active reduction, or definitive immediate closure" — Ellen Encisco (clinical) [Ep 49 · 2:28](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=148)
- "Hydrocolloid dressing technique for giant omphalocele achieved closure in 97% of 40 patients within 30 days and 92% within 15 days" — Ellen Encisco (clinical) [Ep 49 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=234)
- "Hydrocolloid dressing should be placed within first 24 hours before the sac becomes stiff, and the dressing keeps the sac smooth and hydrated" (clinical) [Ep 49 · 4:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=266)
- "Patients with hydrocolloid dressing for omphalocele are kept in ICU, ventilated and completely paralyzed during reduction" (clinical) [Ep 49 · 4:20](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=260)
- "For ruptured omphalocele, the sac can be sutured and then hydrocolloid dressing applied" (clinical) [Ep 49 · 4:45](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=285)
- "Patients with omphalocele have increased risk of midgut volvulus compared to gastroschisis patients" (clinical) [Ep 49 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Patients with omphalocele have increased risk of adhesive bowel obstruction with gastroschisis, but higher risk of midgut volvulus" (clinical) [Ep 49 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Non-rotation does not exclude the possibility of anatomy with narrow base of mesentery and two ends being fairly close together" (clinical) [Ep 49 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "If exposing intestines in omphalocele patient, Ladd procedure is worthwhile because patients have non-rotation or mal-rotation" (opinion) [Ep 49 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "In gastroschisis, the liver is not expected to be eviscerated" (clinical) [Ep 49 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=434)
- "For massive abdominal wall defects with no amnion, options include leaving silo and squeezing down, creating separate silastic silo sewn to fascia or skin, creating silo with PTFE or biologic mesh sewn to fascial edges" (clinical) [Ep 49 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=434)
- "Proline mesh can be used for giant defects as it stays in place until closure, with bowel protected within a plastic bag" (clinical) [Ep 49 · 8:18](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=498)
- "Spring-loaded Bentec silo creates outward forces that can make the defect bigger over time in giant abdominal wall defects" (clinical) [Ep 49 · 8:49](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=529)
- "Biologic mesh creates a scaffold that sticks to bowel and allows skin to epithelialize" (clinical) [Ep 49 · 9:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Foreskin from circumcision can be used as a skin graft for abdominal wall coverage" (clinical) [Ep 49 · 9:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Component separation technique involves separating tissue at external oblique about one centimeter beyond rectus sheath on both sides, creating space by dissecting between external and internal oblique" — Ellen Encisco (clinical) [Ep 49 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Incision on anterior rectus sheath can provide additional centimeter of space for closure" — Ellen Encisco (clinical) [Ep 49 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Texas report of component separation in nine children aged 7 days to 10 years achieved fascial closure in vast majority, mostly for omphaloceles and giant defects" — Ellen Encisco (clinical) [Ep 49 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Complex gastroschisis has worse outcomes than simple variety in all measures: hospital length of stay, requirement for further operations, and sepsis rates" (clinical) [Ep 49 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutureless gastroschisis closure involves placing silo or tucking bowel in with occlusive dressing, changed at five days, with defect mostly closed by next change" (clinical) [Ep 49 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutured versus sutureless gastroschisis closure showed no difference in time to full feeds, TPN use, or hospital stay duration" (clinical) [Ep 49 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Sutureless gastroschisis closure resulted in fewer anesthetics, less frequent antibiotic use, and fewer infections and septic events" (clinical) [Ep 49 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Randomized trial of over 50 gastroschisis patients found no difference between immediate closure and silo placement" (clinical) [Ep 49 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)

## Changelog
- Aug 31: 58 doctors auto-found from episode dossiers
- Aug 30: 43 doctors auto-found from episode dossiers
- Aug 30: 34 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 45 doctors auto-found from episode dossiers
- Aug 29: 46 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 60 items, 36 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 2 audience(s)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai