# Gastroschisis — GCMD Library living collection

Everything in the library about gastroschisis — built automatically from dossiers that name it.

Updated: n/a · 27 episodes · 505 cited statements

## Episodes
### Fundamentals
- [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)

### 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)

### Nutritional Management
- [Intestinal Failure - Feeding Access and Nutrition](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740) — video · 118:06 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740.md)
- [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
- [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)
- [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)

### 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)
- [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)
- [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)
- [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)
- [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 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)

### 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)
- [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)

### 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)
- [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)

### Patient & Family Education
- [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
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=0) Introduction and Hirschsprung Disease Study (Ep 23)
- [6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=407) Gastroschisis Management Systematic Review (Ep 23)
- [13:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=836) Clavien-Madadi Classification Validation (Ep 23)
- [18:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1092) Summary and Conclusion (Ep 23)
- [0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0) Introduction and Background (Ep 12)
- [4:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=243) Gastroschisis: Prenatal Counseling and Delivery Planning (Ep 12)
- [8:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=514) Gastroschisis: Initial Management and Closure Techniques (Ep 12)
- [17:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1024) Gastroschisis: Intestinal Atresia Management (Ep 12)
- [22:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1337) Gastroschisis: Prolonged Ileus and Complications (Ep 12)
- [28:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1707) Omphalocele: Prenatal Counseling and Associated Anomalies (Ep 12)
- [32:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1942) Omphalocele: Surgical Management and Reduction Techniques (Ep 12)
- [40:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2417) Omphalocele: Delayed Closure and Patch Repair (Ep 12)
- [45:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2754) Omphalocele: Feeding Issues and Associated Problems (Ep 12)
- [0:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=0) Introduction to Safety Series (Ep 7)
- [0:22](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=22) Error Traps and Culture of Safety in Abdominal Wall Defects (Ep 7)
- [0:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1) Prenatal management and delivery planning for gastroschisis (Ep 1)
- [5:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=316) Postnatal closure techniques for gastroschisis with minimal bowel damage (Ep 1)
- [13:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=782) Management of gastroschisis with intestinal atresia (Ep 1)
- [18:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1085) Feeding intolerance after gastroschisis repair (Ep 1)
- [21:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1272) Management of large omphalocele in term neonate (Ep 1)
- [27:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1639) Assessing abdominal compartment syndrome during closure (Ep 1)
- [32:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1922) Staged repair of giant omphalocele in a 3-year-old (Ep 1)
- [0:06](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=6) Study background and rationale (Ep 3)
- [0:50](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=50) Protocol changes across the care pathway (Ep 3)
- [1:40](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=100) Study outcomes (Ep 3)
- [1:59](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=119) Commentary and summary of five key interventions (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=0) Introduction and Feeding Access Strategies (Ep 2)
- [7:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=420) Surgical Techniques for Feeding Access (Ep 2)
- [17:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1020) Gastrostomy Timing and Indications (Ep 2)
- [28:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1680) STEP Procedure Indications and Timing (Ep 2)
- [40:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=2400) Referral Patterns and Remote Management (Ep 2)
- [54:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3240) Formula Selection and Breast Milk Benefits (Ep 2)
- [72:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=4320) Microbiome Management: Antibiotics versus Prebiotics (Ep 2)
- [90:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5400) Hypermotility Management (Ep 2)
- [104:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6240) Monitoring and Emerging Therapies (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=0) Gastroschisis closure study results (Ep 8)
- [0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0) Introduction and epidemiology of gastroschisis (Ep 9)
- [3:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=180) Spring-loaded silo device description and literature review (Ep 9)
- [7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420) Prenatal management and delivery room preparation (Ep 9)
- [9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540) Silo sizing principles and case examples (Ep 9)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age" — Em Gootee (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 23 · 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 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 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 23 · 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 23 · 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 23 · 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 23 · 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 (host_summary) [Ep 23 · 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 (host_summary) [Ep 23 · 17:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-3rd-quarter-2024-9308?t=1036)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 12 · 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" — Jack Langer (clinical) [Ep 12 · 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, and it's pretty rare to have abnormal chromosomes" — Jack Langer (clinical) [Ep 12 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "Early papers showed a benefit to cesarean section in gastroschisis, but cesarean sections were usually done early at 36 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit" — Jack Langer (clinical) [Ep 12 · 5:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=346)
- "Many studies have failed to show an advantage to cesarean section, and most people nowadays would not do routine cesarean section for gastroschisis" — Jack Langer (clinical) [Ep 12 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery in gastroschisis" — Jack Langer (clinical) [Ep 12 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jack Langer (clinical) [Ep 12 · 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 a lot earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by the inflamed bowel" — Jack Langer (clinical) [Ep 12 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor can usually be successfully induced at 37 weeks, unlike regular pregnancies" — Jack Langer (clinical) [Ep 12 · 7:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=450)
- "Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jack Langer (clinical) [Ep 12 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport of gastroschisis patients, it's important for the baby to be nursed on his or her side, usually right side down, to prevent kinking of the mesentery and ischemia of the bowel" — Jack Langer (clinical) [Ep 12 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "For gastroschisis, bedside closure is the first choice if the bowel is not too thickened and there's not too much peel" — Jack Langer (clinical) [Ep 12 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jack Langer (clinical) [Ep 12 · 11:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jack Langer (clinical) [Ep 12 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "The current approach uses pre-formed silos, slowly pushing on them with fentanyl or morphine sedation in an awake baby, aiming to keep intraabdominal pressure below 20" — Jack Langer (clinical) [Ep 12 · 11:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=707)
- "If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days" — Jack Langer (clinical) [Ep 12 · 12:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=747)
- "The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord" — Todd Ponsky (host_summary) [Ep 12 · 13:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=795)
- "A study by Dr. Baird published in JPS 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 (host_summary) [Ep 12 · 14:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=859)
- "Umbilical hernias from plastic closure generally close by age 2 or 3 years, just like any umbilical hernia" — Jack Langer (clinical) [Ep 12 · 14:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=896)
- "Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later" — Jack Langer (clinical) [Ep 12 · 16:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=972)
- "The disadvantage of leaving a silo on for 24-48 hours is that the abdominal wall defect gets stretched out and bigger, taking longer to close with plastic closure" — Jack Langer (clinical) [Ep 12 · 17:25](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1045)
- "Spring-loaded silos apply pressure outward as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 12 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jack Langer (epidemiological) [Ep 12 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia where bowel gets very dilated but not thick-walled, and late atresia where the abdominal wall defect becomes very small causing ischemia and potentially vanishing gastroschisis" — Jack Langer (clinical) [Ep 12 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years because of intestinal failure centers, better TPN that doesn't damage the liver as much, and control of sepsis" — Jack Langer (clinical) [Ep 12 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "For atresia in gastroschisis, there are three management choices: repair at time of closure, bring out stomas, or drop everything back in and repair the atresia later" — Jack Langer (clinical) [Ep 12 · 20:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1254)
- "There's no good evidence for optimal management of atresia in gastroschisis because it's such a rare occurrence" — Jack Langer (opinion) [Ep 12 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "If bowel looks good without much peel, primary repair of atresia at initial closure is appropriate; if there's concern, drop it back in and repair later" — Jack Langer (clinical) [Ep 12 · 21:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1295)
- "Stomas are brought out only when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose" — Jack Langer (clinical) [Ep 12 · 22:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1321)
- "The umbilicus is the preferred site for neonatal stomas because it results in a scar that would have been there anyway and is convenient for appliance placement" — Jack Langer (clinical) [Ep 12 · 22:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jack Langer (clinical) [Ep 12 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jack Langer (clinical) [Ep 12 · 24:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1467)
- "Metoclopramide (Reglan) can be given intravenously for gastroschisis hypomotility, unlike oral prokinetics where absorption is uncertain" — Jack Langer (clinical) [Ep 12 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A UK study showed cisapride helped gastroschisis patients achieve bowel function more quickly, but cisapride is no longer available" — Jack Langer (clinical) [Ep 12 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A randomized prospective trial is currently underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jack Langer (clinical) [Ep 12 · 25:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1537)
- "At 4 weeks without bowel function, contrast enema is performed to look for mechanical obstruction, sometimes followed by upper GI if enema is inconclusive" — Jack Langer (clinical) [Ep 12 · 25:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1557)
- "If still no bowel function at 6 weeks, laparotomy is typically performed, often finding adhesions which are taken down" — Jack Langer (clinical) [Ep 12 · 26:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1604)
- "Going in too early on gastroschisis patients with prolonged ileus is a mistake" — Jack Langer (opinion) [Ep 12 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, it's usually the right testis that is extruded, and in about half the cases it finds its way down into the scrotum after being reduced" — Jack Langer (clinical) [Ep 12 · 28:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jack Langer (clinical) [Ep 12 · 28:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Karyotype analysis and testing for Beckwith-Wiedemann syndrome are routinely performed for omphalocele patients" — Jack Langer (clinical) [Ep 12 · 28:59](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1739)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jack Langer (clinical) [Ep 12 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "For small omphaloceles, there's no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery" — Jack Langer (clinical) [Ep 12 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair surgically" — Jack Langer (clinical) [Ep 12 · 30:23](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1823)
- "For giant omphaloceles (defined as any omphalocele with a lot of liver out), most surgeons recommend cesarean section, though this is not evidence-based" — Jack Langer (clinical) [Ep 12 · 31:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1864)
- "Giant omphaloceles should be delivered at a perinatal center because they need a pediatric surgeon and experienced neonatologists" — Jack Langer (clinical) [Ep 12 · 31:42](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1902)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jack Langer (clinical) [Ep 12 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "Some giant omphalocele patients have severe pulmonary hypoplasia requiring early intubation and respiratory support" — Jack Langer (clinical) [Ep 12 · 32:09](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1929)
- "The goal in omphalocele management is to reduce viscera without injury from direct trauma or increased intraabdominal pressure" — Jack Langer (clinical) [Ep 12 · 32:38](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1958)
- "Intraabdominal pressure monitoring is very helpful in omphalocele management" — Jack Langer (clinical) [Ep 12 · 33:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1994)
- "Stuart Lacy established the guideline of keeping intraabdominal pressure below 20 mmHg based on rabbit studies in the 1980s, which showed improved outcomes in a prospective study in children" — Jack Langer (clinical) [Ep 12 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Lacy also described an increase in central venous pressure of more than 4 as a concerning threshold" — Jack Langer (clinical) [Ep 12 · 33:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2036)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jack Langer (clinical) [Ep 12 · 34:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of pressure is more important than the absolute number during reduction" — Jack Langer (clinical) [Ep 12 · 34:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "Primary closure is attempted for full-term omphalocele patients without significant cardiac disease, respiratory issues, or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 12 · 34:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2083)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days to allow abdominal wall stretching" — Jack Langer (clinical) [Ep 12 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Sequential sac ligation requires a thick enough sac and umbilical cord insertion at the top rather than the side" — Jack Langer (clinical) [Ep 12 · 35:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2144)
- "Using Duoderm to gradually reduce omphaloceles appears to achieve reduction more quickly than sac ligation" — Jack Langer (clinical) [Ep 12 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or giant omphaloceles where reduction is not feasible" — Jack Langer (clinical) [Ep 12 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles have a small abdominal wall defect but large external contents, making reduction impossible" — Jack Langer (clinical) [Ep 12 · 38:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2329)
- "Sigy Ein had long experience using silver sulfadiazine (Silvadene) for escharotic therapy in omphaloceles" — Jack Langer (clinical) [Ep 12 · 39:26](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2366)
- "With escharotic therapy, the omphalocele is painted with the agent, forms an eschar, eventually epithelializes, and is later repaired like a large ventral hernia" — Jack Langer (clinical) [Ep 12 · 39:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2385)
- "Timing of definitive omphalocele repair after escharotic therapy depends on the individual child, ranging from 6-8 months to 3-4 years depending on defect size and medical comorbidities" — Jack Langer (clinical) [Ep 12 · 40:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2419)
- "Mushroom-shaped omphaloceles never reduce spontaneously and stay large" — Jack Langer (clinical) [Ep 12 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "For mushroom-shaped omphaloceles, the abdominal wall defect can be enlarged surgically as a first step to allow more spontaneous reduction before definitive repair" — Jack Langer (clinical) [Ep 12 · 41:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "The 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure" — Todd Ponsky (clinical) [Ep 12 · 42:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2526)
- "Formal adult-style component separation in small children carries risk of devascularization and can leave patients in worse condition if complications occur" — Jack Langer (clinical) [Ep 12 · 43:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2586)
- "In omphalocele closure, the defect often extends to the costal margin, making the upper portion impossible to close primarily, requiring patch placement" — Jack Langer (clinical) [Ep 12 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails in approximately 50% of omphalocele repairs, requiring reoperation with non-absorbable mesh like Prolene" — Jack Langer (clinical) [Ep 12 · 44:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2641)
- "Omphaloceles can be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jack Langer (clinical) [Ep 12 · 44:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Pentalogy of Cantrell omphaloceles tend to be more superiorly placed" — Jack Langer (clinical) [Ep 12 · 45:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2708)
- "Most pentalogy of Cantrell patients have cardiac problems requiring escharotic therapy for the omphalocele" — Jack Langer (clinical) [Ep 12 · 45:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2719)
- "In pentalogy of Cantrell, the diaphragmatic patch can be placed from above through sternotomy during cardiac surgery, with abdominal wall repair performed later" — Jack Langer (clinical) [Ep 12 · 45:31](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2731)
- "Reflux is very common in omphalocele patients, and many don't eat normally, especially with cardiac disease or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 12 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiologists can place G-tubes under fluoroscopy in giant omphalocele patients by finding a window lateral to the defect" — Jack Langer (clinical) [Ep 12 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "After G-tube maturation, a GJ tube can be placed to allow feeding despite severe reflux" — Jack Langer (clinical) [Ep 12 · 46:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2815)
- "Fundoplication in a child with unrepaired giant omphalocele is extremely difficult because the liver is midline and access to the hiatus is nearly impossible, especially with cardiac disease and congested liver" — Jack Langer (clinical) [Ep 12 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "GJ tube is a better short-term solution than fundoplication for reflux in unrepaired omphalocele, with fundoplication performed at the time of definitive abdominal wall repair" — Jack Langer (clinical) [Ep 12 · 47:42](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2862)
- "In giant omphaloceles with midline liver, the liver can put pressure on the duodenum or pylorus causing mechanical gastric outlet obstruction that worsens reflux" — Jack Langer (clinical) [Ep 12 · 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, so Ladd's procedure is not necessary" — Jack Langer (clinical) [Ep 12 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if the surgeon performs appendectomies during Ladd's procedures" — Jack Langer (opinion) [Ep 12 · 49:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2946)
- "Children with repaired omphaloceles can develop perforated appendicitis with delayed diagnosis due to abnormal appendix location" — Jack Langer (clinical) [Ep 12 · 49:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2958)
- "If a child with omphalocele has renal abnormalities requiring potential Mitrofanoff procedure, the appendix should be preserved" — Jack Langer (clinical) [Ep 12 · 49:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2984)
- "During omphalocele reduction with liver, hepatic veins are very superficial and can be injured during fascial dissection if not careful" — Jack Langer (clinical) [Ep 12 · 50:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "Kinking of hepatic veins during omphalocele reduction is prevented by using intraabdominal pressure monitoring and not being too aggressive with reduction when pressures exceed 20" — Jack Langer (clinical) [Ep 12 · 50:38](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3038)
- "In immediate omphalocele reduction, fascial edges can usually be approximated at the bottom but often not at the top, requiring patch placement" — Jack Langer (clinical) [Ep 12 · 50:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3056)
- "For partial omphalocele reduction with liver still protruding at the top, a temporary Gore-Tex or silastic patch can be sewn on with skin closed over it, then removed in 1-2 weeks for definitive fascial closure" — Jack Langer (clinical) [Ep 12 · 51:09](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3069)
- "A culture of safety is a deliberate way of doing things to avoid complications." — Sherif Emil (clinical) [Ep 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 3:00](https://library.globalcastmd.com/watch/error-traps-and-culture-of-safety-in-abdominal-wall-defects-1720?t=180)
- "Most damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy, supported by animal and clinical studies." (clinical) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=165)
- "Delivering gastroschisis at 37 weeks results in better neonatal outcomes compared to waiting for spontaneous labor." (clinical) [Ep 1 · 3:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=194)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population." (epidemiological) [Ep 1 · 3:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=224)
- "About half of gastroschisis pregnancies go into labor spontaneously before 37 weeks." (epidemiological) [Ep 1 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=236)
- "No perinatal center in Canada performs routine cesarean sections for gastroschisis." (epidemiological) [Ep 1 · 4:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=277)
- "Routine cesarean section for gastroschisis was standard of care 15-20 years ago but has gone out of favor." (guideline) [Ep 1 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=289)
- "Using forceps and retractors for bedside reduction can harm the bowel in some cases." (clinical) [Ep 1 · 8:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=498)
- "A pre-formed silo allows gentle reduction of gastroschisis contents without harming the bowel, and in about one-third of cases the bowel can be reduced immediately and the silo removed." (clinical) [Ep 1 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=507)
- "Waiting for the neonate to lose 10% of body weight reduces bowel edema and makes reduction easier." (clinical) [Ep 1 · 9:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=554)
- "Leaving a silo on for more than one day causes the fascial defect to enlarge significantly." (clinical) [Ep 1 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=581)
- "A larger fascial defect after silo removal takes longer to contract and heal if not surgically closed." (clinical) [Ep 1 · 9:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=594)
- "Rafensberger's group closed 80% of gastroschisis cases primarily; current practice has decreased to one-third to one-half primary closures." (epidemiological) [Ep 1 · 10:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=602)
- "Plastic closure (non-surgical closure with dressing) produces extremely good results for gastroschisis, often with a small umbilical hernia that closes by age 2 in the vast majority of cases." (clinical) [Ep 1 · 11:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=697)
- "Plastic closure avoids the need for operating room and general anesthesia in successful bedside reductions." (clinical) [Ep 1 · 11:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=710)
- "There are two types of intestinal atresia in gastroschisis: early-developing atresia not always associated with bowel thickening, and late atresia due to very small abdominal wall defect." (clinical) [Ep 1 · 15:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=958)
- "Primary repair of atresia in gastroschisis is appropriate when the bowel does not look damaged." (clinical) [Ep 1 · 15:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=900)
- "If the bowel looks nasty or matted, the atresia should be managed by reduction and delayed repair at 6 weeks." (clinical) [Ep 1 · 15:09](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=909)
- "Bringing an ostomy out through the umbilicus avoids a lateral scar and makes appliance placement easier." (clinical) [Ep 1 · 16:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1001)
- "Gord Cameron first described umbilical ostomies in the 1980s." (epidemiological) [Ep 1 · 17:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1073)
- "At 4 weeks post-gastroschisis repair with feeding intolerance, waiting longer is reasonable; at 8 weeks, exploration is warranted." (opinion) [Ep 1 · 20:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1207)
- "A mechanical stricture causing feeding intolerance after gastroschisis repair, when fixed surgically, can result in full feeds within 1-2 weeks." (clinical) [Ep 1 · 19:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1186)
- "Removing the omphalocele sac and attempting closure can lead to inability to achieve closure and need for prosthetic patch." (clinical) [Ep 1 · 22:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1333)
- "A partially ruptured omphalocele sac can be closed and painted, functioning as an autogenous silo." (clinical) [Ep 1 · 22:23](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1343)
- "Schuster-type repair uses mesh sutured to fascia with gradual closure over the intact sac, eventually allowing primary repair." (clinical) [Ep 1 · 22:31](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1351)
- "For large omphalocele in a full-term baby with no other problems, staged closure with patch and skin coverage is preferable to paint-and-wait, which takes months." (opinion) [Ep 1 · 23:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1385)
- "Lateral component separation can facilitate bringing fascial edges together in omphalocele closure." (clinical) [Ep 1 · 23:32](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1412)
- "Keeping the omphalocele sac supple with antibiotic ointment, applying stacked 4x4s, and wrapping with Ace wrap can facilitate gradual reduction." (clinical) [Ep 1 · 23:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1433)
- "Wrapping Duoderm around an omphalocele and tightening daily can achieve gradual reduction without sutures." (host_summary) [Ep 1 · 24:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1477)
- "Botox has been used successfully in adult ventral hernia repair to relax muscle and facilitate closure." (host_summary) [Ep 1 · 24:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1497)
- "Silver sulfadiazine is commonly used to paint omphaloceles, though some use Betadine initially or Xerform." (host_summary) [Ep 1 · 26:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1568)
- "Aquacel applied to omphalocele sac is not recommended as it does not come off easily." (opinion) [Ep 1 · 26:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1588)
- "Pharmacy may restrict silver sulfadiazine use in the first month due to sulfa interaction concerns." (guideline) [Ep 1 · 26:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1618)
- "Ventilatory parameters are the most reliable measure of safe abdominal closure tension." (opinion) [Ep 1 · 28:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1684)
- "Bladder pressure measurement is standard practice at Cincinnati Children's for 24 hours post-closure, though its reliability is questioned." (clinical) [Ep 1 · 28:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1731)
- "Intragastric pressure via NG tube is easy to measure intraoperatively and provides a useful guide, with 20 mmHg as a suggested threshold." (clinical) [Ep 1 · 29:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1796)
- "Intragastric pressure of 12 mmHg with a stable baby provides reassurance that closure is safe; pressure of 35-40 mmHg raises concern even if the baby appears stable." (clinical) [Ep 1 · 31:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=1865)
- "Omphaloceles with a big opening and much content externalized often reduce spontaneously over 6-12 months with paint-and-wait, making eventual closure straightforward." (clinical) [Ep 1 · 35:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2145)
- "Omphaloceles with a narrow opening require staged enlargement of the defect to allow gradual reduction over 2-3 stages without need for patch or component separation." (clinical) [Ep 1 · 36:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2161)
- "In older children with giant omphalocele, rapid reduction can cause abdominal compartment syndrome and death; time must be allowed for abdominal domain expansion." (clinical) [Ep 1 · 36:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2200)
- "When enlarging the fascial defect in a giant omphalocele with liver externalized, the inferior direction is safer to avoid hepatic veins superiorly." (clinical) [Ep 1 · 37:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-639?t=2223)
- "In Latin American countries, mortality from gastroschisis can exceed 15%" (host_summary) [Ep 3 · 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 protocol adoption" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 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 attempted" (host_summary) [Ep 3 · 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, which was limited by OR availability and required general anesthesia" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 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, and feeding advancement was totally at the discretion of the surgeon" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 1:31](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=91)
- "After the protocol, no patients were paralyzed" (host_summary) [Ep 3 · 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" (host_summary) [Ep 3 · 1:35](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=95)
- "The authors found a shorter time to arrival after protocol implementation" (host_summary) [Ep 3 · 1:42](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=102)
- "After protocol implementation, there was less general anesthesia use" (host_summary) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, fewer central lines were placed" (host_summary) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, fewer patients needed to be intubated" (host_summary) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "After protocol implementation, patients who were intubated spent less time on the ventilator" (host_summary) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=105)
- "The mortality rate went from 22% to 2% after protocol implementation" (host_summary) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=113)
- "The Hospital Infantil de Mexico team had a 22% mortality with gastroschisis before the protocol, which was higher than most" (host_summary) [Ep 3 · 2:11](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=131)
- "The five protocol changes resulted in a reduction from 22% mortality to 2% mortality" (host_summary) [Ep 3 · 2:17](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=137)
- "Moving from surgical central lines to PICC lines reduced mortality" (host_summary) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/91-decrease-in-mortality-with-gastroschisis-bundle-816?t=147)
- "Breast milk provides significant benefit to time to wean off parenteral nutrition in gastroschisis and NEC patients compared to formula-only feeding." — Michael Helmrath (clinical) [Ep 2 · 59:57](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3597)
- "Breast milk contains non-nutrient oligosaccharides (2-fucosyllactose, 3-fucosyllactose) that are immunomodulatory and affect microflora, not present in current formulas." — Michael Helmrath (clinical) [Ep 2 · 86:39](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5199)
- "STEP procedures done in the first year of life, especially in infants not progressing with enteral feeds, are not beneficial unless specifically avoiding line infections and bacterial overgrowth." — Michael Helmrath (opinion) [Ep 2 · 29:35](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1775)
- "In the STEP registry paper on early neonatal STEP, only 3 patients came off parenteral nutrition, whereas natural data predict 80-90% of such patients would be off TPN at 12 months without surgery." — Michael Helmrath (clinical) [Ep 2 · 31:32](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1892)
- "Dilated bowel does not become motile because you did a STEP procedure on it; if bowel hasn't been able to advance feeds, STEP will not make non-functioning bowel work." — Michael Helmrath (opinion) [Ep 2 · 29:46](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1786)
- "The one thing that makes bowel adapt is feeding the bowel; procedures that cause problems in reinitiating feeds cause damage to the patient." — Michael Helmrath (clinical) [Ep 2 · 30:13](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1813)
- "In a classic French study by Jolie, adults with short bowel syndrome had 60% absorption with ad lib feeding, 85% with continuous drip feeds, and 75% with half calories by mouth plus overnight drip feeds." — Sam Kocoshis (host_summary) [Ep 2 · 17:15](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1035)
- "Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum, has lower caloric density and protein, and freezing may inactivate trophic factors." — Sam Kocoshis (clinical) [Ep 2 · 62:40](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=3760)
- "About 60% of patients weaned off TPN have deficiencies in one micronutrient or another." — Sam Kocoshis (epidemiological) [Ep 2 · 71:51](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=4311)
- "Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates aerobic overgrowth; 2/3 of bloodstream infections were seen in patients on prophylactic Flagyl." — Sam Kocoshis (clinical) [Ep 2 · 90:10](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5410)
- "Prebiotics (oligosaccharides) induce a more healthful flora; probiotics are not routinely recommended due to case reports of central line infections, though these likely occurred through direct line contamination rather than translocation." — Sam Kocoshis (opinion) [Ep 2 · 83:28](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5008)
- "If using antibiotics for bacterial overgrowth, selective decontamination with non-absorbable aminoglycosides (tobramycin) and colistin may be preferable to metronidazole." — Sam Kocoshis (opinion) [Ep 2 · 92:27](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=5547)
- "Citrulline is produced by the gut and may predict ability to wean off TPN when measured as a total number, but as a weekly or monthly lab it does not inform clinical care changes." — Michael Helmrath (clinical) [Ep 2 · 75:49](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=4549)
- "GLP-2 analog can reduce fecal output such that TPN can be reduced by about 20% in 60-70% of adult patients, and totally emancipate about 20% from TPN in extension studies." — Sam Kocoshis (host_summary) [Ep 2 · 114:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6840)
- "When creating a jejunal feeding access, dividing the bowel 2-3 cm distal to ligament of Treitz and bringing the distal bowel up as a chimney with side-to-end anastomosis allows placement of a Mickey button without luminal obstruction." — Michael Helmrath (clinical) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=195)
- "Placing a 3-4 French feeding tube in distal bowel and bringing it out as a stent (not maturing as mucous fistula) allows easy distal feeding by syringe injection without catheter access issues." — Michael Helmrath (clinical) [Ep 2 · 1:12](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=72)
- "When operating on a 2-month-old with jejunal atresia unable to advance feeds beyond 20 mL/kg, if the anastomosis is patent but dilated bowel is present and the child has 50% estimated bowel length, tapering is preferable to STEP." — Michael Helmrath (opinion) [Ep 2 · 28:07](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=1687)
- "Acceptable stoma output is not defined by a hard number; patients with 40-50 cc/kg output can continue feeding if electrolyte profile is acceptable and CO2 is not dropping into the teens." — Michael Helmrath (clinical) [Ep 2 · 111:28](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6688)
- "Knee-jerk reactions to volume of output (unless patient is sick with acidosis and abnormal electrolytes) should be avoided; variable feeding amounts over longer periods are detrimental to weaning from TPN." — Michael Helmrath (opinion) [Ep 2 · 112:03](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6723)
- "In infants, only pancreatic proteases are present in adult quantities; amylases appear between 6-12 months and lipase reaches adult levels by end of first year." — Sam Kocoshis (clinical) [Ep 2 · 109:38](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6578)
- "Pancreatic enzymes in short gut patients go through before they've released, and there is concern they may cause strictures or stoma problems in areas of stenosis and dysmotility." — Michael Helmrath (opinion) [Ep 2 · 109:07](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6547)
- "Cholestyramine in effective doses will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars; homeopathic doses may improve stool appearance but not reduce volume." — Sam Kocoshis (clinical) [Ep 2 · 106:00](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6360)
- "Ursodiol (Actigall) in very short gut can contribute to diarrhea due to osmotic component and has no real benefit in preventing cholestasis." — Simon Horslen or Jeff Rudolph (clinical) [Ep 2 · 107:25](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6445)
- "Anti-inflammatory agents (5-ASA products, steroid-based enemas) can be helpful in managing hypermotility when there is documented inflammation, particularly in challenging Hirschsprung's patients with dysbiosis." — Michael Helmrath (clinical) [Ep 2 · 104:08](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=6248)
- "Since developing a mature multidisciplinary intestinal rehabilitation program, internal transplant candidates have declined by 75%, and intestinal transplants are almost non-existent." — Sam Kocoshis (epidemiological) [Ep 2 · 41:08](https://library.globalcastmd.com/watch/intestinal-failure-feeding-access-and-nutrition-740?t=2468)
- "Hawkins et al. conducted a large multi-center study comparing silo versus immediate closure in gastroschisis." (host_summary) [Ep 8 · 0:06](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=6)
- "The Hawkins et al. study was published in the August issue of GPS (Journal of Pediatric Surgery)." (host_summary) [Ep 8 · 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." (host_summary) [Ep 8 · 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 outcome measures." (host_summary) [Ep 8 · 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 for gastroschisis." (host_summary) [Ep 8 · 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 for gastroschisis." (host_summary) [Ep 8 · 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 for gastroschisis." (host_summary) [Ep 8 · 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 for gastroschisis." (host_summary) [Ep 8 · 0:18](https://library.globalcastmd.com/watch/immediate-vs-silo-closure-for-gastroschisis-2022?t=18)
- "Gastroschisis has a reported incidence of 1 in 6,000 to 1 in 10,000, but is much more common in many parts of the U.S., including Southern California." (host_summary) [Ep 9 · 0:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=0)
- "At this pediatric surgery practice serving two neonatal intensive care units, 30 to 40 patients per year are treated for gastroschisis, making it second only to inguinal hernias as a congenital anomaly requiring surgical correction." (epidemiological) [Ep 9 · 1:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=60)
- "Traditional staged closure with sutured silastic silo carries risks of silo disruption, fascial dehiscence, and infectious complications." (host_summary) [Ep 9 · 2:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=120)
- "The spring-loaded silo allows for fast, pain-free, suture-less silo placement without need for a formal operation." (host_summary) [Ep 9 · 3:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=180)
- "Dr. James Fisher and colleagues from Loma Linda University were the first to publish a series of patients undergoing routine bedside silo placement." (host_summary) [Ep 9 · 4:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=240)
- "Several retrospective studies from large U.S. centers reported that routine silo placement with delayed closure showed one or more advantages: decreased airway pressures, earlier extubation, decreased incidence of necrotizing enterocolitis, decreased infectious complications, more rapid return of bowel function, decreased length of stay, and decreased hospital charges." (host_summary) [Ep 9 · 5:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=300)
- "For the last five years on the UCI pediatric surgery service, spring-loaded silos have been routinely placed for patients with gastroschisis with excellent results." (clinical) [Ep 9 · 6:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=360)
- "At these centers, most women carrying a fetus with gastroschisis are seen by the pediatric surgeon prior to delivery, with close collaboration with perinatologists." (clinical) [Ep 9 · 7:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=420)
- "Most babies are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed, nor is early labor induced." (clinical) [Ep 9 · 7:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=450)
- "The baby is sedated with fentanyl and midazolam drips, intubated, and given a single dose of Vecuronium for the silo placement procedure." (clinical) [Ep 9 · 8:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=480)
- "While silo placement is feasible without sedation, intubation, or paralysis, these interventions create optimal conditions and a well-controlled situation." (opinion) [Ep 9 · 8:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=510)
- "The Bentec silo is available in seven sizes, from 3 cm to 15 cm diameter, with the ring diameter determining the volume of the silastic cylinder." (host_summary) [Ep 9 · 9:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=540)
- "A ring that is 2 cm larger than the diameter of the defect is typically chosen." (clinical) [Ep 9 · 9:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=570)
- "Since most defects are 2 to 3 cm in diameter, 4 and 5 cm silos are the most commonly used." (clinical) [Ep 9 · 10:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=600)
- "A larger silo may be chosen if the bowel is more distended or edematous, or there is significant peel." (clinical) [Ep 9 · 10:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=630)
- "Gastroschisis cases involving an atresia typically contain severely distended bowel and often require a 7.5 cm silo." (clinical) [Ep 9 · 11:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=660)
- "A severely distended distal colon with meconium is a good indication of the probable absence of a proximal atresia or stenosis." (clinical) [Ep 9 · 13:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=780)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction." (clinical) [Ep 9 · 13:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=810)
- "If an obstruction exists without perforation, the institutional policy is to proceed with silo placement and closure, followed by exploration four to six weeks later." (clinical) [Ep 9 · 15:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=900)
- "The ring should be maintained just palpable under the fascia but not elevating the abdominal wall, which would lead to abdominal wall congestion and complicate final closure." (clinical) [Ep 9 · 18:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1080)
- "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 9 · 18:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1110)
- "Over the ensuing days, resolution of bowel edema, accommodation by the abdominal cavity, and gravity result in gradual spontaneous reduction, aided by once or twice daily active reduction." (clinical) [Ep 9 · 19:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1140)
- "Final closure is performed when the silo contents are within 2 cm of the abdominal wall." (clinical) [Ep 9 · 19:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1170)
- "The silo is left in place for the shortest time possible; unnecessary prolongation has no advantages, may slowly enlarge the defect making closure more involved, and may increase infectious and other potential complications." (clinical) [Ep 9 · 20:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1200)
- "The abdominal wall is stretched to aid in a tension-free closure, which often produces some minor post-operative congestion of the abdominal wall." (clinical) [Ep 9 · 21:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1290)
- "It is important to stay in the correct plane during fascial mobilization in order not to compromise the fascia or skin." (clinical) [Ep 9 · 22:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1350)
- "Skin closure suture is taken from inside out approximately three millimeters from the skin edge; the edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection." (clinical) [Ep 9 · 24:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1440)
- "Essential factors for optimal outcome include appropriate choice of silo size, avoiding mesenteric torsion, final closure when near-complete reduction is achieved and not prolonging silo duration, close observation of silo configuration and contents, purse-string closure of fascia and skin, and preservation of the umbilical stump." (clinical) [Ep 9 · 25:00](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1500)
- "The Bentec silo can be used for staged reduction of omphalocele after excision of the sac, with gradual reduction of liver along with bowel." (clinical) [Ep 9 · 26:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1580)
- "When a large silo is required for a prolonged period, a few corner stitches between the silo ring and the abdominal wall prevent premature dislodgement of the silo." (clinical) [Ep 9 · 26:40](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2235?t=1600)
- "Gastroschisis has a reported incidence of 1 in 6000 to 1 in 10,000, but is much more common in many parts of the US including Southern California." (host_summary) [Ep 10 · 0:39](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=39)
- "At UCI pediatric surgery practice serving 2 neonatal intensive care units, 30 to 40 patients per year with gastroschisis are treated, making it second only to inguinal hernias as a congenital anomaly requiring surgical correction." (epidemiological) [Ep 10 · 0:49](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=49)
- "Traditional staged closure with sutured elastic silo involves risks of silo disruption, fascial dehiscence, and infectious complications." (host_summary) [Ep 10 · 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." (host_summary) [Ep 10 · 1:27](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=87)
- "Doctor James Fisher and colleagues from Loma Linda University were the first to publish a series of patients to undergo routine silo placement at the bedside." (host_summary) [Ep 10 · 2:08](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=128)
- "Several retrospective studies from large US centers reported that patients who underwent routine silo placement with delayed closure showed one or more advantages: decreased airway pressures, earlier extubation, decreased incidence of necrotizing enterocolitis, decreased infectious complications, more rapid return of bowel function, decreased length of stay, and decreased hospital charges." (host_summary) [Ep 10 · 2:43](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=163)
- "For the last 5 years on the UCI pediatric surgery service, spring-loaded silos have been routinely placed for patients with gastroschisis with excellent results." (clinical) [Ep 10 · 3:26](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=206)
- "Most babies with gastroschisis are delivered vaginally after spontaneous onset of labor; routine cesarean section is not performed, nor is early labor induced." (clinical) [Ep 10 · 4:30](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=270)
- "For silo placement, the baby is sedated with fentanyl and midazolam drips, intubated, and given a single dose of vecuronium; while placement is feasible without these interventions, they create optimal conditions and a well-controlled situation." (clinical) [Ep 10 · 4:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=292)
- "The Bentek silo is available in 7 sizes from 3 centimeters to 15 centimeters, defined by the diameter of the reinforced ring." (host_summary) [Ep 10 · 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; since most defects are 2 to 3 centimeters in diameter, 4 and 5 centimeter silos are most commonly used." (clinical) [Ep 10 · 5:37](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=337)
- "Gastroschisis cases involving an atresia typically contain severely distended bowel and often require a 7.5 centimeter silo." (clinical) [Ep 10 · 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 typical and is a good indication of the probable absence of a proximal atresia or stenosis." (host_summary) [Ep 10 · 6:56](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=416)
- "Evacuation of the colon is important as it will significantly decrease the size of the colon and allow for faster reduction." (clinical) [Ep 10 · 7:07](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=427)
- "If an obstruction exists without perforation, the policy is to proceed with silo placement and closure, followed by exploration 4 to 6 weeks later." (clinical) [Ep 10 · 8:09](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=489)
- "If the ring has too much traction it will cause abdominal wall congestion and edema, complicating closure later on." (host_summary) [Ep 10 · 13:02](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=782)
- "Too little traction will allow the ring to exert constant pressure on the abdominal contents, most notably the duodenum, with a risk of pressure necrosis." (host_summary) [Ep 10 · 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 is within 2 centimeters of the abdominal wall." (clinical) [Ep 10 · 13:20](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=800)
- "The silo is left in place for the shortest time possible; unnecessary prolongation has no advantages, may make closure more involved by slowly enlarging the defect, and may increase infectious and other potential complications." (clinical) [Ep 10 · 13:26](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=806)
- "The silo creates a closed system by completely containing the bowel and peritoneal fluid." (host_summary) [Ep 10 · 13:52](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=832)
- "Stretching the abdominal wall aids in a tension-free closure and often produces some minor postoperative congestion of the abdominal wall." (clinical) [Ep 10 · 14:47](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=887)
- "A 1 centimeter fascial edge is mobilized in both directions to the border of the umbilical stump." (host_summary) [Ep 10 · 17:06](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1026)
- "For skin closure, bites are taken approximately 3 millimeters from the skin edge because the edge is often slightly ischemic and bites exactly in the skin edge are likely to cause skin necrosis and possible wound infection." (clinical) [Ep 10 · 21:07](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1267)
- "The baby remained stable without any increase in airway pressures during the closure procedure, which was completed in under 25 minutes." (host_summary) [Ep 10 · 23:38](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1418)
- "Essential factors for optimal outcome include: appropriate choice of silo size, avoiding mesenteric torsion, final closure when near complete reduction is achieved and not prolonging silo duration, close observation of silo configuration and contents, purse string closure of fascia and skin, and preservation of the umbilical stump." (host_summary) [Ep 10 · 24:25](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1465)
- "The Bentek silo can be used for staged reduction of omphalocele after excision of the sac, with the liver gradually reduced along with the bowel." (clinical) [Ep 10 · 25:31](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1531)
- "When a large silo is required for a prolonged period, a few corner stitches between the silo ring and the abdominal wall prevent premature dislodgement of the silo." (clinical) [Ep 10 · 26:02](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1562)
- "The silo can be used in cases of neonatal abdominal compartment syndrome, such as in severe diffuse necrotizing enterocolitis." (clinical) [Ep 10 · 26:34](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1594)
- "At the University of California Irvine, this method is applied to all patients with gastroschisis and selectively used in other situations where abdominal wall closure is not possible." (clinical) [Ep 10 · 26:59](https://library.globalcastmd.com/watch/staged-closure-of-gastroschisis-with-spring-loaded-silo-2251?t=1619)
- "The sutureless gastroschisis closure technique originated when Tony Sandler at Iowa covered a large defect with umbilical cord and tachyderm, intending to return later, but found the wound had closed spontaneously." — Salim (clinical) [Ep 11 · 2:27](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147)
- "Sandler's first series of sutureless closures included about 10 patients and reported that they did not need to go to the OR and closed on their own." — Salim (clinical) [Ep 11 · 4:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=270)
- "Multiple retrospective studies reported that sutureless repair patients eat quicker, go home faster, and are probably cheaper to manage." — Salim (host_summary) [Ep 11 · 4:50](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=290)
- "A randomized study by Brisoni et al. published in the Journal of the American College of Surgeons found that sutureless repair patients took longer to eat and had longer hospital length of stay." — Salim (host_summary) [Ep 11 · 5:10](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=310)
- "A subsequent 98-patient study from UCSF showed a benefit for sutureless repair in terms of time to feeding and length of stay, conflicting with the Brisoni randomized trial." — Salim (host_summary) [Ep 11 · 5:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=340)
- "The old adage that you must close the fascia for all gastroschisis babies is probably not true; some version of skin closure is adequate." — Salim (opinion) [Ep 11 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Data over five years shows that about 13% of sutureless repair patients will need an umbilical hernia repair, which is higher than babies who got fascial repair." — Salim (clinical) [Ep 11 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Robert Baird's paper from McGill showed everything was better about tape closure, including a lower umbilical hernia rate, which was surprising." — Todd (host_summary) [Ep 11 · 6:19](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379)
- "Fear of feeding after sutureless closure—hesitation to feed because of concern about distension and evisceration—may be driving longer length of stay." — Todd (opinion) [Ep 11 · 7:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=440)
- "A feeding protocol was instituted at the speaker's NICU: if residual output is less than 20 per kilo, it comes out; if tolerating, advance by 20 per kilo each day." — Todd (clinical) [Ep 11 · 7:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=450)
- "In prospective trials, natural selection bias may occur if easier cases are chosen for sutureless closure, leading to better outcomes independent of technique." — Salim (opinion) [Ep 11 · 7:58](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=478)
- "The UCSF study with 98 patients published in JAMA Surgery found a 13% rate of umbilical hernia repair over five years of follow-up in sutureless closure patients." — Salim (host_summary) [Ep 11 · 9:45](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=585)
- "Studies have shown that when fascial closure is attempted without a silo (immediate repair), those patients tend to have a higher incidence of umbilical or ventral hernias requiring repair." — Salim (host_summary) [Ep 11 · 10:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=620)
- "Every single general anesthetic agent in every class (volatile gas, IV, ketamine, NMDA receptor blockers) has been shown in rat, mice, and sheep studies to cause increased apoptosis and pervasive developmental issues." — Salim (host_summary) [Ep 11 · 11:47](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=707)
- "The GAS trial and PANDA study in humans showed no difference in neurodevelopmental outcome at five years in babies randomized to spinal versus general anesthesia." — Salim (host_summary) [Ep 11 · 12:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=750)
- "The heterogeneity of the gastroschisis population—some cases are easy (one or two loops, little Tylenol) while others are complicated (need silo, OR)—makes a huge difference in results and biases non-randomized trials." — Mac (opinion) [Ep 11 · 12:54](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=774)
- "Tony Sandler no longer uses the umbilical cord for sutureless closure; it is not as important as once thought and just sits there." — Salim (host_summary) [Ep 11 · 15:06](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906)
- "Some surgeons put a silo on, reduce with the silo, and then apply tape, so inability to immediately reduce does not preclude sutureless closure." — Salim (clinical) [Ep 11 · 15:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=930)
- "At UCLA's UC fetal consortium, all gastroschisis cases are attempted without general anesthesia, without intubation, and with minimal narcotics, using standardized antibiotic and feeding protocols." (clinical) [Ep 11 · 16:02](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=962)
- "The UCLA consortium found that length of stay did not decrease with the standardized protocol, but use of antibiotics, intubation days, and opioid use significantly decreased." (clinical) [Ep 11 · 16:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "At UCLA, one surgeon was able to open the defect, reduce everything, and still do a skin or sutureless closure with great outcomes." (clinical) [Ep 11 · 16:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "Complicated gastroschisis cases (atresia, perforation) are excluded from the UCLA sutureless closure pathway." (clinical) [Ep 11 · 16:51](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1011)
- "The gastroschisis prognostic score (GPS), which assigned a score based on degree of peel, bowel distension, and matting, did not prove useful in predicting outcomes." — Salim (clinical) [Ep 11 · 17:33](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1053)
- "If a gastroschisis case has a very thick peel, very distended bowel, and lots of bowel loops out, immediate closure should not be considered; a silo should be used for reduction." — Salim (opinion) [Ep 11 · 18:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1120)
- "At the end of silo reduction, a sutureless repair can be performed; immediate closure is not required." — Salim (clinical) [Ep 11 · 19:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1160)
- "There is no real big need for fascial closure, no matter the size of the gastroschisis defect; skin closure alone is probably adequate." — Salim (opinion) [Ep 11 · 20:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1200)
- "Matted bowel does not play into the decision for sutureless closure; if it cannot be immediately reduced, a silo is used, and sutureless repair can be done after reduction." — Todd (clinical) [Ep 11 · 20:31](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1231)
- "In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself." — Rod Gerardo (host_summary) [Ep 14 · 1:44](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=104)
- "The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less antibiotic use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 14 · 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 compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 14 · 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 compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less ventilator use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The positive outcomes for sutureless repair were observed even when considering patients who required silo use." — Rod Gerardo (host_summary) [Ep 14 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster." — Jason Frischer (opinion) [Ep 14 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions." — Jason Frischer (opinion) [Ep 14 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection." — Jason Frischer (clinical) [Ep 14 · 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 due to tissue manipulation." — Jason Frischer (opinion) [Ep 14 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates." — Jason Frischer (clinical) [Ep 14 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate." — Jason Frischer (host_summary) [Ep 14 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up." — Jason Frischer (clinical) [Ep 14 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure." — Rod Gerardo (host_summary) [Ep 14 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects." — Fung-Yen Lim (clinical) [Ep 15 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging." — Fung-Yen Lim (clinical) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 1:54](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=114)
- "Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction." — Fung-Yen Lim (clinical) [Ep 15 · 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 (IUFD) can occur in these patients." — Fung-Yen Lim (clinical) [Ep 15 · 2:56](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=176)
- "If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery." — Fung-Yen Lim (clinical) [Ep 15 · 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 (host_summary) [Ep 15 · 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 mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies." — Fung-Yen Lim (epidemiological) [Ep 15 · 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." — Fung-Yen Lim (epidemiological) [Ep 15 · 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 due to intrauterine growth restriction." — Fung-Yen Lim (epidemiological) [Ep 15 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7." — Fung-Yen Lim (epidemiological) [Ep 15 · 3:27](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=207)
- "Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions." — Fung-Yen Lim (epidemiological) [Ep 15 · 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 age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3." — Fung-Yen Lim (epidemiological) [Ep 15 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele." — Fung-Yen Lim (epidemiological) [Ep 15 · 4:19](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=259)
- "Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold." — Fung-Yen Lim (clinical) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 5:02](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=302)
- "Primary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly." — Fung-Yen Lim (clinical) [Ep 15 · 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 are issues with the bowel, including atresia, compromised bowel, or perforation." — Fung-Yen Lim (clinical) [Ep 15 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "Some patients develop intestinal perforation after only two to four days of enteral feeding." — Fung-Yen Lim (clinical) [Ep 15 · 6:07](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=367)
- "In the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure." — Todd Ponsky (host_summary) [Ep 15 · 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, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time." — Fung-Yen Lim (clinical) [Ep 15 · 6:58](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=418)
- "For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering." — Fung-Yen Lim (clinical) [Ep 15 · 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, sewing meshes to the edges of the fascia without interrupting the membrane." — Fung-Yen Lim (clinical) [Ep 15 · 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 placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin." — Todd Ponsky (host_summary) [Ep 15 · 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." — Fung-Yen Lim (clinical) [Ep 15 · 8:43](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=523)
- "Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have." — Gail Besner (opinion) [Ep 16 · 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 approximately 12-13 years ago but did not include how to incentivize people for academic work." — Gail Besner (clinical) [Ep 16 · 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 where people accumulate points based on number of publications, presentations, and other academic pursuits." — Gail Besner (clinical) [Ep 16 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable." — Gail Besner (clinical) [Ep 16 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=207)
- "After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding." (host_summary) [Ep 16 · 3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase." — Rod Gerardo (host_summary) [Ep 16 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases." — Todd Ponsky (clinical) [Ep 16 · 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 was a retrospective review comparing outcomes before and after implementation of a protocol in 2012, covering patients from 2008 to 2019." (host_summary) [Ep 16 · 5:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine Hospital, the approach to gastroschisis differed from other institutions in that there was very low use of silos, with pretty much every patient having an attempt at immediate bedside sutureless closure following a protocol developed several years prior." — Charza Jaharifard (clinical) [Ep 16 · 6:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=418)
- "Before and after protocol implementation at BC Children's Hospital, approximately 75% of gastroschisis patients could be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation." — Charza Jaharifard (clinical) [Ep 16 · 7:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced." — Charza Jaharifard (clinical) [Ep 16 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure of gastroschisis, if babies are extubated within 48 hours, parents can hold them within 48 hours, or immediately if managed without intubation." — Charza Jaharifard (clinical) [Ep 16 · 8:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "In prior studies of placental mesenchymal stem cells for in utero MMC repair, two surgeries were performed on lambs: one to create the defect and one to repair it, both in utero, with PMSCs used during repair." (host_summary) [Ep 16 · 10:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=617)
- "In the current study, a single operation was performed at approximately 100 days gestational age where the MMC defect was created and repaired simultaneously, with PMSCs placed directly onto the spinal cord." (host_summary) [Ep 16 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "The PMSCs did not persist in the placentas, uteri, or lambs at 3 months follow-up." (host_summary) [Ep 16 · 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 in the ovine model at 3 months." (host_summary) [Ep 16 · 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 in utero myelomeningocele repair have been initiated with the first two patients enrolled." (host_summary) [Ep 16 · 11:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "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 17 · 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 17 · 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 17 · 0:55](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=55)
- "For large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases." — Todd Ponsky (host_summary) [Ep 17 · 1:31](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=91)
- "A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele." — Fung Lim (clinical) [Ep 17 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects." — Fung Lim (clinical) [Ep 17 · 1:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=114)
- "For gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging." — Todd Ponsky (host_summary) [Ep 17 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies." — Todd Ponsky (host_summary) [Ep 17 · 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 (host_summary) [Ep 17 · 2:12](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=132)
- "Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients." — Fung Lim (clinical) [Ep 17 · 2:51](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently." — Fung Lim (clinical) [Ep 17 · 2:51](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=171)
- "Gastroschisis affects approximately one in every 2200 live births." — Todd Ponsky (host_summary) [Ep 17 · 3:15](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=195)
- "Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis infants are premature." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Acetaminophen is identified as a risk factor for gastroschisis." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions." — Fung Lim (epidemiological) [Ep 17 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3." — Fung Lim (epidemiological) [Ep 17 · 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 17 · 4:21](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=261)
- "Minimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold." — Fung Lim (clinical) [Ep 17 · 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 17 · 5:02](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=302)
- "Primary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly." — Fung Lim (clinical) [Ep 17 · 5:32](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=332)
- "Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation." — Fung Lim (clinical) [Ep 17 · 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 17 · 6:03](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=363)
- "The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure." — Fung Lim (clinical) [Ep 17 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "In the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time." — Fung Lim (clinical) [Ep 17 · 6:46](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=406)
- "For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering." — Fung Lim (clinical) [Ep 17 · 7:25](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=445)
- "For omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane." — Fung Lim (clinical) [Ep 17 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "At Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin." — Fung Lim (clinical) [Ep 17 · 7:54](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=474)
- "After sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin." — Todd Ponsky (host_summary) [Ep 17 · 8:38](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=518)
- "Several hospitals have changed their gastroschisis protocols based on recent publications." — Todd Ponsky (host_summary) [Ep 18 · 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 institutions start feeds when NG output is less than 20 mL/kg/day." — Justin (clinical) [Ep 18 · 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)
- "Jason Fraser's institution starts feeding immediately after dressing placement as long as the baby is not sick, not having horrible output, and not vomiting." — Jason Frischer (clinical) [Ep 18 · 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)
- "Fraser's institution does not intubate gastroschisis babies for reduction." — Jason Frischer (clinical) [Ep 18 · 3:54](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=234)
- "Awake reduction can be successful if performed slowly, with stomach emptying, colon decompression, oral sucrose, and gradual abdominal wall stretching." — Jason Frischer (clinical) [Ep 18 · 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 perform gastroschisis reduction under general anesthesia." — Bindi (clinical) [Ep 18 · 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)
- "Cincinnati Children's feeding protocol is based on patient tolerance and data from resource-limited settings where TPN is unavailable and feeding is mandatory." — Jason Frischer (clinical) [Ep 18 · 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 Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients." — Beth Rymeski (clinical) [Ep 18 · 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 Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late." — Beth Rymeski (clinical) [Ep 18 · 8:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=490)
- "Cincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years." — Beth Rymeski (clinical) [Ep 18 · 8:40](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=520)
- "In a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants." — Beth Rymeski (host_summary) [Ep 18 · 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 reduction in surgical site infections with protocol feeding was likely due to decreased care variability rather than the feeding protocol itself." — Jason Frischer (opinion) [Ep 18 · 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 multi-institutional study showed inconclusive results due to significant variation in feeding protocols across institutions." — Jason Frischer (epidemiological) [Ep 18 · 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 Children's average gastroschisis length of stay was 49 days before protocol implementation, which was astronomically higher than comparable NICUs in their cooperative network." — Jason Frischer (epidemiological) [Ep 18 · 11:20](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=680)
- "After implementing a feeding protocol, Cincinnati Children's reduced gastroschisis length of stay by 10 days over two years." — Jason Frischer (epidemiological) [Ep 18 · 12:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=730)
- "Cincinnati Children's has seen a decrease in time from first feed to full feeds but has not yet reduced the time from admission to first feed (except in 2020)." — Jason Frischer (epidemiological) [Ep 18 · 12:10](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=730)
- "Continuous feeds in gastroschisis patients can lead to oral aversion and prolonged length of stay when patients are not taking anything orally." — Justin (clinical) [Ep 18 · 13:14](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=794)
- "Cincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year." — Beth Rymeski (clinical) [Ep 18 · 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 Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support." — Beth Rymeski (epidemiological) [Ep 18 · 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 Children's gastroschisis protocol includes prenatal care coordination with obstetricians and neonatologists, with surgery continuing to follow patients throughout hospitalization." — Jason Frischer (clinical) [Ep 18 · 14:20](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=860)
- "Some institutions ignore bilious emesis or bilious NG residuals completely during gastroschisis feeding advancement." — Jason Frischer (host_summary) [Ep 18 · 15:17](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=917)
- "The most important aspects of gastroschisis feeding are defining institutional tolerance criteria, adhering to protocol, and continuously evaluating the infant's condition." — Jason Frischer (opinion) [Ep 18 · 16:00](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=960)
- "For significant feeding intolerance, Cincinnati Children's protocol calls for stopping feeds for six hours, though this is not clearly evidence-based." — Jason Frischer (clinical) [Ep 18 · 16:40](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1000)
- "Cincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families." — Beth Rymeski (clinical) [Ep 18 · 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 Cincinnati Children's gastroschisis patient who was primarily reduced on day of life zero was discharged at approximately two weeks and remained well at two-week follow-up, though this is an outlier on the faster end." — Jason Frischer (clinical) [Ep 18 · 17:22](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1042)
- "Cincinnati Children's current average gastroschisis length of stay is 30 to 34 days." — Jason Frischer (epidemiological) [Ep 18 · 17:22](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1042)
- "Cincinnati Children's has not seen any aspirations with their early aggressive feeding approach, though they acknowledge they are still early in implementation and continue to monitor data." — Jason Frischer (epidemiological) [Ep 18 · 18:14](https://library.globalcastmd.com/watch/update-course-2022-updates-in-gastroschisis-feeding-protocols-jason-fraser-beth-rymeski-and-steven-lee-5824?t=1094)
- "Much of the data supporting early feeding in gastroschisis originated from resource-limited countries without TPN access, though implementing this approach in Africa has proven difficult due to poor tolerance." — Justin (epidemiological) [Ep 18 · 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 Cincinnati Children's, approximately two-thirds of gastroschisis cases cannot be reduced immediately and are placed in a silo for gradual reduction followed by sutureless closure, with feeds started after closure." — Jason Frischer (clinical) [Ep 18 · 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)
- "Stevens et al. examined CDC Wonder database data between 1999 and 2020 for pediatric firearm and automobile fatalities." — Ellen Encisco (host_summary) [Ep 20 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Stevens et al. used the Gifford's Law Center annual gun law scorecard between 2014 and 2020 to assess state gun law scores." — Ellen Encisco (host_summary) [Ep 20 · 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 (host_summary) [Ep 20 · 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 (host_summary) [Ep 20 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- "Gabapentin is an anticonvulsant often used off-label as part of multimodal pain control after major surgery." — Alex Halpern (host_summary) [Ep 20 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Lascano et al. performed a retrospective cohort study at Children's Hospital of LA looking at kids age 2 to 18 who underwent appendectomy for perforated appendicitis between 2014 and 2019." — Alex Halpern (host_summary) [Ep 20 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "In the Lascano et al. study, kids who received gabapentin had decreased postoperative opioid use." — Alex Halpern (host_summary) [Ep 20 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "In the Lascano et al. study, kids who received gabapentin had decreased postoperative length of stay." — Alex Halpern (host_summary) [Ep 20 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- "Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016." — Cecilia Gigena (host_summary) [Ep 20 · 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 (host_summary) [Ep 20 · 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 (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia." — Cecilia Gigena (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia." — Cecilia Gigena (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases." — Cecilia Gigena (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery." — Cecilia Gigena (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk." — Cecilia Gigena (host_summary) [Ep 20 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- "Infants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds." — Em Tombash (host_summary) [Ep 19 · 1:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60)
- "Based on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated." — Em Tombash (host_summary) [Ep 19 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=120)
- "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds." — Em Tombash (host_summary) [Ep 19 · 2:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150)
- "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis." — Em Tombash (host_summary) [Ep 19 · 2:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=165)
- "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis." — Em Tombash (host_summary) [Ep 19 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=240)
- "Serial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area." — Em Tombash (host_summary) [Ep 19 · 4:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=255)
- "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component." — Em Tombash (host_summary) [Ep 19 · 4:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=270)
- "Initial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected." — Em Tombash (host_summary) [Ep 19 · 4:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=285)
- "Management of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines." — Em Tombash (host_summary) [Ep 19 · 5:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=345)
- "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction." — Em Tombash (host_summary) [Ep 19 · 6:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=360)
- "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention." — Em Tombash (host_summary) [Ep 19 · 6:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=390)
- "Outpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality." — Em Tombash (host_summary) [Ep 19 · 6:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=405)
- "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 19 · 7:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450)
- "Recent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections." — Em Tombash (host_summary) [Ep 19 · 7:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=465)
- "Adult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 19 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Recent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations." — Em Tombash (host_summary) [Ep 19 · 8:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=495)
- "Case-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery." — Em Tombash (host_summary) [Ep 19 · 8:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=525)
- "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 (host_summary) [Ep 19 · 9:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=585)
- "There are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country." — Em Tombash (host_summary) [Ep 19 · 10:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600)
- "As pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is." — Em Tombash (host_summary) [Ep 19 · 10:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=615)
- "Pediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy." — Em Tombash (host_summary) [Ep 19 · 10:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=645)
- "Unwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray." — Em Tombash (host_summary) [Ep 19 · 11:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=705)
- "The gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise." — Em Tombash (host_summary) [Ep 19 · 12:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=720)
- "CT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress." — Em Tombash (host_summary) [Ep 19 · 12:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=735)
- "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies." — Em Tombash (host_summary) [Ep 19 · 12:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=750)
- "CT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure." — Em Tombash (host_summary) [Ep 19 · 12:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=765)
- "The largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months." — Em Tombash (host_summary) [Ep 19 · 13:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=810)
- "Death or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage." — Em Tombash (host_summary) [Ep 19 · 14:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840)
- "The prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC." — Em Tombash (host_summary) [Ep 19 · 14:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=855)
- "For infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies." — Em Tombash (host_summary) [Ep 19 · 14:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=885)
- "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups." — Em Tombash (host_summary) [Ep 19 · 15:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=945)
- "Individuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments." — Em Tombash (host_summary) [Ep 19 · 16:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960)
- "Placing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging." — Em Tombash (host_summary) [Ep 19 · 16:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=975)
- "Bystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions." — Em Tombash (host_summary) [Ep 19 · 16:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1005)
- "Blunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures." — Em Tombash (host_summary) [Ep 19 · 17:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1050)
- "A 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission." — Em Tombash (host_summary) [Ep 19 · 18:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1095)
- "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation." — Em Tombash (host_summary) [Ep 19 · 18:45](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1125)
- "The IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome." — Em Tombash (host_summary) [Ep 19 · 19:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1170)
- "Patients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy." — Em Tombash (host_summary) [Ep 19 · 20:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200)
- "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy." — Em Tombash (host_summary) [Ep 19 · 20:15](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1215)
- "Monotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis." — Em Tombash (host_summary) [Ep 19 · 20:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230)
- "Gastroschisis occurs when the front of a baby's belly does not form properly during early pregnancy, resulting in an opening on the right side of the belly button through which the intestines pass." (host_summary) [Ep 21 · 0:06](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=6)
- "Gastroschisis is classed as a rare birth defect." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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)." (host_summary) [Ep 21 · 0:45](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=45)
- "Ongoing care for babies with gastroschisis should be provided at a specialist center by a dedicated team of professionals with knowledge and experience of the condition." (host_summary) [Ep 21 · 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 for the baby before and after birth as a newborn." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 1:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=70)
- "Some babies with gastroschisis may be transferred to a dedicated intensive care unit if they are born prematurely." (host_summary) [Ep 21 · 1:18](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=78)
- "After birth, the baby's intestines are wrapped in a sterile bag to avoid damage." (host_summary) [Ep 21 · 1:24](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=84)
- "Babies with gastroschisis receive the fluid they need via a tube that delivers it through a vein." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 1:33](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=93)
- "Surgical repair can be done in one operation (primary repair) or in several steps (staged repair), depending on the baby's circumstances and severity of gastroschisis." (host_summary) [Ep 21 · 1:41](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=101)
- "Further surgery may be needed if other malformations are also present." (host_summary) [Ep 21 · 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, a method called parenteral nutrition." (host_summary) [Ep 21 · 1:59](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=119)
- "Hospital stay duration differs depending on the severity of gastroschisis, any complications, and how well the baby responds to treatment, often ranging between 2 to 10 weeks but may be longer." (host_summary) [Ep 21 · 2:10](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=130)
- "Follow-up care by a multidisciplinary team (MDT) of different clinical specialists is required to monitor the baby's growth and development." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 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." (host_summary) [Ep 21 · 2:55](https://library.globalcastmd.com/watch/what-is-gastroschisis-an-ernica-animation-for-parents-and-families-7812?t=175)
- "MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis" — Em Gootee (host_summary) [Ep 22 · 1:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=85)
- "Higher levels of MMP-7 are associated with the diagnosis of biliary atresia" — Em Gootee (host_summary) [Ep 22 · 1:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=103)
- "In a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7" — Em Gootee (host_summary) [Ep 22 · 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 (gamma glutamyl transpeptidase) and direct bilirubin" — Em Gootee (host_summary) [Ep 22 · 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, and blood GGT levels are used to detect diseases of the liver and bile ducts" — Em Gootee (host_summary) [Ep 22 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=182)
- "Biliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes" — Em Gootee (host_summary) [Ep 22 · 3:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=199)
- "Having lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis" — Em Gootee (host_summary) [Ep 22 · 4:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=249)
- "The mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown" — Em Gootee (host_summary) [Ep 22 · 4:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=281)
- "In a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants" — Em Gootee (host_summary) [Ep 22 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=422)
- "Of 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula" — Em Gootee (host_summary) [Ep 22 · 7:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=463)
- "Patients with uncomplicated 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 22 · 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 exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis" — Em Gootee (host_summary) [Ep 22 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=507)
- "Patients with uncomplicated gastroschisis who received some formula appeared to have slightly faster time getting to full feeds, likely related to timing of closure rather than feeding type" — Mike Livingston (clinical) [Ep 22 · 8:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=514)
- "Patients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure" — Em Gootee (host_summary) [Ep 22 · 8:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=533)
- "A systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease" — Em Gootee (host_summary) [Ep 22 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=766)
- "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 to adult care (around 25 years)" — Em Gootee (host_summary) [Ep 22 · 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 (opinion) [Ep 22 · 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 colorectal patients showed agreement with those for medical patients that existing guidelines were based on" — Sebastian King (clinical) [Ep 22 · 13:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=822)
- "Patients felt that 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 transitions smooth" — Sebastian King (clinical) [Ep 22 · 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 from pediatric to adult care happened in a timely or coordinated manner" — Whit Holcomb (clinical) [Ep 22 · 14:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=862)
- "No models of transfer of care for colorectal patients from pediatric to adult settings were identified in the systematic review" — Whit Holcomb (clinical) [Ep 22 · 14:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2024-9154?t=878)
- "The ABSA Outcomes and Evidence-based Practice Committee performed a systematic review on optimal initial management of gastroschisis." — Alex Halpern (host_summary) [Ep 24 · 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 (host_summary) [Ep 24 · 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 (host_summary) [Ep 24 · 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 (host_summary) [Ep 24 · 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 (host_summary) [Ep 24 · 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 (host_summary) [Ep 24 · 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 help provide evidence-based care for infants with gastroschisis." — Alex Halpern (host_summary) [Ep 24 · 0:41](https://library.globalcastmd.com/watch/management-of-gastroschisis-timing-of-delivery-antibiotic-usage-and-closure-considerations-9626?t=41)
- "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 (host_summary) [Ep 25 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=60)
- "The Brent et al. study compared patients presenting with esophageal button batteries before algorithm implementation (2015-2019) to those after implementation (2019-2022)." — Eleanor Cisco (host_summary) [Ep 25 · 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 implementing the new algorithm at Connecticut Children's." — Eleanor Cisco (host_summary) [Ep 25 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=85)
- "The McMaster University team performed a retrospective review of infants born between 2014 and 2022 with uncomplicated gastroschisis." — Alex Halpern (host_summary) [Ep 25 · 2:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=128)
- "Infants with uncomplicated gastroschisis who received exclusive breast milk had similar outcomes to those with supplemental or exclusive formula intake." — Alex Halpern (host_summary) [Ep 25 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "In uncomplicated gastroschisis, there were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, rates of necrotizing enterocolitis, and length of hospital stay." — Alex Halpern (host_summary) [Ep 25 · 2:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=137)
- "The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience." — Cecilia Jenna (host_summary) [Ep 25 · 3:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=188)
- "The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia." — Cecilia Jenna (host_summary) [Ep 25 · 3:27](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=207)
- "Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter." — Cecilia Jenna (host_summary) [Ep 25 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter." — Cecilia Jenna (host_summary) [Ep 25 · 3:32](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=212)
- "Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures." — Cecilia Jenna (opinion) [Ep 25 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-16-9732?t=224)
- "This is a retrospective study using educational data from children born between 1991 and 2022." — Lizzie Lee (host_summary) [Ep 26 · 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)
- "Researchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments between 208 children with gastroschisis and over 2000 age-matched controls." — Lizzie Lee (host_summary) [Ep 26 · 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 (host_summary) [Ep 26 · 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 (host_summary) [Ep 26 · 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 Beotti et al. prospective study on postoperative calibrations in Hirschsprung disease took place 2021 to 2023 and included 33 patients under six months old who underwent endorectal pull-through surgeries." — Lizzie Lee (host_summary) [Ep 27 · 1:03](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=63)
- "In the Beotti study, patients were assigned to a new non-dilation protocol group or a traditional dilation group." — Lizzie Lee (host_summary) [Ep 27 · 1:14](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=74)
- "The Beotti study primary outcomes were anastomotic complications, enterocolitis, and constipation." — Lizzie Lee (host_summary) [Ep 27 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=80)
- "In the Beotti study, there was no significant difference in anastomotic complications between the two groups, but the non-dilation group had less enterocolitis and less constipation." — Lizzie Lee (host_summary) [Ep 27 · 1:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=87)
- "Choosing not to do postoperative anal dilations after Hirschsprung pull-through may be a good alternative with benefits like lower constipation and enterocolitis." — Lizzie Lee (host_summary) [Ep 27 · 1:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=96)
- "The APSA Outcomes and Evidence-based Practice Committee systematic review by Slidell et al. found that delivery after 37 weeks is optimal for gastroschisis." — Alex Halpern (host_summary) [Ep 27 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=131)
- "For gastroschisis, prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure." — Alex Halpern (host_summary) [Ep 27 · 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 (host_summary) [Ep 27 · 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 (host_summary) [Ep 27 · 2:28](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=148)
- "The APSA systematic review concluded that there is a need for high quality randomized controlled trials to help provide evidence-based care for gastroschisis infants." — Alex Halpern (host_summary) [Ep 27 · 2:42](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=162)
- "The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume." — Cecilia Gigena (host_summary) [Ep 27 · 3:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=196)
- "The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers." — Cecilia Gigena (host_summary) [Ep 27 · 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, even though they have significantly sicker patients." — Cecilia Gigena (host_summary) [Ep 27 · 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 (host_summary) [Ep 27 · 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 (host_summary) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-22-11118?t=240)
- "Most umbilical hernias will close spontaneously in the first year and some in the second year." — Kenneth Azarow (clinical) [Ep 13 · 2:58](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=178)
- "Age 2 is the earliest Dr. Azarow would consider umbilical hernia repair, and only after extensive counseling; optimal timing is before school entry (age 4–5)." — Kenneth Azarow (opinion) [Ep 13 · 3:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=185)
- "A long proboscis does not affect the decision to operate early on an umbilical hernia." — Kenneth Azarow (opinion) [Ep 13 · 3:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=227)
- "Larger umbilical defects (>1 cm) are less likely to close spontaneously, but this does not justify early surgery." — Kenneth Azarow (clinical) [Ep 13 · 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 (opinion) [Ep 13 · 4:40](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=280)
- "Emerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair." — Todd Ponsky (host_summary) [Ep 13 · 4:54](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=294)
- "True incarcerated umbilical hernias requiring emergency surgery must present with bowel obstruction symptoms (vomiting, inability to feed)." — Kenneth Azarow (clinical) [Ep 13 · 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 13 · 5:49](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=349)
- "Incarcerated omentum or fat at the umbilicus can be treated with NSAIDs; infected urachal cysts with antibiotics." — Kenneth Azarow (clinical) [Ep 13 · 6:09](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=369)
- "Dr. Azarow cannot recall ever performing emergency surgery for an incarcerated umbilical hernia." — Kenneth Azarow (opinion) [Ep 13 · 6:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=379)
- "LMA anesthesia can be used for umbilical hernia repair if adequate abdominal wall relaxation is achieved, but this is anesthesiologist-dependent." — Kenneth Azarow (clinical) [Ep 13 · 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 (lower infection risk in semi-contaminated field)." — Kenneth Azarow (clinical) [Ep 13 · 8:26](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=506)
- "Dr. Azarow uses prophylactic antibiotics for umbilical hernia repair but acknowledges this is anecdotal practice." — Kenneth Azarow (opinion) [Ep 13 · 8:51](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=531)
- "Umbilicoplasty (excision of redundant skin) should be performed during umbilical hernia repair to achieve a flat, cosmetically acceptable result." — Kenneth Azarow (opinion) [Ep 13 · 10:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=619)
- "Umbilicoplasty technique involves creating a pedicled skin flap with blood supply from above or below, avoiding complete circumferential incision." — Kenneth Azarow (clinical) [Ep 13 · 10:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=637)
- "Tacking the undersurface of umbilical skin to the fascia with braided suture (Vicryl) promotes inflammatory adhesion and prevents recurrent proboscis." — Kenneth Azarow (clinical) [Ep 13 · 11:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=702)
- "A pressure dressing should remain in place for 3 days after umbilical hernia repair." — Kenneth Azarow (clinical) [Ep 13 · 12:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=742)
- "Gastroschisis is actually an umbilical ring defect, not a paraumbilical defect, because the natural history is for the hole to close spontaneously (which only occurs at the umbilical ring)." — Kenneth Azarow (clinical) [Ep 13 · 12:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=757)
- "Over half of gastroschisis patients closed with sutureless technique develop large umbilical hernias, but most close spontaneously over 2–3 years." — Kenneth Azarow (clinical) [Ep 13 · 13:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=804)
- "A Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure." — Todd Ponsky (host_summary) [Ep 13 · 13:45](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=825)
- "Suturing the gastroschisis defect makes the umbilical ring edge ischemic and destroys its integrity, leading to hernias that won't close spontaneously." — Kenneth Azarow (clinical) [Ep 13 · 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 to allow abdominal domain expansion; operating too early is a mistake." — Kenneth Azarow (opinion) [Ep 13 · 15:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=900)
- "Parents should watch for the child's flanks bulging when lying flat—this indicates the abdominal girth is expanding and primary closure may be achievable." — Kenneth Azarow (clinical) [Ep 13 · 15:34](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=934)
- "If mesh placement seems inevitable for omphalocele, wait longer—many can be primarily closed if given sufficient time." — Kenneth Azarow (opinion) [Ep 13 · 15:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=913)
- "For large umbilical hernias in older teenagers, laparoscopic repair with mesh can be considered if primary closure seems unlikely." — Kenneth Azarow (clinical) [Ep 13 · 16:48](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1008)
- "A 5 mm umbilical defect very rarely causes intestinal incarceration; small pieces of fat may get caught and cause discomfort." — Kenneth Azarow (clinical) [Ep 13 · 17:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1043)
- "Repair of small asymptomatic umbilical hernias is not absolutely indicated and can be watched indefinitely if the child has no symptoms." — Kenneth Azarow (opinion) [Ep 13 · 17:17](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1037)
- "A Nebraska study showed that operating on umbilical drainage in the first 3 months increases complication rates; many resolve spontaneously by 6 months." — Kenneth Azarow (epidemiological) [Ep 13 · 19:17](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1157)
- "Infants with tiny drops of clear or whitish umbilical drainage should be watched for 6 months before considering surgery." — Kenneth Azarow (opinion) [Ep 13 · 19:08](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1148)
- "Dr. Azarow has stopped operating in the first 6 months for minor umbilical drainage or granulomas." — Kenneth Azarow (opinion) [Ep 13 · 19:29](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1169)
- "Umbilical granulomas can be treated with silver nitrate application; many resolve without surgery." — Kenneth Azarow (clinical) [Ep 13 · 20:59](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1259)
- "Office ligation of umbilical granulomas is not recommended unless the stalk is very narrow; they often don't fall off easily." — Kenneth Azarow (opinion) [Ep 13 · 21:11](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1271)
- "A prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early." — Todd Ponsky (epidemiological) [Ep 13 · 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, so the same principle applies to umbilical granulomas." — Kenneth Azarow (clinical) [Ep 13 · 21:49](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1309)
- "For persistent umbilical drainage at 6–12 months, perform umbilical exploration through a hernia repair incision, divide the fascia inferiorly to visualize the urachal track, and bluntly dissect to the bladder dome." — Kenneth Azarow (clinical) [Ep 13 · 22:10](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1330)
- "The distal epithelialized portion of the urachal remnant must be excised from the umbilical skin, taking care not to devascularize the umbilicus." — Kenneth Azarow (clinical) [Ep 13 · 22:32](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1352)
- "A Nebraska study found no VCUG or ultrasound findings that changed management of urachal remnants, so Dr. Azarow does not perform preoperative imaging." — Kenneth Azarow (epidemiological) [Ep 13 · 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 percutaneous drainage by interventional radiology." — Kenneth Azarow (clinical) [Ep 13 · 24:52](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1492)
- "After cooling down an infected urachal cyst, the entire congenital remnant should be excised electively to prevent recurrent abscess." — Kenneth Azarow (clinical) [Ep 13 · 25:01](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1501)
- "Elective urachal remnant excision is performed laparoscopically with a supraumbilical port and a 12 mm lateral port for stapling across the bladder dome." — Kenneth Azarow (clinical) [Ep 13 · 25:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1531)
- "Patent omphalomesenteric duct with stool draining from the umbilicus will not close spontaneously and requires surgery before hospital discharge." — Kenneth Azarow (clinical) [Ep 13 · 26:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1583)
- "Patent omphalomesenteric duct poses risk of volvulus from small bowel wrapping around the fistula tract." — Kenneth Azarow (clinical) [Ep 13 · 26:36](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1596)
- "Patent omphalomesenteric duct is approached through umbilical exploration; laparoscopy can assist if bowel is already twisted around the tract." — Kenneth Azarow (clinical) [Ep 13 · 26:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1616)
- "Epigastric hernias (epiploceles) are purely elective and should only be repaired if causing discomfort; they are preperitoneal fat through a pinhole defect, not true hernias." — Kenneth Azarow (clinical) [Ep 13 · 28:06](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1686)
- "The fascial defect in epigastric hernias is typically only 1 millimeter in diameter." — Kenneth Azarow (clinical) [Ep 13 · 28:46](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1726)
- "Analysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years." — Todd Ponsky (epidemiological) [Ep 13 · 29:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1762)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 4 · 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 with gastroschisis" — Jack Langer (clinical) [Ep 4 · 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 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit" — Jack Langer (clinical) [Ep 4 · 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" — Jack Langer (clinical) [Ep 4 · 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" — Jack Langer (clinical) [Ep 4 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=389)
- "Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jack Langer (clinical) [Ep 4 · 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 the inflamed bowel" — Jack Langer (clinical) [Ep 4 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=427)
- "Labor induction at 37 weeks is successful most of the time in gastroschisis pregnancies, unlike regular pregnancies" — Jack Langer (clinical) [Ep 4 · 7:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=450)
- "Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jack Langer (clinical) [Ep 4 · 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 ischemia of the bowel" — Jack Langer (clinical) [Ep 4 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=601)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jack Langer (clinical) [Ep 4 · 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" — Jack Langer (clinical) [Ep 4 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=689)
- "Current technique uses pre-formed silos with fentanyl or morphine sedation without intubation in awake babies, slowly pushing bowel in while monitoring intraabdominal pressure to keep it below 20" — Jack Langer (clinical) [Ep 4 · 11:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=707)
- "If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days" — Jack Langer (clinical) [Ep 4 · 12:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=747)
- "Anthony Sandler championed the sutureless plastic closure approach after training in Toronto" — Jack Langer (clinical) [Ep 4 · 13:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=820)
- "Dr. Baird published a paper in JPS showing 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 (host_summary) [Ep 4 · 14:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=859)
- "Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later" — Jack Langer (clinical) [Ep 4 · 16:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=972)
- "Leaving a silo on for 24-48 hours causes the abdominal wall defect to stretch and get bigger, taking longer to close with plastic closure" — Jack Langer (clinical) [Ep 4 · 17:25](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1045)
- "Spring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 4 · 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%" — Jack Langer (epidemiological) [Ep 4 · 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 a constricting defect causing ischemia and potentially vanishing gastroschisis" — Jack Langer (clinical) [Ep 4 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1141)
- "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 improved sepsis control" — Jack Langer (clinical) [Ep 4 · 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 in a couple months" — Jack Langer (clinical) [Ep 4 · 20:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1254)
- "There is no good evidence for optimal management of atresia in gastroschisis because it's rare, so approach should be individualized" — Jack Langer (opinion) [Ep 4 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1275)
- "If bowel looks good without much peel, repair the atresia and reduce at the same sitting; if concerning, drop it back in without repair" — Jack Langer (clinical) [Ep 4 · 21:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1295)
- "Stomas are only brought out when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose" — Jack Langer (clinical) [Ep 4 · 22:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1321)
- "The umbilicus is the preferred site for neonatal stomas; prolapse occurs regardless of location" — Jack Langer (clinical) [Ep 4 · 22:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1370)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jack Langer (clinical) [Ep 4 · 24:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1467)
- "Metoclopramide (Reglan) can be given intravenously as a prokinetic agent in gastroschisis patients with hypomotility" — Jack Langer (clinical) [Ep 4 · 24:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1495)
- "A UK study showed cisapride shortened time to bowel function, but cisapride is no longer available" — Jack Langer (clinical) [Ep 4 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1502)
- "Toronto is conducting a randomized prospective trial to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jack Langer (clinical) [Ep 4 · 25:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1537)
- "At 4 weeks without bowel function, start with contrast enema to look for mechanical obstruction, can also do upper GI" — Jack Langer (clinical) [Ep 4 · 25:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1557)
- "If still no resolution at 6 weeks, laparotomy is usually performed; sometimes mechanical obstruction is found, sometimes just adhesions" — Jack Langer (clinical) [Ep 4 · 26:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1604)
- "Going in too early on gastroschisis patients with prolonged ileus is a mistake" — Jack Langer (opinion) [Ep 4 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1641)
- "Undescended testis (usually right) in gastroschisis is directed down into the pelvis during reduction; in about half the cases it finds its way to the scrotum" — Jack Langer (clinical) [Ep 4 · 28:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1683)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jack Langer (clinical) [Ep 4 · 28:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1723)
- "Karyotype analysis and testing for Beckwith-Wiedemann syndrome are routinely done for omphalocele patients" — Jack Langer (clinical) [Ep 4 · 28:59](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1739)
- "Small omphaloceles without liver are counterintuitively more likely to be associated with abnormal chromosomes than large omphaloceles" — Jack Langer (clinical) [Ep 4 · 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" — Jack Langer (clinical) [Ep 4 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1805)
- "Small omphaloceles are simple to repair surgically" — Jack Langer (clinical) [Ep 4 · 30:23](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1823)
- "For giant omphaloceles (with significant liver), most recommend cesarean section, though this is not evidence-based" — Jack Langer (clinical) [Ep 4 · 31:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1864)
- "Giant omphaloceles should be delivered at a perinatal center due to need for pediatric surgeon and experienced neonatologists" — Jack Langer (clinical) [Ep 4 · 31:42](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1902)
- "Pulmonary hypoplasia is associated with giant omphaloceles but is very difficult to diagnose prenatally; some patients require early intubation and respiratory support" — Jack Langer (clinical) [Ep 4 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1915)
- "Stuart Lacy established intraabdominal pressure guideline of 20 mmHg based on rabbit studies in the 1980s, then validated in prospective study in children showing improved outcomes" — Jack Langer (clinical) [Ep 4 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2008)
- "Lacy also described increase in central venous pressure of more than 4 as a concerning threshold" — Jack Langer (clinical) [Ep 4 · 33:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2036)
- "Intraabdominal pressure can be measured through nasogastric tube or Foley catheter (intravesical pressure); the trend is more important than absolute number" — Jack Langer (clinical) [Ep 4 · 34:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2042)
- "Primary closure is attempted for full-term omphalocele patients without significant cardiac disease, respiratory issues, or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 4 · 34:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2083)
- "The Montreal group described using the omphalocele sac as a silo, sequentially ligating it over days to allow abdominal wall stretching before definitive closure" — Jack Langer (clinical) [Ep 4 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2107)
- "Sequential sac ligation requires a thick enough sac and umbilical cord coming off the top rather than the side" — Jack Langer (clinical) [Ep 4 · 35:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2144)
- "Cristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time" — Todd Ponsky (host_summary) [Ep 4 · 37:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2242)
- "Duoderm compression appears to achieve reduction more quickly than sac ligation and doesn't require a sac amenable to ligation" — Jack Langer (clinical) [Ep 4 · 37:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2263)
- "Indications for escharotic therapy include prematurity, bad cardiac disease, pulmonary hypoplasia, multiple anomalies, abnormal chromosomes, or omphalocele too giant to reduce" — Jack Langer (clinical) [Ep 4 · 38:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2295)
- "Mushroom-shaped omphaloceles (small abdominal wall defect with large amount of viscera out) are impossible to reduce primarily" — Jack Langer (clinical) [Ep 4 · 38:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2329)
- "Sigy Ein used silver sulfadiazine (Silvadene) for escharotic therapy in omphaloceles for many years; Toronto published long-term follow-up" — Jack Langer (clinical) [Ep 4 · 39:26](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2366)
- "Timing of delayed omphalocele repair depends on patient specifics; some can be repaired at 6-8 months if defect reduces spontaneously, others require waiting 3-4 years for cardiac or pulmonary optimization" — Jack Langer (clinical) [Ep 4 · 40:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2419)
- "Mushroom-shaped omphaloceles never reduce spontaneously and stay large" — Jack Langer (clinical) [Ep 4 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2470)
- "For mushroom-shaped omphaloceles, the abdominal wall defect can be enlarged as a first step by incising the lower edge fascia, closing skin, and allowing more spontaneous reduction before definitive repair" — Jack Langer (clinical) [Ep 4 · 41:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2480)
- "Phil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer" — Todd Ponsky (clinical) [Ep 4 · 42:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2523)
- "Formal adult-style component separation in small children carries risk of devascularization and worsening the situation" — Jack Langer (clinical) [Ep 4 · 43:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2586)
- "In omphaloceles extending to the costal margin, the upper defect cannot be closed, so inferior defect is closed and a patch placed superiorly" — Jack Langer (clinical) [Ep 4 · 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 closure; can be replaced with non-absorbable prolene mesh" — Jack Langer (clinical) [Ep 4 · 44:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2641)
- "Stratus is being used more recently for patches but long-term follow-up is not yet available to compare with Surgisis" — Jack Langer (clinical) [Ep 4 · 44:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2659)
- "Omphaloceles can be part of pentalogy of Cantrell, often with missing pericardium or Morgagni hernia; these tend to be more superiorly placed" — Jack Langer (clinical) [Ep 4 · 44:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2684)
- "For pentalogy of Cantrell patients, escharotic therapy is used due to cardiac problems; cardiac surgeons can patch the diaphragm from above through sternotomy, then abdominal wall is repaired later after cardiac optimization" — Jack Langer (clinical) [Ep 4 · 45:24](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2724)
- "Reflux is very common in omphalocele patients, especially those with bad hearts or pulmonary hypoplasia who don't eat normally" — Jack Langer (clinical) [Ep 4 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2768)
- "Interventional radiologists can place G-tubes under fluoroscopy in giant omphalocele patients by finding a window lateral to the defect, then convert to GJ tube after maturation" — Jack Langer (clinical) [Ep 4 · 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 liver is midline and accessing the hiatus is nearly impossible, especially with cardiac disease and congested liver" — Jack Langer (clinical) [Ep 4 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2835)
- "GJ tube is a better short-term solution for reflux in omphalocele; fundoplication can be performed when fixing the abdominal wall defect after medical optimization" — Jack Langer (clinical) [Ep 4 · 47:42](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2862)
- "In large omphaloceles with midline liver, the liver can put pressure on the duodenum or pylorus causing mechanical gastric outlet obstruction that worsens reflux" — Jack Langer (clinical) [Ep 4 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888)
- "Non-rotation in omphalocele is not a problem because it's not associated with risk of midgut volvulus, unlike malrotation" — Jack Langer (clinical) [Ep 4 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2929)
- "Inversion appendectomy during Ladd procedure makes sense if the appendix is encountered, as several omphalocele patients have developed perforated appendicitis with delayed diagnosis due to abnormal appendix location" — Jack Langer (clinical) [Ep 4 · 49:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2946)
- "If a child has renal abnormality requiring potential Mitrofanoff, the appendix should be preserved" — Jack Langer (clinical) [Ep 4 · 49:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2984)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not careful" — Jack Langer (clinical) [Ep 4 · 50:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3010)
- "Kinking of hepatic veins during reduction has not been a problem when using intraabdominal pressure monitoring and not being too aggressive with pressures above 20" — Jack Langer (clinical) [Ep 4 · 50:31](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3031)
- "In immediate omphalocele reduction, fascial edges can usually be approximated at the bottom but often not at the top, requiring patch placement" — Jack Langer (clinical) [Ep 4 · 50:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3056)
- "For partial reductions with liver still protruding superiorly, Gore-Tex or silastic can be sewn on, skin closed over it, then removed in 1-2 weeks after stretching allows fascial closure" — Jack Langer (clinical) [Ep 4 · 51:09](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3069)
- "The abdominal wall forms around the 4th week of gestation, well before most women know they are pregnant." — Joyce (clinical) [Ep 6 · 0:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=31)
- "During the 6th week of gestation, rapid growth of intestines and liver expansion causes herniation of the midgut into the umbilical cord." — Joyce (clinical) [Ep 6 · 0:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=40)
- "Around the 10th week of gestation, herniated bowel loops return to the abdominal cavity and the small bowel and colon assume a fixed position." — Joyce (clinical) [Ep 6 · 0:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=50)
- "In gastroschisis, the umbilical cord is located to the left of the defect; in omphalocele it is in the center." — Joyce (clinical) [Ep 6 · 1:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=84)
- "With gastroschisis, bowel is exposed in utero causing it to be thickened, matted, and inflamed; with omphalocele the bowel is covered and remains normal." — Joyce (clinical) [Ep 6 · 1:32](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=92)
- "Associated anomalies occur in around 10% of gastroschisis cases but 60-75% of omphalocele cases, correlating with increased mortality in omphalocele." — Joyce (epidemiological) [Ep 6 · 1:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=112)
- "Gastroschisis is herniation of intestinal loops through a full-thickness defect in the anterior abdominal wall, usually lateral to the umbilicus on the right more than the left, around 4 cm in size, with no covering sac." — Joyce (clinical) [Ep 6 · 2:14](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=134)
- "The etiology of gastroschisis remains unknown. Leading theories propose a vascular event involving the right umbilical vein or right omphalomesenteric artery causing necrosis and abdominal wall weakening." — Joyce (clinical) [Ep 6 · 2:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=160)
- "The incidence of gastroschisis has risen over the last 20 years to as high as 5 per 10,000 live births." — Joyce (epidemiological) [Ep 6 · 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 6 · 3:16](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=196)
- "Risk factors for gastroschisis are multifactorial but include young maternal age (<20 years), smoking, and use of vasoconstrictive medications." — Joyce (epidemiological) [Ep 6 · 3:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=217)
- "Around 90% of gastroschisis cases are diagnosed prenatally on routine ultrasound." — Joyce (epidemiological) [Ep 6 · 3:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231)
- "There is no evidence in the literature to support either C-section or vaginal delivery in regards to outcome for gastroschisis." — Joyce (clinical) [Ep 6 · 4:48](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=288)
- "Initial delivery room management focuses on supporting the infant and keeping the bowel warm and moist: assess airway/breathing/circulation, assess bowel viability, place bowel and lower extremities in bowel bag with intestines central to decrease kinking risk." — Joyce (guideline) [Ep 6 · 5:01](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=301)
- "Gastroschisis infants experience excessive fluid losses from exposed bowel and require maintenance of temperature >36°C to decrease stress." — Joyce (clinical) [Ep 6 · 5:35](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=335)
- "An NG or OG tube is placed to decompress the stomach and prevent further intestinal distention in gastroschisis." — Joyce (guideline) [Ep 6 · 5:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=351)
- "There is about a 10% associated occurrence of intestinal atresia with gastroschisis." — Joyce (epidemiological) [Ep 6 · 7:10](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430)
- "Intestinal atresia in gastroschisis can be treated at time of abdominal wall closure with resection and primary anastomosis, or the bowel can be reduced with atresia intact and repaired 4-12 weeks later, possibly requiring temporary ostomy especially with distal atresia." — Joyce (clinical) [Ep 6 · 7:22](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=442)
- "Surgical management of gastroschisis focuses on safe viscera reduction, identifying and treating associated defects (atresia, perforation), closure of the defect, early recognition of complications, and nutritional support." — Joyce (guideline) [Ep 6 · 7:47](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=467)
- "Closure is accomplished through either primary surgical closure or staged reduction with silo. Defect size, intestinal condition, and abdominal cavity size impact the decision." — Joyce (clinical) [Ep 6 · 8:14](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=494)
- "Staged closure with silo is accomplished gradually over 1 to 14 days, then surgically closed either at bedside or in the OR." — Joyce (clinical) [Ep 6 · 8:40](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=520)
- "At Cincinnati Children's, out of 41 gastroschisis patients in the last 3 years, almost all had staged closures with silos; only a handful with small defects were closed primarily." — Joyce (clinical) [Ep 6 · 8:52](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=532)
- "Lucille Packard Children's Hospital uses a sutureless technique: silo reduction followed by covering the remaining defect with Mepilex and Tegaderm dressings until fully healed (about 6 weeks), leaving an umbilical hernia that may need later repair." — Joyce (clinical) [Ep 6 · 9:37](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=577)
- "Todd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results." — Todd Ponsky (clinical) [Ep 6 · 10:22](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=622)
- "In a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair." — Todd Ponsky (epidemiological) [Ep 6 · 11:03](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663)
- "For non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks)." — Todd Ponsky (clinical) [Ep 6 · 11:53](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=713)
- "Complications of primary gastroschisis closure stem mainly from increased abdominal pressure leading to decreased venous return and possible abdominal compartment syndrome with ischemic injury." — Joyce (clinical) [Ep 6 · 13:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=786)
- "It is important to monitor intra-abdominal pressure during and post gastroschisis closure using bladder pressures, frequent physical exam, urine output monitoring, and assessment of respiratory support requirements." — Joyce (guideline) [Ep 6 · 13:22](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=802)
- "Literature review shows debate about gastroschisis closure method: some groups report earlier feeding and decreased length of stay with primary closure, others report decreased ventilator time, shorter stay, and lower cost with silo reduction. Overall survival is >95% regardless of closure type." — Joyce (epidemiological) [Ep 6 · 15:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906)
- "Post-silo placement nursing care focuses on quick complication recognition: support silo and bowel to avoid kinking/twisting, bowel should be pink with serous (not stool-containing) fluid in bag, monitor lower extremity perfusion, urine output, edema, oxygen requirement, respiratory difficulty, and temperature." — Joyce (guideline) [Ep 6 · 15:38](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=938)
- "Gastroschisis patients may require as much as 140-150 mL/kg/day of fluids to manage losses." — Joyce (clinical) [Ep 6 · 16:54](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1014)
- "At Cincinnati Children's, Betadine-soaked gauze is used around the silo base and changed twice daily." — Joyce (clinical) [Ep 6 · 17:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1044)
- "Todd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output." — Todd Ponsky (opinion) [Ep 6 · 29:22](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1762)
- "Dean agrees that bladder pressures are not routinely used; peak airway pressures are very good, or in pressure-control ventilation watch for significant tidal volume changes, plus good physical exam of the belly for tightness." — Dean (opinion) [Ep 6 · 30:13](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1813)
- "Jenny emphasizes that in Seattle the majority of gastroschisis care is done by advanced practitioners: non-surgical closure, kids out of ICU within days, then weeks on floors managed by nurse practitioners doing fluid management, feeding advancement, and wound care." — Jenny (clinical) [Ep 6 · 30:59](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1859)
- "Of all potential gastroschisis complications, dysmotility is the most universal." — Joyce (clinical) [Ep 6 · 19:56](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1196)
- "Gastroschisis prognosis is mainly dependent on severity of associated problems (prematurity, initial post-op complications) and degree of dysmotility, all impacting course and length of stay." — Joyce (clinical) [Ep 6 · 20:08](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1208)
- "NEC is reported in about 5-10% of gastroschisis patients, tends to occur later in the course, should be treated same as isolated NEC, and shows no correlation with type of closure performed." — Joyce (clinical) [Ep 6 · 20:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1230)
- "Cincinnati feeding protocol: enteral feedings start 24 hours after NG tube removal (when NG output <20 mL/kg/day for 24 hours), begin at 1 mL/hr, increase by 1 mL/hr daily until day 5, then BID increases, then q8h increases by day 8 if tolerated. PO feedings introduced with windows off tube feeds as tolerated, TPN gradually dialed down." — Joyce (guideline) [Ep 6 · 33:46](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2026)
- "Cincinnati is enrolling gastroschisis patients in a feeding study randomizing to either the enteral feeding protocol arm or PO ad-lib feedings arm." — Joyce (clinical) [Ep 6 · 34:33](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2073)
- "Cincinnati data 2010-present: 36 gastroschisis patients required long-term TPN (>30 days). Simple gastroschisis (n=22) averaged 35 days TPN with 3 still on TPN at 1 year. Complex with atresia (n=4) averaged 146 days TPN but all were off TPN on enteral feeds within 10 months." — Joyce (epidemiological) [Ep 6 · 36:31](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2191)
- "Studies show about 1/3 of gastroschisis children are below 10th percentile for weight at 1 year but without neurodevelopmental delays at time of evaluation." — Joyce (host_summary) [Ep 6 · 37:24](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2244)
- "Fallon et al 2012 retrospective review reported that gestational age <37 weeks and development of cholestasis were independently linked to poor growth in gastroschisis, whereas small-for-gestational-age or low birth weight was not." — Joyce (host_summary) [Ep 6 · 38:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2286)
- "Cincinnati group 2010 outcomes for 71 gastroschisis infants (6 complex) treated with standardized nutritional protocol (2006-2009): enteral feedings started around day 16, median length of stay 42 days, 6 patients discharged on TPN, 24% on tube feedings, rest on oral feeding." — Joyce (host_summary) [Ep 6 · 38:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310)
- "Cincinnati 2006-2008 readmission data (n=58, 21% primary closure, remainder silo): 40% readmitted at least once within first year, >25% of readmissions directly gastroschisis-related. Most common reasons: bowel obstruction, abdominal pain/distention." — Joyce (host_summary) [Ep 6 · 39:25](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2365)
- "Cincinnati readmission analysis found no relationship with place of birth, bowel resection requirement, complex vs simple gastroschisis, small-for-gestational-age, delivery mode, feeding timing, TPN duration, length of stay, gender, maternal age, or prenatal diagnosis." — Joyce (host_summary) [Ep 6 · 40:07](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2407)
- "Cincinnati data showed interesting trend (not statistically significant): 67% of primary closure patients readmitted vs 20% of silo patients; bowel obstruction occurred in 17% of primary closure group vs 7% of silo group." — Joyce (host_summary) [Ep 6 · 40:50](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2450)
- "Holland 2010 article 'Gastroschisis: An Update' summarized that there is a need for multi-center prospective studies (due to small numbers at individual centers) and focus on improved evaluation of long-term nutritional and neurodevelopmental outcomes in these relatively well-doing patients." — Joyce (host_summary) [Ep 6 · 41:19](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2479)
- "For gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed." — Todd Ponsky (clinical) [Ep 6 · 42:18](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2538)
- "Most of the damage to the intestine in gastroschisis occurs in the last few weeks of pregnancy, based on animal studies and clinical studies" (clinical) [Ep 5 · 2:45](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=165)
- "The age at spontaneous onset of labor for gastroschisis pregnancy is 3 weeks earlier than the general population" (epidemiological) [Ep 5 · 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 5 · 3:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=236)
- "No perinatal center in Canada was doing routine cesarean sections for gastroschisis based on a national survey" (epidemiological) [Ep 5 · 4:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=277)
- "15 or 20 years ago, routine cesarean section for gastroschisis was pretty much the standard of care" (clinical) [Ep 5 · 4:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=289)
- "Using a pre-formed silo allows gentle reduction of gastroschisis bowel without trauma, and in about a third of cases the bowel can be reduced immediately and the silo removed" (clinical) [Ep 5 · 8:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=507)
- "Waiting for gastroschisis babies to lose their first 10% of body weight reduces bowel edema and makes reduction easier" (clinical) [Ep 5 · 9:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=545)
- "Leaving a silo on for more than a day causes the fascial defect to get much bigger" (clinical) [Ep 5 · 9:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=581)
- "Using plastic closure (non-surgical closure) for gastroschisis gives extremely good results, often with a small umbilical hernia that closes by age 2" (clinical) [Ep 5 · 11:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=697)
- "There are two kinds of intestinal atresia in gastroschisis: early-developing atresia not always associated with bowel thickening, and late-occurring atresia from a very small abdominal wall defect" (clinical) [Ep 5 · 15:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=955)
- "Bringing an ostomy out through the umbilicus avoids additional scars and makes subsequent closure easier" (clinical) [Ep 5 · 16:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=973)
- "Gord Cameron in Hamilton in the 1980s was the first to describe umbilical ostomies" (clinical) [Ep 5 · 17:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1073)
- "At 4 weeks post-gastroschisis repair with feeding intolerance, waiting longer is reasonable as the bowel may still be recovering from motility disorder" (opinion) [Ep 5 · 20:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1204)
- "At 8 weeks post-repair with persistent feeding intolerance, exploration is warranted to rule out mechanical obstruction" (opinion) [Ep 5 · 20:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1246)
- "For large omphalocele, attempting to remove the sac and close primarily can lead to inability to achieve closure and need for prosthetic patch" (clinical) [Ep 5 · 22:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1333)
- "The Schuster repair uses mesh sutured to fascia over intact omphalocele sac with gradual closure, eventually allowing primary repair" (clinical) [Ep 5 · 22:31](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1351)
- "For large omphalocele, patch covered by skin or skin coverage alone is better than paint-and-wait which takes months" (opinion) [Ep 5 · 23:11](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1391)
- "Lateral component separation makes it easier to bring fascial edges together in omphalocele repair" (clinical) [Ep 5 · 23:32](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1412)
- "Antibiotic ointment on omphalocele sac keeps it supple, and using 4x4s with Ace wrap compression can gradually reduce the defect" (clinical) [Ep 5 · 23:53](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1433)
- "Dr. Abello uses Duoderm wrapped around omphalocele and tightens it daily to achieve gradual reduction" (host_summary) [Ep 5 · 24:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1477)
- "Botox has been used successfully by adult hernia surgeons to relax muscle and facilitate closure of large ventral hernias" (host_summary) [Ep 5 · 24:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1497)
- "Intragastric pressure monitoring via NG tube is easy to perform in the OR and provides useful guidance, with 20 as a suggested threshold" (clinical) [Ep 5 · 29:56](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1796)
- "Bladder pressure measurement in tiny newborns is unreliable and cannot be trusted consistently" (opinion) [Ep 5 · 29:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1740)
- "Ventilatory parameters are the most reliable measure for assessing safe closure tension" (opinion) [Ep 5 · 28:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1684)
- "For giant omphalocele in older children, enlarging the fascial defect and allowing staged closure over time without forcing reduction prevents abdominal compartment syndrome" (clinical) [Ep 5 · 36:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2174)
- "In older children with giant omphalocele, the abdomen does not expand as rapidly as in newborns and requires more time between stages" (clinical) [Ep 5 · 36:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2200)
- "When opening the fascial ring in giant omphalocele, opening inferiorly avoids encountering hepatic veins at the superior aspect" (clinical) [Ep 5 · 36:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2218)

## Changelog
- Sep 9: 1 item no longer name gastroschisis
- Sep 7: 8 items added automatically
- Sep 7: 14 items added automatically
- Sep 7: 3 items no longer name gastroschisis
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 9 items added automatically

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