# Omphalocele — GCMD Library living collection

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

Updated: n/a · 10 episodes · 369 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)

### Surgical Management
- [Abdominal Wall Defects](https://library.globalcastmd.com/watch/abdominal-wall-defects-639) — video · 37:50 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-639.md)
- [Gastroschisis: Advanced Practice Providers](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049) — video · 43:21 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049.md)
- [Gastroschisis - Clinical Practice Updates](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996) — video · [machine version](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996.md)

### 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)

### Case-Based Learning
- [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 Omphalocele? An ERNICA animation for parents and families](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811) — video · 3:19 · [machine version](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811.md)

## Chapters
- [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)
- [0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0) Introduction and Background (Ep 7)
- [4:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=243) Gastroschisis: Prenatal Counseling and Delivery Planning (Ep 7)
- [8:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=514) Gastroschisis: Initial Management and Closure Techniques (Ep 7)
- [17:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1024) Gastroschisis: Intestinal Atresia Management (Ep 7)
- [22:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1337) Gastroschisis: Prolonged Ileus and Complications (Ep 7)
- [28:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1707) Omphalocele: Prenatal Counseling and Associated Anomalies (Ep 7)
- [32:22](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1942) Omphalocele: Surgical Management and Reduction Techniques (Ep 7)
- [40:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2417) Omphalocele: Delayed Closure and Patch Repair (Ep 7)
- [45:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2754) Omphalocele: Feeding Issues and Associated Problems (Ep 7)
- [0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=0) Introduction and Background (Ep 2)
- [4:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=243) Gastroschisis: Prenatal Counseling and Delivery Planning (Ep 2)
- [8:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=514) Gastroschisis: Initial Management and Closure Techniques (Ep 2)
- [16:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1014) Gastroschisis: Intestinal Atresia Management (Ep 2)
- [22:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1337) Gastroschisis: Prolonged Ileus and Complications (Ep 2)
- [28:31](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1711) Omphalocele: Prenatal Counseling and Small Defects (Ep 2)
- [40:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2417) Giant Omphalocele: Reduction Techniques and Escharotic Therapy (Ep 2)
- [48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888) Omphalocele: Complications and Associated Conditions (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=0) Embryology and Differential Diagnosis of Abdominal Wall Defects (Ep 4)
- [3:51](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=231) Prenatal Diagnosis and Initial Stabilization (Ep 4)
- [7:10](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=430) Surgical Management Options: Primary vs Staged Closure (Ep 4)
- [11:03](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=663) Silo Reduction Technique and Monitoring (Ep 4)
- [15:06](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=906) Postoperative Monitoring and Complications (Ep 4)
- [19:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1170) Prognosis and Necrotizing Enterocolitis Risk (Ep 4)
- [21:04](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1264) Case Presentation: 36-Week Infant with Gastroschisis (Ep 4)
- [31:27](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=1887) Feeding Advancement and Prolonged Ileus (Ep 4)
- [35:05](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2105) Long-Term Nutritional Outcomes and TPN Duration (Ep 4)
- [38:30](https://library.globalcastmd.com/watch/gastroschisis-advanced-practice-providers-1049?t=2310) Readmission Patterns and Future Research Needs (Ep 4)
- [0:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1) Prenatal Management and Delivery Planning for Gastroschisis (Ep 3)
- [5:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=316) Postnatal Closure Techniques for Gastroschisis (Ep 3)
- [13:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=782) Management of Gastroschisis with Intestinal Atresia (Ep 3)
- [18:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1085) Feeding Intolerance After Gastroschisis Repair (Ep 3)
- [21:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1272) Management of Large Omphalocele in Term Neonate (Ep 3)
- [27:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=1639) Monitoring for Abdominal Compartment Syndrome (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 51:09](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3069)
- "The front of a baby's belly does not form properly during early pregnancy in omphalocele" (clinical) [Ep 10 · 0:06](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=6)
- "In omphalocele, the baby has an opening in their belly button through which organs pass and are covered by a thin sac" (clinical) [Ep 10 · 0:11](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=11)
- "Omphalocele is classed as a rare birth defect" (epidemiological) [Ep 10 · 0:21](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=21)
- "Sometimes only a portion of the small intestine passes through the opening in omphalocele" (clinical) [Ep 10 · 0:26](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=26)
- "In other cases, more organs including some or most of the liver pass through the opening" (clinical) [Ep 10 · 0:30](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=30)
- "When the liver is involved, it is called large or giant omphalocele" (clinical) [Ep 10 · 0:30](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=30)
- "The cause of omphalocele is unknown" (clinical) [Ep 10 · 0:40](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=40)
- "Omphalocele can be a feature of many genetic syndromes" (clinical) [Ep 10 · 0:43](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "Many babies with omphalocele have other birth defects" (epidemiological) [Ep 10 · 0:43](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=43)
- "A diagnosis of omphalocele can be made before birth using ultrasound" (clinical) [Ep 10 · 0:51](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=51)
- "Prenatal tests should be carried out to identify any associated anomalies in omphalocele" (guideline) [Ep 10 · 1:00](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=60)
- "Ongoing care for babies with omphalocele should be provided at a specialist center by a dedicated team with knowledge and experience" (guideline) [Ep 10 · 1:06](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=66)
- "Omphalocele is a serious condition and can be life threatening for the baby before birth and as a newborn" (clinical) [Ep 10 · 1:17](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=77)
- "Most babies with omphalocele do survive" (epidemiological) [Ep 10 · 1:24](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=84)
- "Some babies with giant omphalocele may be transferred to a dedicated intensive care unit after birth" (clinical) [Ep 10 · 1:32](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=92)
- "The contents of the belly that have passed through the opening are wrapped in a sterile bag to avoid damage" (clinical) [Ep 10 · 1:39](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=99)
- "When the baby is stable, surgery can be performed to place the organs back in the belly and close the opening" (clinical) [Ep 10 · 1:46](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=106)
- "Small omphaloceles can be repaired in one operation called a primary repair" (clinical) [Ep 10 · 1:54](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=114)
- "For babies with giant omphalocele, repair is done in several steps called a staged repair" (clinical) [Ep 10 · 2:01](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=121)
- "In some giant omphalocele cases, there may not be enough room in the newborn baby's belly for the organs to fit back inside" (clinical) [Ep 10 · 2:08](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=128)
- "When there is insufficient abdominal domain, surgery may be postponed for weeks or months to allow the lungs and body to grow" (clinical) [Ep 10 · 2:17](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=137)
- "Babies may be able to return home during the period of delayed surgery with appropriate nursing care in place" (clinical) [Ep 10 · 2:27](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=147)
- "Hospital stay duration differs depending on the severity of the omphalocele, any associated anomalies or complications, and response to treatment" (clinical) [Ep 10 · 2:33](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=153)
- "Follow up care by a multidisciplinary team (MDT) of different clinical specialists is required" (guideline) [Ep 10 · 2:45](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=165)
- "Some babies may experience ongoing difficulties that require different types and levels of care, such as feeding or breathing difficulties" (clinical) [Ep 10 · 2:55](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=175)
- "Identifying any complications or difficulties early is very important" (guideline) [Ep 10 · 3:05](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=185)
- "Babies with giant omphaloceles need to be monitored more closely" (guideline) [Ep 10 · 3:10](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=190)
- "Peer support can be accessed through patient and family support groups" (clinical) [Ep 10 · 3:15](https://library.globalcastmd.com/watch/what-is-omphalocele-an-ernica-animation-for-parents-and-families-7811?t=195)
- "A culture of safety is a deliberate way of doing things to avoid complications." — Sherif Emil (clinical) [Ep 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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)
- "Giant omphalocele (≥5 cm or liver in sac) patients had greater time to full feeds, required more TPN, had greater risk of respiratory insufficiency, and higher incidence of chromosomal anomalies compared to routine omphalocele in a two-center 20-year retrospective study of 97 survivors." (clinical) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "56 of 97 giant omphalocele patients were identified as having pulmonary hypertension, with most diagnosed within the first week of life." (epidemiological) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "Five patients with giant omphalocele had no signs of pulmonary hypertension on initial echo within first seven days but subsequently developed severe pulmonary hypertension after sepsis episodes, with two deaths and one requiring pulmonary vasodilator for more than a year." (clinical) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "One patient developed severe pulmonary hypertension 52 days after initial echo showed no pulmonary hypertension, triggered by a single episode of sepsis." (clinical) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0)
- "The sac-preserving active reduction technique developed by Dr. Abello from Colombia has been used in almost 40 patients over three years by Miguel Gilfoid's group." — Miguel Guelfand (clinical) [Ep 6 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days." — Miguel Guelfand (clinical) [Ep 6 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process." — Miguel Guelfand (clinical) [Ep 6 · 5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300)
- "The hydrocolloid dressing should ideally be applied within the first 24 hours after birth so the sac doesn't become very stiff, and it keeps the sac very smooth and hydrated." — Miguel Guelfand (clinical) [Ep 6 · 6:47](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully." — Miguel Guelfand (clinical) [Ep 6 · 6:47](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407)
- "Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable." — Miguel Guelfand (clinical) [Ep 6 · 8:01](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=481)
- "In a study by Amy Wegner comparing omphalocele and gastroschisis, gastroschisis had higher risk of adhesive bowel obstruction, but omphalocele had higher risk of midgut volvulus." (clinical) [Ep 6 · 9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "Patients with omphalocele have non-rotation or malrotation and will not have the same adhesions as gastroschisis patients." (clinical) [Ep 6 · 9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556)
- "If the surgical technique for omphalocele closure involves exposing the intestines, it may be worth considering a Ladd procedure, but not worth going through the sac if the technique maintains the sac." (opinion) [Ep 6 · 10:31](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631)
- "During diaphragmatic hernia repair, the key move to decrease volvulus risk is to unroll the cecum and proximal bowel if they are rolled together like a scroll, ensuring small bowel is to the right, colon to the left, and anterior surface of mesentery is exposed." (clinical) [Ep 6 · 13:10](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=790)
- "Non-rotation does not exclude the possibility of having anatomy with a narrow base of mesentery and the two ends being fairly close together, creating volvulus risk." (clinical) [Ep 6 · 14:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=873)
- "In gastroschisis, the liver is not expected to be herniated outside the abdomen." (clinical) [Ep 6 · 17:52](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1072)
- "For massive abdominal wall defects where there is no amnion and nothing to sew, Miguel Gilfoid uses a prolene mesh that stays in place until closure can be achieved, protecting it with a plastic bag around the bowel." — Miguel Guelfand (clinical) [Ep 6 · 19:10](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1150)
- "With giant abdominal wall defects, when a spring-loaded (tech) silo is placed and pushed down, the forces go outward and can actually make the defect much bigger over time." (clinical) [Ep 6 · 20:24](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1224)
- "Biologic mesh can be used as a scaffold that sticks to the bowel and allows skin to epithelialize over massive defects." (clinical) [Ep 6 · 21:23](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1283)
- "Miguel Gilfoid reports that 80% of massive gastroschisis cases can be closed within two to three months using prolene mesh that remains in place for months." — Miguel Guelfand (clinical) [Ep 6 · 23:21](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401)
- "Tissue expanders placed inside the belly without any domain would push all contents up and out rather than creating useful space, according to plastic surgery colleagues." (host_summary) [Ep 6 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "Component separation technique involves separating tissue at the external oblique about a centimeter beyond the rectus sheath bilaterally, then dissecting between external oblique and the transversus/internal oblique, which creates substantial room for closure." (clinical) [Ep 6 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "An incision on top of the anterior rectus sheath can provide another centimeter of advancement during component separation." (clinical) [Ep 6 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "A group from UT Houston (Cogen, Rich, and Recy) reported using component separation in nine children aged 7 days to 10 years, majority with omphalocele and giant defects, achieving fascial closure in almost every case, with some requiring mesh to bridge defects." (host_summary) [Ep 6 · 26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593)
- "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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 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 8 · 8:43](https://library.globalcastmd.com/watch/omphalocele-and-gastroschisis-with-dr-foong-yen-lim-5006?t=523)
- "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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 3:27](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=207)
- "Nearly 60% of gastroschisis infants are premature." — Fung Lim (epidemiological) [Ep 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 8:38](https://library.globalcastmd.com/watch/omphalocele-gastroschisis-5255?t=518)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 36:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-update-course-2013-1059?t=2218)

## Changelog
- Sep 8: 1 item no longer name omphalocele
- Sep 7: 11 items added automatically

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