# Umbilical Hernia — GCMD Library living collection

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

Updated: n/a · 3 episodes · 68 cited statements

## Episodes
### Evidence & Research
- [Sutureless Closure of Gastroschisis - APSA Practice Gaps 2019](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302) — video · 21:04 · [machine version](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302.md)
- [Gastroschisis and sutureless abdominal wall closure](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557) — podcast · 12:17 · [machine version](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557.md)

### In-Depth Reviews
- [Umbilical Cord Defects with Dr. Kenneth Azarow](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298) — podcast · 30:16 · [machine version](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=0) Introduction and podcast overview (Ep 2)
- [1:02](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=62) Timing of umbilical hernia repair in young children (Ep 2)
- [5:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=313) Incarcerated umbilical hernias and emergency presentations (Ep 2)
- [7:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=439) Technical aspects of umbilical hernia repair (Ep 2)
- [11:51](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=711) Umbilical hernias associated with gastroschisis and omphalocele (Ep 2)
- [16:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=991) Umbilical drainage and granulomas in infants (Ep 2)
- [20:04](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1204) Surgical technique for urachal remnants (Ep 2)
- [23:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1436) Infected urachal cysts and abscess management (Ep 2)
- [26:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1572) Patent omphalomesenteric duct with stool drainage (Ep 2)
- [27:52](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1672) Epigastric hernias (epiploceles) and closing remarks (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=0) Case presentation and audience polling on gastroschisis closure techniques (Ep 1)
- [2:27](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147) Origin and evidence for sutureless gastroschisis repair (Ep 1)
- [6:19](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379) Practice variation, feeding protocols, and patient selection bias (Ep 1)
- [10:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=640) Anesthesia considerations and the minimally invasive surgery concept (Ep 1)
- [15:06](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906) Standardized protocols, complicated gastroschisis, and role of bowel peel (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=0) Introduction and Historical Context of Sutureless Closure (Ep 3)
- [2:45](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=165) Evolution to Consortium Study (Ep 3)
- [5:29](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=329) Study Design and Primary Outcomes (Ep 3)
- [7:59](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=479) Interpretation of Findings and Future Directions (Ep 3)
- [10:19](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=619) Clinical Implications and Closing Thoughts (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The sutureless gastroschisis closure technique originated when Tony Sandler at Iowa covered a large defect with umbilical cord and tachyderm, intending to return later, but found the wound had closed spontaneously." — Salim (clinical) [Ep 1 · 2:27](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=147)
- "Sandler's first series of sutureless closures included about 10 patients and reported that they did not need to go to the OR and closed on their own." — Salim (clinical) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=270)
- "Multiple retrospective studies reported that sutureless repair patients eat quicker, go home faster, and are probably cheaper to manage." — Salim (host_summary) [Ep 1 · 4:50](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=290)
- "A randomized study by Brisoni et al. published in the Journal of the American College of Surgeons found that sutureless repair patients took longer to eat and had longer hospital length of stay." — Salim (host_summary) [Ep 1 · 5:10](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=310)
- "A subsequent 98-patient study from UCSF showed a benefit for sutureless repair in terms of time to feeding and length of stay, conflicting with the Brisoni randomized trial." — Salim (host_summary) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=340)
- "The old adage that you must close the fascia for all gastroschisis babies is probably not true; some version of skin closure is adequate." — Salim (opinion) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Data over five years shows that about 13% of sutureless repair patients will need an umbilical hernia repair, which is higher than babies who got fascial repair." — Salim (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=360)
- "Robert Baird's paper from McGill showed everything was better about tape closure, including a lower umbilical hernia rate, which was surprising." — Todd (host_summary) [Ep 1 · 6:19](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=379)
- "Fear of feeding after sutureless closure—hesitation to feed because of concern about distension and evisceration—may be driving longer length of stay." — Todd (opinion) [Ep 1 · 7:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=440)
- "A feeding protocol was instituted at the speaker's NICU: if residual output is less than 20 per kilo, it comes out; if tolerating, advance by 20 per kilo each day." — Todd (clinical) [Ep 1 · 7:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=450)
- "In prospective trials, natural selection bias may occur if easier cases are chosen for sutureless closure, leading to better outcomes independent of technique." — Salim (opinion) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=478)
- "The UCSF study with 98 patients published in JAMA Surgery found a 13% rate of umbilical hernia repair over five years of follow-up in sutureless closure patients." — Salim (host_summary) [Ep 1 · 9:45](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=585)
- "Studies have shown that when fascial closure is attempted without a silo (immediate repair), those patients tend to have a higher incidence of umbilical or ventral hernias requiring repair." — Salim (host_summary) [Ep 1 · 10:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=620)
- "Every single general anesthetic agent in every class (volatile gas, IV, ketamine, NMDA receptor blockers) has been shown in rat, mice, and sheep studies to cause increased apoptosis and pervasive developmental issues." — Salim (host_summary) [Ep 1 · 11:47](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=707)
- "The GAS trial and PANDA study in humans showed no difference in neurodevelopmental outcome at five years in babies randomized to spinal versus general anesthesia." — Salim (host_summary) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=750)
- "The heterogeneity of the gastroschisis population—some cases are easy (one or two loops, little Tylenol) while others are complicated (need silo, OR)—makes a huge difference in results and biases non-randomized trials." — Mac (opinion) [Ep 1 · 12:54](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=774)
- "Tony Sandler no longer uses the umbilical cord for sutureless closure; it is not as important as once thought and just sits there." — Salim (host_summary) [Ep 1 · 15:06](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=906)
- "Some surgeons put a silo on, reduce with the silo, and then apply tape, so inability to immediately reduce does not preclude sutureless closure." — Salim (clinical) [Ep 1 · 15:30](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=930)
- "At UCLA's UC fetal consortium, all gastroschisis cases are attempted without general anesthesia, without intubation, and with minimal narcotics, using standardized antibiotic and feeding protocols." (clinical) [Ep 1 · 16:02](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=962)
- "The UCLA consortium found that length of stay did not decrease with the standardized protocol, but use of antibiotics, intubation days, and opioid use significantly decreased." (clinical) [Ep 1 · 16:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "At UCLA, one surgeon was able to open the defect, reduce everything, and still do a skin or sutureless closure with great outcomes." (clinical) [Ep 1 · 16:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1000)
- "Complicated gastroschisis cases (atresia, perforation) are excluded from the UCLA sutureless closure pathway." (clinical) [Ep 1 · 16:51](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1011)
- "The gastroschisis prognostic score (GPS), which assigned a score based on degree of peel, bowel distension, and matting, did not prove useful in predicting outcomes." — Salim (clinical) [Ep 1 · 17:33](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1053)
- "If a gastroschisis case has a very thick peel, very distended bowel, and lots of bowel loops out, immediate closure should not be considered; a silo should be used for reduction." — Salim (opinion) [Ep 1 · 18:40](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1120)
- "At the end of silo reduction, a sutureless repair can be performed; immediate closure is not required." — Salim (clinical) [Ep 1 · 19:20](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1160)
- "There is no real big need for fascial closure, no matter the size of the gastroschisis defect; skin closure alone is probably adequate." — Salim (opinion) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1200)
- "Matted bowel does not play into the decision for sutureless closure; if it cannot be immediately reduced, a silo is used, and sutureless repair can be done after reduction." — Todd (clinical) [Ep 1 · 20:31](https://library.globalcastmd.com/watch/sutureless-closure-of-gastroschisis-apsa-practice-gaps-2019-2302?t=1231)
- "In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself." — Rod Gerardo (host_summary) [Ep 3 · 1:44](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=104)
- "The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less antibiotic use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Sutureless closure patients had less ventilator use compared to sutured closure patients." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "The positive outcomes for sutureless repair were observed even when considering patients who required silo use." — Rod Gerardo (host_summary) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=361)
- "Due to the heterogeneity of gastroschisis, patients able to undergo primary repair probably had more favorable bowel and theoretically would have less hospital stay and feed faster." — Jason Frischer (opinion) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "Many patients who underwent sutureless repair were done in more recent cohorts and tended towards less interventions." — Jason Frischer (opinion) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=440)
- "In sutured repair, mobilizing flaps from the skin and fascia causes redness and bruising around the incision, which puts patients at higher risk for potential infection." — Jason Frischer (clinical) [Ep 3 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The finding of increased antibiotics needed after sutured repair was expected due to tissue manipulation." — Jason Frischer (opinion) [Ep 3 · 8:05](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=485)
- "The next phase of the study is examining the same patients over several years of follow-up to assess growth and umbilical hernia repair rates." — Jason Frischer (clinical) [Ep 3 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Initial small studies showed that some sutureless patients had a high umbilical hernia repair rate, or at least a high umbilical hernia rate." — Jason Frischer (host_summary) [Ep 3 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "The consortium is working on operationalizing protocolization of gastroschisis closure across member institutions for a more prospective study with long-term follow-up." — Jason Frischer (clinical) [Ep 3 · 8:50](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=530)
- "Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure." — Rod Gerardo (host_summary) [Ep 3 · 11:22](https://library.globalcastmd.com/watch/gastroschisis-and-sutureless-abdominal-wall-closure-3557?t=682)
- "Most umbilical hernias will close spontaneously in the first year and some in the second year." — Kenneth Azarow (clinical) [Ep 2 · 2:58](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=178)
- "Age 2 is the earliest Dr. Azarow would consider umbilical hernia repair, and only after extensive counseling; optimal timing is before school entry (age 4–5)." — Kenneth Azarow (opinion) [Ep 2 · 3:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=185)
- "A long proboscis does not affect the decision to operate early on an umbilical hernia." — Kenneth Azarow (opinion) [Ep 2 · 3:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=227)
- "Larger umbilical defects (>1 cm) are less likely to close spontaneously, but this does not justify early surgery." — Kenneth Azarow (clinical) [Ep 2 · 4:12](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=252)
- "Race or ethnicity of the child does not affect the decision on timing of umbilical hernia repair." — Kenneth Azarow (opinion) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=280)
- "Emerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair." — Todd Ponsky (host_summary) [Ep 2 · 4:54](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=294)
- "True incarcerated umbilical hernias requiring emergency surgery must present with bowel obstruction symptoms (vomiting, inability to feed)." — Kenneth Azarow (clinical) [Ep 2 · 5:38](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=338)
- "Red, tender umbilical lumps in children are usually incarcerated omentum, preperitoneal fat, or infected urachal cysts—not incarcerated bowel." — Kenneth Azarow (clinical) [Ep 2 · 5:49](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=349)
- "Incarcerated omentum or fat at the umbilicus can be treated with NSAIDs; infected urachal cysts with antibiotics." — Kenneth Azarow (clinical) [Ep 2 · 6:09](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=369)
- "Dr. Azarow cannot recall ever performing emergency surgery for an incarcerated umbilical hernia." — Kenneth Azarow (opinion) [Ep 2 · 6:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=379)
- "LMA anesthesia can be used for umbilical hernia repair if adequate abdominal wall relaxation is achieved, but this is anesthesiologist-dependent." — Kenneth Azarow (clinical) [Ep 2 · 7:47](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=467)
- "PDS or Maxon suture is preferred for umbilical hernia repair because it lasts twice as long as Vicryl and is non-braided (lower infection risk in semi-contaminated field)." — Kenneth Azarow (clinical) [Ep 2 · 8:26](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=506)
- "Dr. Azarow uses prophylactic antibiotics for umbilical hernia repair but acknowledges this is anecdotal practice." — Kenneth Azarow (opinion) [Ep 2 · 8:51](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=531)
- "Umbilicoplasty (excision of redundant skin) should be performed during umbilical hernia repair to achieve a flat, cosmetically acceptable result." — Kenneth Azarow (opinion) [Ep 2 · 10:19](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=619)
- "Umbilicoplasty technique involves creating a pedicled skin flap with blood supply from above or below, avoiding complete circumferential incision." — Kenneth Azarow (clinical) [Ep 2 · 10:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=637)
- "Tacking the undersurface of umbilical skin to the fascia with braided suture (Vicryl) promotes inflammatory adhesion and prevents recurrent proboscis." — Kenneth Azarow (clinical) [Ep 2 · 11:42](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=702)
- "A pressure dressing should remain in place for 3 days after umbilical hernia repair." — Kenneth Azarow (clinical) [Ep 2 · 12:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=742)
- "Gastroschisis is actually an umbilical ring defect, not a paraumbilical defect, because the natural history is for the hole to close spontaneously (which only occurs at the umbilical ring)." — Kenneth Azarow (clinical) [Ep 2 · 12:37](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=757)
- "Over half of gastroschisis patients closed with sutureless technique develop large umbilical hernias, but most close spontaneously over 2–3 years." — Kenneth Azarow (clinical) [Ep 2 · 13:24](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=804)
- "A Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure." — Todd Ponsky (host_summary) [Ep 2 · 13:45](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=825)
- "Suturing the gastroschisis defect makes the umbilical ring edge ischemic and destroys its integrity, leading to hernias that won't close spontaneously." — Kenneth Azarow (clinical) [Ep 2 · 14:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=853)
- "Omphalocele repair should be delayed as long as possible to allow abdominal domain expansion; operating too early is a mistake." — Kenneth Azarow (opinion) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=900)
- "Parents should watch for the child's flanks bulging when lying flat—this indicates the abdominal girth is expanding and primary closure may be achievable." — Kenneth Azarow (clinical) [Ep 2 · 15:34](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=934)
- "If mesh placement seems inevitable for omphalocele, wait longer—many can be primarily closed if given sufficient time." — Kenneth Azarow (opinion) [Ep 2 · 15:13](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=913)
- "For large umbilical hernias in older teenagers, laparoscopic repair with mesh can be considered if primary closure seems unlikely." — Kenneth Azarow (clinical) [Ep 2 · 16:48](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1008)
- "A 5 mm umbilical defect very rarely causes intestinal incarceration; small pieces of fat may get caught and cause discomfort." — Kenneth Azarow (clinical) [Ep 2 · 17:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1043)
- "Repair of small asymptomatic umbilical hernias is not absolutely indicated and can be watched indefinitely if the child has no symptoms." — Kenneth Azarow (opinion) [Ep 2 · 17:17](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1037)
- "A Nebraska study showed that operating on umbilical drainage in the first 3 months increases complication rates; many resolve spontaneously by 6 months." — Kenneth Azarow (epidemiological) [Ep 2 · 19:17](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1157)
- "Infants with tiny drops of clear or whitish umbilical drainage should be watched for 6 months before considering surgery." — Kenneth Azarow (opinion) [Ep 2 · 19:08](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1148)
- "Dr. Azarow has stopped operating in the first 6 months for minor umbilical drainage or granulomas." — Kenneth Azarow (opinion) [Ep 2 · 19:29](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1169)
- "Umbilical granulomas can be treated with silver nitrate application; many resolve without surgery." — Kenneth Azarow (clinical) [Ep 2 · 20:59](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1259)
- "Office ligation of umbilical granulomas is not recommended unless the stalk is very narrow; they often don't fall off easily." — Kenneth Azarow (opinion) [Ep 2 · 21:11](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1271)
- "A prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early." — Todd Ponsky (epidemiological) [Ep 2 · 21:33](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1293)
- "Steroid cream works better than silver nitrate for granulation tissue at gastrostomy sites, so the same principle applies to umbilical granulomas." — Kenneth Azarow (clinical) [Ep 2 · 21:49](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1309)
- "For persistent umbilical drainage at 6–12 months, perform umbilical exploration through a hernia repair incision, divide the fascia inferiorly to visualize the urachal track, and bluntly dissect to the bladder dome." — Kenneth Azarow (clinical) [Ep 2 · 22:10](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1330)
- "The distal epithelialized portion of the urachal remnant must be excised from the umbilical skin, taking care not to devascularize the umbilicus." — Kenneth Azarow (clinical) [Ep 2 · 22:32](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1352)
- "A Nebraska study found no VCUG or ultrasound findings that changed management of urachal remnants, so Dr. Azarow does not perform preoperative imaging." — Kenneth Azarow (epidemiological) [Ep 2 · 24:05](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1445)
- "Infected urachal cysts can usually be treated with antibiotics alone; true abscesses require percutaneous drainage by interventional radiology." — Kenneth Azarow (clinical) [Ep 2 · 24:52](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1492)
- "After cooling down an infected urachal cyst, the entire congenital remnant should be excised electively to prevent recurrent abscess." — Kenneth Azarow (clinical) [Ep 2 · 25:01](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1501)
- "Elective urachal remnant excision is performed laparoscopically with a supraumbilical port and a 12 mm lateral port for stapling across the bladder dome." — Kenneth Azarow (clinical) [Ep 2 · 25:31](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1531)
- "Patent omphalomesenteric duct with stool draining from the umbilicus will not close spontaneously and requires surgery before hospital discharge." — Kenneth Azarow (clinical) [Ep 2 · 26:23](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1583)
- "Patent omphalomesenteric duct poses risk of volvulus from small bowel wrapping around the fistula tract." — Kenneth Azarow (clinical) [Ep 2 · 26:36](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1596)
- "Patent omphalomesenteric duct is approached through umbilical exploration; laparoscopy can assist if bowel is already twisted around the tract." — Kenneth Azarow (clinical) [Ep 2 · 26:56](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1616)
- "Epigastric hernias (epiploceles) are purely elective and should only be repaired if causing discomfort; they are preperitoneal fat through a pinhole defect, not true hernias." — Kenneth Azarow (clinical) [Ep 2 · 28:06](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1686)
- "The fascial defect in epigastric hernias is typically only 1 millimeter in diameter." — Kenneth Azarow (clinical) [Ep 2 · 28:46](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1726)
- "Analysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years." — Todd Ponsky (epidemiological) [Ep 2 · 29:22](https://library.globalcastmd.com/watch/umbilical-cord-defects-with-dr-kenneth-azarow-298?t=1762)

## Changelog
- Sep 7: 3 items added automatically

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