# Gastroschisis - Clinical Practice Updates — GCMD Library

This clip from the 2020 Pediatric Surgery Update Course features, Miguel Guelfand, MD; Shawn St. Peter, MD; and Saleem Islam, MD; presenting challenging cases for review by our panelists.

Highlighted Topics Include:
- Omphalocele
- Pulmanary hypertension
- Ruptured omphalocele
- Biologic mesh interventions
- Gastroschisis interventions (non-matted bowel)
- Gastroschisis - Sutureless closure

Type: video · posted 2020-09-14 Canonical: https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996 ## Chapters - [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) Giant Omphalocele Physiology and Pulmonary Hypertension Risk - [5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) Sac-Preserving Active Reduction Technique - [10:31](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631) Ladd Procedure Debate for Omphalocele Closure - [15:48](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=948) Ruptured Giant Omphalocele Case Presentation - [23:21](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1401) Component Separation for Definitive Closure ## Statements - "Giant omphaloceles (5 cm or greater or liver in sac) have greater time to full feeds and require more TPN compared to routine omphaloceles" — Sean (clinical) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "Giant omphaloceles have greater risk of respiratory insufficiency and higher incidence of chromosomal anomalies" — Sean (clinical) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "56 of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within first week of life" — Sean (epidemiological) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "Five patients had no signs of pulmonary hypertension on first echo within first seven days but subsequently developed severe pulmonary hypertension, all associated with sepsis episodes" — Sean (clinical) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "Two of the five patients with delayed pulmonary hypertension died, and one required pulmonary vasodilator for more than a year" — Sean (clinical) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "One patient developed severe pulmonary hypertension 52 days after initial echo showed no pulmonary hypertension, triggered by single episode of sepsis" — Sean (clinical) [0:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=0) - "The sac-preserving hydrocolloid technique developed by Dr. Abello has been used in almost 40 patients over three years" — Miguel Gilfoyd (clinical) [5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) - "97% of patients treated with sac-preserving technique achieved closure within 30 days, and 92% within 15 days" — Miguel Gilfoyd (clinical) [5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) - "All patients treated with sac-preserving technique are kept in ICU, ventilated and completely paralyzed during reduction" — Miguel Gilfoyd (clinical) [5:00](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=300) - "The hydrocolloid dressing should be applied within first 24 hours before the sac becomes very stiff" — Miguel Gilfoyd (clinical) [6:47](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=407) - "Three patients with ruptured omphalocele sacs were sutured and then had hydrocolloid dressing applied successfully" — Miguel Gilfoyd (clinical) [7:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=457) - "Compressions can usually start within 48 hours if baby is stable" — Miguel Gilfoyd (clinical) [8:01](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=481) - "Risk of adhesive bowel obstruction is higher with gastroschisis, but risk of midgut volvulus is higher in patients with omphalocele" — Sean (clinical) [9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556) - "Patients with omphalocele have non-rotation or malrotation and will not have the same adhesions as gastroschisis" — Sean (clinical) [9:16](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=556) - "If closure technique involves exposing the intestines, Ladd procedure may be worthwhile; if sac is maintained, not worth going through sac" — Sean (opinion) [10:31](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=631) - "In diaphragmatic hernia repair, key move is to unroll bowel like a scroll to increase distance between ends of mesentery and decrease volvulus risk" — Todd (clinical) [13:10](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=790) - "Non-rotation does not exclude possibility of unfavorable anatomy with narrow base of mesentery and two ends close together" — Sean (clinical) [14:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=873) - "In gastroschisis, entire liver being out is not expected; when almost no abdominal domain exists, management becomes very challenging" — Saleem (clinical) [16:42](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1002) - "Spring-loaded tech silo on giant abdominal wall defect can make defect much bigger over time as forces go outward" — Todd (clinical) [20:24](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1224) - "Biologic mesh can be used as scaffold to allow skin epithelialization in giant defects" — Saleem (clinical) [21:23](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1283) - "Prolene mesh can stay in place for months without removal, with 80% of giant defects closable within 2-3 months" — Miguel Gilfoyd (clinical) [24:18](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1458) - "Tissue expanders placed subcutaneously can create redundant healthy skin, particularly important for cases initially treated with paint and wait" — Eric (clinical) [25:37](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1537) - "Component separation technique involves separating tissue at external oblique about 1 cm beyond rectus sheath on both sides, creating significant space" — Sean (clinical) [26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593) - "UT Houston group reported component separation use in 9 children aged 7 days to 10 years, achieving fascial closure in vast majority" — Sean (clinical) [26:33](https://library.globalcastmd.com/watch/gastroschisis-clinical-practice-updates-2996?t=1593) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai