Miguel Guelfand

272 statements · 15 topics · summaries given as host listed separately

Congenital Lung Lesions (CPAM) · guest expert

Featured statements

▶ Ep 5 · 45:17
there's nothing wrong. The thing is that I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed
quote · Abdominal Wall Defects: Omphalocele & Gastroschisis
▶ Ep 5 · 39:41
I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything
quote · Abdominal Wall Defects: Omphalocele & Gastroschisis
▶ Ep 6 · 42:20
we don't invert, we don't go to the inversion of the amnios until it's completely flat. Because we know it's going to be, we, it won't, it won't be good. You need to be completely flat and then you can go to the inversion of the ambulance
quote · Congenital Heart Disease
▶ Ep 6 · 12:44
The thing you don't want to get is that the amnios get dry, that obviously facilitates the reduction of the, of the, of the umfaloys for sure
quote · Congenital Heart Disease
▶ Ep 9 · 13:52
not always, not all the times, the umbilical cord is the apex, so you have to be careful
quote · Giant Omphalocele
▶ Ep 17 · 19:10
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.
clinical · Abdominal Wall Defects

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Miguel's statements about Abdominal Wall Defects 11 statements

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Gastroschisis - Clinical Practice Updates

▶ Ep 17 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 17 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 17 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 17 · 5:00
clinical 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. ↗
▶ Ep 17 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 17 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 17 · 6:47
clinical 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. ↗
▶ Ep 17 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 17 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 17 · 19:10
clinical 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. ↗
▶ Ep 17 · 23:21
clinical 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's statements about Abdominal Wall Defects: Omphalocele & Gastroschisis 49 statements

Open the Abdominal Wall Defects: Omphalocele & Gastroschisis collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 1 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 1 · 5:00
clinical 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. ↗
▶ Ep 1 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 1 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 1 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 1 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 1 · 6:47
clinical 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. ↗
▶ Ep 1 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 1 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 1 · 19:10
clinical 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. ↗
▶ Ep 1 · 23:21
clinical 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. ↗

EUPSA Webinar "GIANT OMPHALOCELE II"

▶ Ep 5 · 8:02
quote basically, anytime you touch the baby, he wanted to die ↗
▶ Ep 5 · 8:27
clinical The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago ↗
▶ Ep 5 · 8:52
quote This is a, for, for us it was a game changer in terms of how to manage this patient and the outcomes are, are really amazing compared with the other, you know, pain and weight on the surgical asylum ↗
▶ Ep 5 · 11:20
clinical In the series of 50 patients, 98% required only one surgery for closure ↗
▶ Ep 5 · 12:34
clinical The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction ↗
▶ Ep 5 · 12:44
quote The thing you don't want to get is that the amnios get dry, that obviously facilitates the reduction of the, of the, of the umfaloys for sure ↗
▶ Ep 5 · 13:00
clinical The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele ↗
▶ Ep 5 · 13:52
quote not always, not all the times, the umbilical cord is the apex, so you have to be careful ↗
▶ Ep 5 · 13:59
clinical Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele ↗
▶ Ep 5 · 14:53
clinical The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition ↗
▶ Ep 5 · 15:07
clinical In the first 2-3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4-5 years, the protocol changed to sedation only with paralysis used only during silo reduction ↗
▶ Ep 5 · 16:07
clinical Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure ↗
▶ Ep 5 · 16:48
clinical 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure ↗
▶ Ep 5 · 17:18
clinical In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days ↗
▶ Ep 5 · 17:50
clinical Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection ↗
▶ Ep 5 · 18:24
clinical There was no mortality related to the silo technique; four mortalities occurred related to other malformations ↗
▶ Ep 5 · 39:41
clinical Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction ↗
▶ Ep 5 · 39:41
quote I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything ↗
▶ Ep 5 · 40:46
quote When you're not progressing enough, we definitely paralyze completely the patient, and I, we talked to the, to the ICU page uh ICU doctor and said, you need to give me a week of full paralyzation because if not, we're going to be so ↗
▶ Ep 5 · 40:46
clinical When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction ↗
▶ Ep 5 · 41:29
clinical The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm ↗
▶ Ep 5 · 41:29
clinical The silo is changed every 4-5 weeks because it loses traction as it gets wet ↗
▶ Ep 5 · 42:14
clinical Patients are not fed during the reduction phase to avoid bowel distention ↗
▶ Ep 5 · 42:20
clinical Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated ↗
▶ Ep 5 · 42:20
quote we don't invert, we don't go to the inversion of the amnios until it's completely flat. Because we know it's going to be, we, it won't, it won't be good. You need to be completely flat and then you can go to the inversion of the ambulance ↗
▶ Ep 5 · 42:38
clinical A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia ↗
▶ Ep 5 · 43:51
clinical The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling ↗
▶ Ep 5 · 45:17
quote there's nothing wrong. The thing is that I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed ↗
▶ Ep 5 · 47:20
clinical The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed ↗
▶ Ep 5 · 47:20
quote this had to be very thoughtful talk with the, uh, NICU doctors. Uh, they hate to have those patients intubated for nothing. And they need to understand what is our, uh, what's our goal ↗
▶ Ep 5 · 48:12
clinical Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top ↗
▶ Ep 5 · 48:53
clinical For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed ↗
▶ Ep 5 · 50:11
clinical Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias ↗
▶ Ep 5 · 50:48
clinical The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients ↗
▶ Ep 5 · 52:24
clinical For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle ↗
▶ Ep 5 · 54:28
clinical Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension ↗
▶ Ep 5 · 58:49
clinical Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks ↗
▶ Ep 5 · 1:02:51
clinical Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases ↗
Miguel's statements about Congenital Heart Disease 38 statements

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EUPSA Webinar "GIANT OMPHALOCELE II"

▶ Ep 6 · 8:02
quote basically, anytime you touch the baby, he wanted to die ↗
▶ Ep 6 · 8:27
clinical The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago ↗
▶ Ep 6 · 8:52
quote This is a, for, for us it was a game changer in terms of how to manage this patient and the outcomes are, are really amazing compared with the other, you know, pain and weight on the surgical asylum ↗
▶ Ep 6 · 11:20
clinical In the series of 50 patients, 98% required only one surgery for closure ↗
▶ Ep 6 · 12:34
clinical The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction ↗
▶ Ep 6 · 12:44
quote The thing you don't want to get is that the amnios get dry, that obviously facilitates the reduction of the, of the, of the umfaloys for sure ↗
▶ Ep 6 · 13:00
clinical The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele ↗
▶ Ep 6 · 13:52
quote not always, not all the times, the umbilical cord is the apex, so you have to be careful ↗
▶ Ep 6 · 13:59
clinical Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele ↗
▶ Ep 6 · 14:53
clinical The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition ↗
▶ Ep 6 · 15:07
clinical In the first 2-3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4-5 years, the protocol changed to sedation only with paralysis used only during silo reduction ↗
▶ Ep 6 · 16:07
clinical Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure ↗
▶ Ep 6 · 16:48
clinical 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure ↗
▶ Ep 6 · 17:18
clinical In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days ↗
▶ Ep 6 · 17:50
clinical Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection ↗
▶ Ep 6 · 18:24
clinical There was no mortality related to the silo technique; four mortalities occurred related to other malformations ↗
▶ Ep 6 · 39:41
quote I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything ↗
▶ Ep 6 · 39:41
clinical Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction ↗
▶ Ep 6 · 40:46
quote When you're not progressing enough, we definitely paralyze completely the patient, and I, we talked to the, to the ICU page uh ICU doctor and said, you need to give me a week of full paralyzation because if not, we're going to be so ↗
▶ Ep 6 · 40:46
clinical When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction ↗
▶ Ep 6 · 41:29
clinical The silo is changed every 4-5 weeks because it loses traction as it gets wet ↗
▶ Ep 6 · 41:29
clinical The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm ↗
▶ Ep 6 · 42:14
clinical Patients are not fed during the reduction phase to avoid bowel distention ↗
▶ Ep 6 · 42:20
clinical Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated ↗
▶ Ep 6 · 42:20
quote we don't invert, we don't go to the inversion of the amnios until it's completely flat. Because we know it's going to be, we, it won't, it won't be good. You need to be completely flat and then you can go to the inversion of the ambulance ↗
▶ Ep 6 · 42:38
clinical A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia ↗
▶ Ep 6 · 43:51
clinical The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling ↗
▶ Ep 6 · 45:17
quote there's nothing wrong. The thing is that I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed ↗
▶ Ep 6 · 47:20
quote this had to be very thoughtful talk with the, uh, NICU doctors. Uh, they hate to have those patients intubated for nothing. And they need to understand what is our, uh, what's our goal ↗
▶ Ep 6 · 47:20
clinical The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed ↗
▶ Ep 6 · 48:12
clinical Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top ↗
▶ Ep 6 · 48:53
clinical For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed ↗
▶ Ep 6 · 50:11
clinical Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias ↗
▶ Ep 6 · 50:48
clinical The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients ↗
▶ Ep 6 · 52:24
clinical For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle ↗
▶ Ep 6 · 54:28
clinical Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension ↗
▶ Ep 6 · 58:49
clinical Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks ↗
▶ Ep 6 · 1:02:51
clinical Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases ↗
Miguel's statements about Congenital Lung Lesions (CPAM) 6 statements

Open the Congenital Lung Lesions (CPAM) collection →

Complications and Beyond

▶ Ep 22 · 30:22
clinical Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step ↗
▶ Ep 22 · 30:22
clinical Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step ↗
▶ Ep 22 · 37:57
clinical After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair ↗
▶ Ep 22 · 37:57
clinical After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair ↗
▶ Ep 22 · 53:00
clinical Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery ↗
▶ Ep 22 · 53:00
clinical Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery ↗
Miguel's statements about Congenital Pulmonary Airway Malformation 3 statements

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Complications and Beyond

▶ Ep 19 · 30:22
clinical Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step ↗
▶ Ep 19 · 37:57
clinical After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair ↗
▶ Ep 19 · 53:00
clinical Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery ↗
Miguel's statements about Congenital Pulmonary Airway Malformation 3 statements

Open the Congenital Pulmonary Airway Malformation collection →

Complications and Beyond

▶ Ep 19 · 30:22
clinical Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step ↗
▶ Ep 19 · 37:57
clinical After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair ↗
▶ Ep 19 · 53:00
clinical Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery ↗
Miguel's statements about Esophageal Atresia 6 statements

Open the Esophageal Atresia collection →

Complications and Beyond

▶ Ep 2 · 30:22
clinical Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step ↗
▶ Ep 2 · 37:57
clinical After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair ↗
▶ Ep 2 · 53:00
clinical Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery ↗

APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso

▶ Ep 31 · 5:45
quote This is a game, a, a, a change of the game, and absolutely, I agree with Dr. La Russo in terms of the results ↗
▶ Ep 31 · 6:00
quote definitely if a lot of people People are seeing that, uh, mainly young people, we need to stop using the transom the tube and start doing exactly what Doctor La Russo said to stop, uh, and reducing the stricture of the, our patients with esoattricia. ↗
▶ Ep 31 · 6:45
quote Sometime in the middle of the night, some of the tube can get dislodged and for any reason, a nice nurse, very helpful, replaced the, the, eh eh tube without our consent. So that's another risk involved with the using of transramic tube in Solatricia ↗
Miguel's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 11 statements

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Gastroschisis - Clinical Practice Updates

▶ Ep 23 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 23 · 5:00
clinical 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. ↗
▶ Ep 23 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 23 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 23 · 6:47
clinical 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. ↗
▶ Ep 23 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 23 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 23 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 23 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 23 · 19:10
clinical 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. ↗
▶ Ep 23 · 23:21
clinical 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's statements about Giant Omphalocele 11 statements

Open the Giant Omphalocele collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 3 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 3 · 5:00
clinical 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. ↗
▶ Ep 3 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 3 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 3 · 6:47
clinical 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. ↗
▶ Ep 3 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 3 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 3 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 3 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 3 · 19:10
clinical 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. ↗
▶ Ep 3 · 23:21
clinical 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's statements about Giant Omphalocele 49 statements

Open the Giant Omphalocele collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 3 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 3 · 5:00
clinical 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. ↗
▶ Ep 3 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 3 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 3 · 6:47
clinical 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. ↗
▶ Ep 3 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 3 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 3 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 3 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 3 · 19:10
clinical 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. ↗
▶ Ep 3 · 23:21
clinical 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. ↗

EUPSA Webinar "GIANT OMPHALOCELE II"

▶ Ep 9 · 8:02
quote basically, anytime you touch the baby, he wanted to die ↗
▶ Ep 9 · 8:27
clinical The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago ↗
▶ Ep 9 · 8:52
quote This is a, for, for us it was a game changer in terms of how to manage this patient and the outcomes are, are really amazing compared with the other, you know, pain and weight on the surgical asylum ↗
▶ Ep 9 · 11:20
clinical In the series of 50 patients, 98% required only one surgery for closure ↗
▶ Ep 9 · 12:34
clinical The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction ↗
▶ Ep 9 · 12:44
quote The thing you don't want to get is that the amnios get dry, that obviously facilitates the reduction of the, of the, of the umfaloys for sure ↗
▶ Ep 9 · 13:00
clinical The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele ↗
▶ Ep 9 · 13:52
quote not always, not all the times, the umbilical cord is the apex, so you have to be careful ↗
▶ Ep 9 · 13:59
clinical Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele ↗
▶ Ep 9 · 14:53
clinical The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition ↗
▶ Ep 9 · 15:07
clinical In the first 2-3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4-5 years, the protocol changed to sedation only with paralysis used only during silo reduction ↗
▶ Ep 9 · 16:07
clinical Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure ↗
▶ Ep 9 · 16:48
clinical 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure ↗
▶ Ep 9 · 17:18
clinical In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days ↗
▶ Ep 9 · 17:50
clinical Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection ↗
▶ Ep 9 · 18:24
clinical There was no mortality related to the silo technique; four mortalities occurred related to other malformations ↗
▶ Ep 9 · 39:41
quote I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything ↗
▶ Ep 9 · 39:41
clinical Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction ↗
▶ Ep 9 · 40:46
clinical When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction ↗
▶ Ep 9 · 40:46
quote When you're not progressing enough, we definitely paralyze completely the patient, and I, we talked to the, to the ICU page uh ICU doctor and said, you need to give me a week of full paralyzation because if not, we're going to be so ↗
▶ Ep 9 · 41:29
clinical The silo is changed every 4-5 weeks because it loses traction as it gets wet ↗
▶ Ep 9 · 41:29
clinical The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm ↗
▶ Ep 9 · 42:14
clinical Patients are not fed during the reduction phase to avoid bowel distention ↗
▶ Ep 9 · 42:20
quote we don't invert, we don't go to the inversion of the amnios until it's completely flat. Because we know it's going to be, we, it won't, it won't be good. You need to be completely flat and then you can go to the inversion of the ambulance ↗
▶ Ep 9 · 42:20
clinical Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated ↗
▶ Ep 9 · 42:38
clinical A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia ↗
▶ Ep 9 · 43:51
clinical The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling ↗
▶ Ep 9 · 45:17
quote there's nothing wrong. The thing is that I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed ↗
▶ Ep 9 · 47:20
clinical The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed ↗
▶ Ep 9 · 47:20
quote this had to be very thoughtful talk with the, uh, NICU doctors. Uh, they hate to have those patients intubated for nothing. And they need to understand what is our, uh, what's our goal ↗
▶ Ep 9 · 48:12
clinical Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top ↗
▶ Ep 9 · 48:53
clinical For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed ↗
▶ Ep 9 · 50:11
clinical Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias ↗
▶ Ep 9 · 50:48
clinical The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients ↗
▶ Ep 9 · 52:24
clinical For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle ↗
▶ Ep 9 · 54:28
clinical Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension ↗
▶ Ep 9 · 58:49
clinical Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks ↗
▶ Ep 9 · 1:02:51
clinical Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases ↗
Miguel's statements about Intestinal Rehab 11 statements

Open the Intestinal Rehab collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 32 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 32 · 5:00
clinical 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. ↗
▶ Ep 32 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 32 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 32 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 32 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 32 · 6:47
clinical 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. ↗
▶ Ep 32 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 32 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 32 · 19:10
clinical 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. ↗
▶ Ep 32 · 23:21
clinical 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's statements about Neonatal & Pediatric Minimally Invasive Surgery 49 statements

Open the Neonatal & Pediatric Minimally Invasive Surgery collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 2 · 5:00
clinical 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. ↗
▶ Ep 2 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 2 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 2 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 2 · 6:47
clinical 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. ↗
▶ Ep 2 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 2 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 2 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 2 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 2 · 19:10
clinical 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. ↗
▶ Ep 2 · 23:21
clinical 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. ↗

EUPSA Webinar "GIANT OMPHALOCELE II"

▶ Ep 31 · 8:02
quote basically, anytime you touch the baby, he wanted to die ↗
▶ Ep 31 · 8:27
clinical The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago ↗
▶ Ep 31 · 8:52
quote This is a, for, for us it was a game changer in terms of how to manage this patient and the outcomes are, are really amazing compared with the other, you know, pain and weight on the surgical asylum ↗
▶ Ep 31 · 11:20
clinical In the series of 50 patients, 98% required only one surgery for closure ↗
▶ Ep 31 · 12:34
clinical The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction ↗
▶ Ep 31 · 12:44
quote The thing you don't want to get is that the amnios get dry, that obviously facilitates the reduction of the, of the, of the umfaloys for sure ↗
▶ Ep 31 · 13:00
clinical The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele ↗
▶ Ep 31 · 13:52
quote not always, not all the times, the umbilical cord is the apex, so you have to be careful ↗
▶ Ep 31 · 13:59
clinical Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele ↗
▶ Ep 31 · 14:53
clinical The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition ↗
▶ Ep 31 · 15:07
clinical In the first 2-3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4-5 years, the protocol changed to sedation only with paralysis used only during silo reduction ↗
▶ Ep 31 · 16:07
clinical Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure ↗
▶ Ep 31 · 16:48
clinical 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure ↗
▶ Ep 31 · 17:18
clinical In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days ↗
▶ Ep 31 · 17:50
clinical Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection ↗
▶ Ep 31 · 18:24
clinical There was no mortality related to the silo technique; four mortalities occurred related to other malformations ↗
▶ Ep 31 · 39:41
quote I personally, I don't measure uh intraabdominal pressure directly. I, I believe in clinical signs better than nothing because if the pressure, the, you know, is 20 and the baby is doing perfectly well, everybody's happy, but the pressure is 3 and the baby is doing poorly, so we'll change everything ↗
▶ Ep 31 · 39:41
clinical Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction ↗
▶ Ep 31 · 40:46
quote When you're not progressing enough, we definitely paralyze completely the patient, and I, we talked to the, to the ICU page uh ICU doctor and said, you need to give me a week of full paralyzation because if not, we're going to be so ↗
▶ Ep 31 · 40:46
clinical When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction ↗
▶ Ep 31 · 41:29
clinical The silo is changed every 4-5 weeks because it loses traction as it gets wet ↗
▶ Ep 31 · 41:29
clinical The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm ↗
▶ Ep 31 · 42:14
clinical Patients are not fed during the reduction phase to avoid bowel distention ↗
▶ Ep 31 · 42:20
quote we don't invert, we don't go to the inversion of the amnios until it's completely flat. Because we know it's going to be, we, it won't, it won't be good. You need to be completely flat and then you can go to the inversion of the ambulance ↗
▶ Ep 31 · 42:20
clinical Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated ↗
▶ Ep 31 · 42:38
clinical A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia ↗
▶ Ep 31 · 43:51
clinical The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling ↗
▶ Ep 31 · 45:17
quote there's nothing wrong. The thing is that I don't like to have a patient for, for, for 1 month or 2 months in the hospital, send it home with a high giant ventral hernia, and then come back in 12 to 16 months to have the surgery if I can do everything in majority of the patient in 1 month and send it home with every, everything just fixed ↗
▶ Ep 31 · 47:20
quote this had to be very thoughtful talk with the, uh, NICU doctors. Uh, they hate to have those patients intubated for nothing. And they need to understand what is our, uh, what's our goal ↗
▶ Ep 31 · 47:20
clinical The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed ↗
▶ Ep 31 · 48:12
clinical Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top ↗
▶ Ep 31 · 48:53
clinical For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed ↗
▶ Ep 31 · 50:11
clinical Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias ↗
▶ Ep 31 · 50:48
clinical The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients ↗
▶ Ep 31 · 52:24
clinical For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle ↗
▶ Ep 31 · 54:28
clinical Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension ↗
▶ Ep 31 · 58:49
clinical Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks ↗
▶ Ep 31 · 1:02:51
clinical Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases ↗
Miguel's statements about Omphalocele 11 statements

Open the Omphalocele collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 8 · 5:00
clinical 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. ↗
▶ Ep 8 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 8 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 8 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 8 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 8 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 8 · 6:47
clinical 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. ↗
▶ Ep 8 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 8 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 8 · 19:10
clinical 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. ↗
▶ Ep 8 · 23:21
clinical 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's statements about Omphalocele 11 statements

Open the Omphalocele collection →

Gastroschisis - Clinical Practice Updates

▶ Ep 7 · 5:00
clinical All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process. ↗
▶ Ep 7 · 5:00
clinical 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. ↗
▶ Ep 7 · 5:00
clinical Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days. ↗
▶ Ep 7 · 5:00
quote the thing that that the initial picture is a a bill in this case was a little bigger than the initial that you showed but this is this is a um a technique developed by Dr. Abello from Colombia that we uh start doing that about three years ago and together we have treated almost 40 patients already and it's a very easy and very smooth technique. ↗
▶ Ep 7 · 6:47
quote you just put this, I mean, hours after the baby is born. Yeah. Uh you don't paint it at all. Uh actually you have to put it over hopefully within the first 24 hours so the sack doesn't get, you know, very stiff. Uh and the hydrocoloid get the the the sack very very smooth, very hydrate. ↗
▶ Ep 7 · 6:47
clinical Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully. ↗
▶ Ep 7 · 6:47
clinical 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. ↗
▶ Ep 7 · 8:01
quote I I I I I didn't say doesn't work, but it gets stiffer. So, the beauty of this that you I mean, the baby has to be stable to start doing the compressions, but usually you can you can start within 48 hours. ↗
▶ Ep 7 · 8:01
clinical Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable. ↗
▶ Ep 7 · 19:10
clinical 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. ↗
▶ Ep 7 · 23:21
clinical 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's statements about Tracheoesophageal Fistula 3 statements

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APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso

▶ Ep 21 · 5:45
quote This is a game, a, a, a change of the game, and absolutely, I agree with Dr. La Russo in terms of the results ↗
▶ Ep 21 · 6:00
quote definitely if a lot of people People are seeing that, uh, mainly young people, we need to stop using the transom the tube and start doing exactly what Doctor La Russo said to stop, uh, and reducing the stricture of the, our patients with esoattricia. ↗
▶ Ep 21 · 6:45
quote Sometime in the middle of the night, some of the tube can get dislodged and for any reason, a nice nurse, very helpful, replaced the, the, eh eh tube without our consent. So that's another risk involved with the using of transramic tube in Solatricia ↗

Summaries Miguel gave as host · 2 summaries

Recaps of other experts' statements, not Miguel's own clinical position.

Summaries Miguel gave as host · Esophageal Atresia 1 summary

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APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso

▶ Ep 31 · 5:30
host summary Miguel Guelfand summarizes what Dr. Catherine LaRusso said: a long time ago, a surgeon told me not because we're using something or doing something for 30 years means it's a good thing to do. ↗
Summaries Miguel gave as host · Tracheoesophageal Fistula 1 summary

Open the Tracheoesophageal Fistula collection →

APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso

▶ Ep 21 · 5:30
host summary Miguel Guelfand summarizes what Dr. Catherine LaRusso said: a long time ago, a surgeon told me not because we're using something or doing something for 30 years means it's a good thing to do. ↗