Collection
Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
Also covers: gastroschisis · necrotizing enterocolitis · malrotation · omphalocele · Hirschsprung disease · intestinal atresia · midgut volvulus · umbilical hernia
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school. — Rebecca Brown, Umbilical Disorders with Dr. Rebeccah Brown · 6:43
Pyloric Stenosis
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Dr. Bhargava Mullapudi, Pediatric Surgeon at Cincinnati Children’s, and Dr. Gillian Goddard, Pediatric Surgery Research Fellow at Cincinnati Children's, joins Dr. Rae Hanke to review the essentials of pyloric stenosis in this videocast.Pylo
video12:30 · May 2020
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
video14:33 · Dec 2021
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
podcast14:33 · Dec 2021
Omphalocele & Gastroschisis
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Abdominal wall defects like omphalocele and gastroschisis can lead to potentially complex postnatal care which is why today we are going to discuss some key knowledge points from Dr. Foong-Yen Lim: pediatric surgeon at Cincinnati Children’s
video9:32 · Mar 2022
Malrotation with Dr. Meera Kotagal
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In this podcast, we cover the basics of malrotation including embryology, presentation, differentiation, diagnosis, surgical approach, and post operative management with Dr. Meera Kotagal.
Host: Em Tombash
Animations to understand the
podcast13:25 · May 2023
Umbilical Disorders with Dr. Rebeccah Brown
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In this podcast, we explore the conditions, and treatment strategies related to umbilical disorders in newborns and young children with Dr. Rebeccah Brown from Cincinnati Children's.
From umbilical coard anatomy and infections like ompha
podcast11:27 · Jan 2025
Bringing stomas out side-by-side in the incision (rather than separated) facilitates easier takedown without disturbing the entire abdominal cavity. Necrotizing Enterocolitis · 27:00
Necrotizing Enterocolitis
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Dr. Jose Prince discusses necrotizing enterocolitis. His presentation includes management techniques of peritoneal drainage, exploratory laparotomy, diagnostic laparoscopy, complete enterectomy, silo, bowel decompression, and antibiotics as
video35:06 · Nov 2018
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1
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We're back with a new episode from the Intestinal Rehabilitation Center at Cincinnati Children's Hospital. This time we're talking about the management of overwhelming intestinal damage in conditions such as necrotizing enterocolitis and vo
podcast13:27 · Feb 2022
Cincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families. — Beth Rymeski, Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee · 16:58
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
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In this session we discuss protocols for feeding gastroschisis patients with Drs. Jason Fraser, Beth Rymeski, and Steven Lee.
Articles discussed:
Minimizing Variance in Gastroschisis Management Leads to Earlier Full Feeds in Delayed C
video21:09 · Sep 2022
Surgical management of gastroschisis focuses on safe viscera reduction, identifying and treating associated defects (atresia, perforation), closure of the defect, early recognition of complications, and nutritional support. — Joyce, Gastroschisis: Advanced Practice Providers · 7:47
Sutureless Gastroschisis Repair: Technique
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This video demonstrates the technique of the sutureless plastic closure for gastroschisis. This can be performed at the bedside in the NICU without a trip to the operating room. This was originally described by Bianchi and then modified by
video · Jan 2019
Gastroschisis: Advanced Practice Providers
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Joyce Slusher, MSN, CNP, presents on perioperative management of gastroschisis for advanced practice providers.
video43:21 · Jan 2019
Staged Closure of Gastroschisis with Spring-loaded Silo
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video27:11 · Feb 2020
Sutureless Closure of Gastroschisis - APSA Practice Gaps 2019
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At the 7th Annual Pediatric Surgery Update Course, Dr. Saleem Islam discusses sutureless closure of gastroschisis, one of the 2019 practice gaps identified by the American Pediatric Surgical Association’s Professional Development Committee.
video21:04 · Mar 2020
Duodeno-duodenostomy for Duodenal Atresia
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In this video, duodeno-dudenostomy diamond anastomsis for duodenal atresia is demonstrated. The patient is a 2 day old boy that is presented with greenish vomiting since birth. Exploration revealed complete duodenal atresia type three and m
video7:04 · Jun 2021
Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients
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Anna-Maria Ziegler, Daniel Svoboda, Britta Lüken-Darius, Andreas Heydweiller, Fritz Kahl, Sophie Christine Falk, Udo Rolle, Till-Martin Theilen
Purpose: Abdominal wall closure in patients with giant omphalocele (GOC) and complicated gast
video0:56 · Nov 2024
Malrotation Infant
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Surgical technique video demonstrating laparoscopic Ladd procedure in an infant with malrotation presenting with bilious vomiting. Shows systematic division of Ladd bands, duodenal mobilization, bowel derotation, and appendectomy using 3mm
video9:22 · May 2026
Update Course Rewind 2025: Updates in NEC Management
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Narrated by Lizzy Lee, PA-C & Maggie Koenig, this podcast, a rewind from the 2025 Pediatric Surgery Update Course, delves into crucial updates in Necrotizing Enterocolitis (NEC) management. Leading pediatric surgeons Drs. Augusto Zani, Simo
video11:03 · Jul 2026
Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures
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Rach Mena, Gabriela Guillén, Sergio Lopez-Fernandez, Marta Martos Rodríguez, César W Ruiz, Alicia Montaner-Ramon, Manuel López, José A Molino
Background: Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neona
video0:50 · Jan 2025
Current ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma. — Todd Ponsky, Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS · 19:40
91% Decrease in Mortality with Gastroschisis Bundle!
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By adopting a gastroschisis bundle protocol, a group from Hospital Infantil de México Federico Gomez was able to reduce their mortality from 22% to just 2%! Congratulations to Cristian Zalles-Vidal, Jaime Nieto-Zermeño, and the other author
video3:12 · Dec 2018
Immediate vs Silo Closure for Gastroschisis
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Dr. Ponsky reviews his takeaways from the JPS article, “Immediate Versus Silo Closure for Gastroschisis: Results of a Large Multicenter Study.”Link to full article: https://gcmd.co/2PItKT3
video0:26 · Dec 2019
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about using Corticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb about surgical site infections (SSI) are an important source of morbidity and mortality. and feasibility and safe
podcast44:19 · Dec 2020
Gastroschisis and sutureless abdominal wall closure
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Dr. Rod Gerardo and Dr. Todd Ponsky talk to Dr. Jason Fraser about the paradigm shift in gastroschisis management that is still in flux. Plus a deep dive into Dr. Fraser's recent publication: "Sutureless vs sutured abdominal wall closure fo
podcast12:17 · Jan 2021
Journal of Pediatric Surgery Article Review: October 2021
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We're back with the October issue of JPS article highlights. This time we're talking to JPS Editor Dr. Paul Tam and authors Dr. Brittany Johnson, Dr. Nigel Hall, Dr. Richard Wood, and Dr. Giacomo Esposito. Hosts: Ellen Encisco & Rod Gerardo
podcast19:10 · Nov 2021
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
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We're back with the January issue of JPS article highlights. This time we're talking to editor Dr. Cassandra Kelleher and authors Drs. Gail Besner, Shahrazad Joharifard and Sarah Stokes with Dr. Todd Ponsky. Hosts: Ellen Encisco, Em Tombash
podcast13:09 · Feb 2022
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
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Dr. Jose Campos and his team, Sociedad Chilena Cirugia Pediatrica curate the best pediatric surgical articles in non-core pediatric surgery journals and in this session, they describe their 5 favorites from the past year. The conversation i
video22:13 · May 2022
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
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In this session, Dr. Jose Campos leads us through the top publications that are not in the Journal of Pediatric Surgery.
Articles referenced:
1. IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children T
video27:50 · Sep 2022
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
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In this session, members of the APSA Professional Development Committee (PDC) discussed the latest top articles and practice updates. We were joined by Drs. Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder.
Topics discus
video1:04:30 · Sep 2022
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
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New article you should know about by Dr. Cecilia Gigena
"Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enem
video0:56 · Apr 2023
Quick Literature Updates Episode 6
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We’re back with sixth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review four articles covering the most int
video · May 2023
Quick Literature Updates Episode 10
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We’re back with tenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. This episode, we will review three articles covering the most
video · Jul 2023
Quick Literature Updates Episode 11
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We’re back with eleventh episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. This episode, we will review three articles covering the mo
video · Jul 2023
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
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Another article you should know by Cecilia Gigena
"Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus"
Authors: Tim Hundscheid, M.D., Wes Onland, M.D., Ph.D., Elisabeth M.W. Kooi, M.D., Ph.D., Daniel C. Vijlbrief, M
video1:14 · Aug 2023
Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study
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New article review by Alex Halpern, MD!
Full text: https://www.jpedsurg.org/article/S0022-3468(24)00077-0/fulltext
Background: Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that
video0:56 · Aug 2024
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
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We are back with another episode of our Journal of Pediatric Surgery article review podcast. This time we have three publications from the second quarter of 2024, April, May, and June issues. This time we're talking to editors Drs. Mary Bri
podcast17:03 · Sep 2024
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
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We are back with another episode of our Journal of Pediatric Surgery article review podcast. This time we have three publications from the third quarter of 2024, July, August and September issues. This time we're talking to editors Drs. Col
podcast19:28 · Oct 2024
Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations
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Mark B Slidell, Jarod McAteer, Doug Miniati, Stig Sømme, Derek Wakeman, Kristy Rialon, Don Lucas, Alana Beres, Henry Chang, Brian Englum, Akemi Kawaguchi, Katherine Gonzalez, Elizabeth Speck, Gustavo Villalona, Afif Kulaylat, Rebecca Rentea
video0:55 · Jan 2025
Quick Literature Updates Episode 16
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We’re back with sixteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most inte
video4:21 · Jan 2025
STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial
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Simon Eaton, Niloofar Ganji, Mandela Thyoka, Maher Shahroor, Augusto Zani, Hazel Pleasants-Terashita, Ali El Ghazzaoui, Jayaram Sivaraj, Stavros Loukogeorgakis, Paolo De Coppi, Sandra Montedonico, Sanja Sindjic-Antunovic, Marija Lukac, Jame
video0:57 · Apr 2025
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
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We are back with another episode of our Journal of Pediatric Surgery article review podcast. This time we have three publications from the first quarter of 2025, January, February and March issues. This time we're talking to editors Drs. Ro
podcast16:35 · May 2025
Quick Literature Updates Ep 22
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We’re back with 22nd episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesti
video4:23 · Oct 2025
Quick Literature Updates Ep 27
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We’re back with 27th episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesti
video4:20 · Feb 2026
Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...
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Dr. Lizzy Lee from Cincinnati Children's discusses a national multidisciplinary survey on the availability and use of bowel ultrasound (BUS) for diagnosing necrotizing enterocolitis (NEC). The study found that while BUS is available in many
video0:55 · Jul 2026
Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction) — Tony Sandler, Compiled Sandler Rapid Fire Sessions: Update Course 2015 · 1:32
Malrotation
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Dr. Soldes discusses the classifications of malrotation through the presentation of case presentations. Discussion topics include Ladd's procedure, volvulus, non-bilious emesis, redundant duodenum, gastroesophageal reflux, and laparoscopy.
video42:31 · Nov 2018
Abdominal Wall Defects
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Dr. Jacob Langer discusses various abdominal wall defects through case presentation.Topics of discussion include atresia, gastroschisis, fascial defects, staged closure by silo, and ruptured omphalocele.
video37:50 · Nov 2018
Tricks - Total Colonic Aganglionosis Associated with Malrotation & Multiple...
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Dr. Sahned Jaafar presents a difficult case of total colonic aganglionosis with malrotation and Hirschsprungs disease. The presentation is followed by a comprehensive discussion of surgical approaches to this case.
video15:41 · Nov 2018
Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...
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Dr. Anthony Sandler discusses bilateral Wilm's tumors, complex gastroschisis, and complex ileal atresia.
video29:44 · Nov 2018
Malrotation Rapid Fire Session: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Kenneth Azarow,Dr. Kenneth Azarow, Surgeon-in-Chief for Doernbecher Children’s Hospital, presents on malrotation-volvulus. Topics discussed includemalrotatio
video8:59 · Jan 2019
Compiled Sandler Rapid Fire Sessions: Update Course 2015
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Dr. Anthony Sandler from Children's National Medical Center leads the discussion in a rapid fire format for multiple cases, including management of Wilms tumor, gastroschisis, and complex ileal atresia.
video29:44 · Jan 2019
Abdominal Wall Defects: Update Course 2013
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Dr. Jacob Langer discusses various abdominal wall defects through case presentation.Topics of discussion include atresia, gastroschisis, fascial defects, staged closure by silo, and ruptured omphalocele.
video37:40 · Jan 2019
Total Colonic Hirschsprung Disease with Malrotation: Difficult Cases
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Dr. Sahned Jaafar presents a difficult case of total colonic aganglionosis Hirschsprung disease with malrotation. The presentation is followed by a comprehensive discussion of surgical approaches to this case.
video13:15 · Jan 2019
NEC: Update Course 2013
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Dr. Jose Prince discusses necrotizing enterocolitis. His presentation includes management techniques of peritoneal drainage, exploratory laparotomy, diagnostic laparoscopy, complete enterectomy, silo, bowel decompression, and use of antibio
video34:22 · Jan 2019
Gastroschisis - Clinical Practice Updates
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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
- Pul
video · Sep 2020
Malrotation and Volvulus with Trinity
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Surgical technique video demonstrating laparoscopic reduction of midgut volvulus with Ladd procedure in a 12-year-old with chronic symptoms and acute obstruction. Shows systematic band division, bowel derotation, mesenteric widening, and ap
video8:02 · May 2026
The new GERD guidelines (joint North America and Europe) recommend treating with PPI for 2 months then attempting to wean, with goal of weaning twice yearly. — Rachel Rosen, Gastroesophageal Reflux Disease · 43:42
Malrotation - Volvulus - Meconium Ileus - Solid Organ Injury: Update Course 2015
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Dr. Kenneth Azarow,Surgeon-in-Chief for Doernbecher Children’s Hospital,presents on malrotation-volvulus, meconium ileus, andsolid organ injury. Topics covered by Dr. Azarow include malrotation and heterotaxy, non rotation, right and leftat
video27:04 · Nov 2018
Necrotizing Enterocolitis with Dr. Gail Besner
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Discussion between Dr. Todd Ponsky and Dr. Gail Besner about necrotizing enterocolitis
podcast46:29 · Jan 2019
Abdominal Wall Defects with Dr. Jacob Langer
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Dr Jacob Langer discusses abdominal wall defects with Dr. Todd Ponsky.Edited by Ian C. Glenn, MD and Sophia Abdulhai, MDAn interactive discussion about gastroschisis and omphalocele between Todd Ponsky, MD and Jacob "Jack" Langer, MD. Dr. L
podcast52:45 · Jan 2019
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
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8:10am - APSA PDC TOP 10 - Review of 2018 Top Ten, Antibiotic stewardship, New concept in small bowel obstruction, Adherence to the Surviving Sepsis campaign guidelines and New APSA Trauma committee solid organ injury protocol10am - APSA PD
video4:45:42 · Jul 2020
Gastroesophageal Reflux Disease
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This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb.Dr. Rachel Rosen is Director of the A
podcast1:21:04 · Dec 2020
Intestinal Failure with Dr. Brad Warner
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Discussion with Dr. Brad W. Warner about intestinal failureWhat is intestinal failure?An umbrella term for when the small bowel is unable to digest and absorb an adequate amount of nutrients to sustain a patient through enteral means alone.
podcast52:46 · Dec 2020
Necrotizing Enterocolitis with Dr. Gail Besner
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Discussion between Dr. Todd Ponsky and Dr. Gail Besner about necrotizing enterocolitisHistory:Patients will often present with abdominal distention, high gastric residuals and bloody stools.First make sure the problem is in the abdomen.Pat
podcast46:29 · Dec 2020
Hirschsprung Disease Part I with Marc Levitt
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Dr. Marc Levitt and Dr. Todd Ponsky discuss Hirschsprung disease.Dr. Ponsky: Welcome to "Stay Current” in pediatric surgery, I’m Todd Ponsky, a pediatric surgeon at Akron Children’s Hospital and today we’re going to be focusing on Hirschspr
podcast59:20 · Dec 2020
Abdominal Wall Defects with Dr. Jacob Langer
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Dr Jacob Langer discusses abdominal wall defects with Dr. Todd Ponsky.Edited by Ian C. Glenn, MD and Sophia Abdulhai, MDAn interactive discussion about gastroschisis and omphalocele between Todd Ponsky, MD and Jacob "Jack" Langer, MD. Dr. L
podcast52:45 · Dec 2020
Umbilical Cord Defects with Dr. Kenneth Azarow
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This podcast discusses the work up and management of umbilical cord defects. Dr. Todd A. Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Kenneth S. Azarow is surgeon-in-chie
podcast30:16 · Dec 2020
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
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Omphalocele and Gastroschisis are abdominal wall defects that develop in-utero and surgically treated post-birth. Join Dr. Foong-Yen Lim, Surgical Director of the Cincinnati Children’s Fetal Care Center, and Dr. Todd Ponsky to discuss the p
podcast9:31 · Feb 2022
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
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Today is #NECday so we went back to a conversation between Dr. Todd Ponsky and Dr. Gail Besner about necrotizing enterocolitis. Enjoy this Stay Current Throwback on NEC. https://pubmed.ncbi.nlm.nih.gov/34506326/
podcast47:54 · May 2022
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
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General surgery residentRodrigo Gerardo, MD reviews the highlights from the 2020 Update Course including MMP7 for diagnosing biliary atresia, complex gastroschisis, and so much more.
video23:20 · May 2022
Neonatal Gastric Volvulus with Dr. Jason Frischer
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Gastric volvulus is a rare pathology for the pediatric surgical patient and when it happens, you want to be ready for potential surgical intervention. In this episode, Dr. Jason Frischer discusses the basics of diagnosis and management for
podcast11:17 · Jun 2022
Update Course Rewind: 2022 Top Ten Key Takeaways
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The 10th annual Pediatric Surgery Update Course was held as a webinar on August 30, 2022. We had a lot of lively discussion and engaging presentations on the latest updates in pediatric surgery. In this video we are reviewing the top ten ke
video · Jun 2023
Update Course Rewind: Omphalocele & Gastroschisis 2020
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Abdominal wall defects like omphalocele and gastroschisis can present in interesting ways. At last year
podcast15:18 · Jun 2026
Once released from the cell, extracellular CIRP acts as a DAMP by enhancing the release of cytokines and chemokines and amplifying the inflammatory cascade — Colleen Nofi, Dr. Colleen Nofi - Best of the Best in Pediatric Surgery 2025 · 1:19
Dr. Colleen Nofi - Best of the Best in Pediatric Surgery 2025
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Watch APSA's Dr. Colleen Nofi’s presentation on “Extracellular Cirp Exacerbates Necrotizing Enterocolitis” at the 2025 Best of the Best in Pediatric Surgery event!
Moderators: Drs. Todd Ponsky, Dan von Allmen, and Meera Kotagal
video8:06 · Mar 2025
Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC) - Validation in a Large Animal Model
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Rahul Gadde, Jason Xia, Sophia Hameedi, Angela Saulsbery, Carly Schafer, Lourenço Sbragia, Oluyinka O Olutoye
Background: Necrotizing enterocolitis (NEC) remains a devastating intestinal disease that affects 5-7% of preterm neonates. Rem
video0:59 · Apr 2025
What is Gastroschisis? An ERNICA animation for parents and families
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Animation video [in English]. Target audience: Parents and families. The video could also be used as an explanatory tool by healthcare professionals.
For further details about this condition, possible complications and specialised care,
video2:59 · Dec 2023
Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls
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Osamuyi Asemota, Gabrielle Derraugh, Matthew Levesque, Anna C Shawyer, Suyin A Lum Min, Richard Keijzer
Background: Research on long-term cognitive outcomes of children with gastroschisis is limited and inconsistent. This study aimed to
video0:53 · Apr 2025
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Takeaways+ Show
Gastroschisis and intestinal atresia frequently coexist, with atresia incidence between 5–10% [e821-c16, e959-c18]. Two distinct patterns emerge: early-onset atresia with dilated but non-thickened bowel, and late atresia from progressive constriction causing ischemia and necrosis—termed "vanishing gastroschisis" when the defect constricts severely [e821-c17, e821-c18, e959-c19, e959-c20]. Management remains controversial; options include immediate repair at closure, stoma creation, or delayed exploration at 4–6 weeks [e821-c20, e9616-c17]. No high-quality evidence guides choice [e821-c20, e959-c22]. Necrotizing enterocolitis (NEC) shares overlapping pathophysiology with these ischemic insults. Volvulus—whether midgut or gastric—demands urgent intervention . In malrotation with heterotaxy, right atrial isomerism confers higher volvulus risk than left [e879-c2, e879-c3]. Hirschsprung disease rarely presents as a true emergency if irrigations are performed correctly: large-bore tube (≥20F), small aliquots, active mixing [e311-c1, e311-c2]. Stasis precipitates bacterial translocation and sepsis . For total colonic aganglionosis, timing of pull-through hinges on ileostomy output consistency—not age or weight—because liquid effluent predicts poor anastomotic healing [e645-c16, e645-c17, e1052-c17, e1052-c18]. Sodium loss from high-output ileostomy arrests growth even when serum sodium remains normal; measure effluent and urinary sodium [e645-c24, e645-c25, e645-c27, e1052-c23, e1052-c24, e1052-c26].
- Atresia complicates 5–10% of gastroschisis; two types exist—early (dilated bowel) and late (vanishing gastroschisis from constriction ischemia). No evidence favors immediate repair, stoma, or delayed approach.
- Proper Hirschsprung irrigation (≥20F tube, 10–20 cc aliquots, active mixing) prevents emergency. Stasis causes bacterial translocation and sepsis, not mechanical obstruction alone.
- In total colonic Hirschsprung, defer pull-through until ileostomy output firms (typically with solids), not by age/weight. Liquid effluent predicts anastomotic failure.
- High-output ileostomy causes growth failure via sodium loss despite normal serum sodium. Measure effluent (>5–7 mEq/L) and urinary sodium to guide replacement.
- Right atrial isomerism in heterotaxy carries higher malrotation volvulus risk than left. Volvulus—midgut or gastric—is an absolute operative indication.
For patients & families
Physicians discussed several conditions that can cause serious bowel problems in babies and young children. Gastroschisis happens when a baby's intestines develop outside the body through an opening in the belly wall; doctors work to close this opening soon after birth, and most babies do well, though feeding can take time to establish [e821-c2, e821-c3, e821-c22, e959-c2]. Necrotizing enterocolitis (NEC) is an inflammatory disease of the intestine seen mostly in premature babies; it can be treated with rest for the bowel and antibiotics, but some babies need surgery to remove damaged tissue [e930-c1, e930-c10, e930-c14]. Intestinal atresia means a section of bowel didn't form properly before birth, creating a blockage that requires surgery to reconnect the healthy parts [e296-c18, e821-c16]. Volvulus occurs when the bowel twists on itself, cutting off blood supply—this is a true emergency requiring immediate surgery . Doctors also talked about Hirschsprung disease, where nerve cells are missing from part of the colon, making it hard for stool to pass; surgery removes the affected segment and connects healthy bowel [e311-c1, e311-c11]. Recovery and long-term outcomes vary, but multidisciplinary teams now help many of these children grow and thrive [e296-c41, e4741-c20].
Physicians discussed several conditions that can cause serious bowel problems in babies and young children. Gastroschisis happens when a baby's intestines develop outside the body through an opening in the belly wall; doctors work to close this opening soon after birth, and most babies do well, though feeding can take time to establish [e821-c2, e821-c3, e821-c22, e959-c2]. Necrotizing enterocolitis (NEC) is an inflammatory disease of the intestine seen mostly in premature babies; it can be treated with rest for the bowel and antibiotics, but some babies need surgery to remove damaged tissue [e930-c1, e930-c10, e930-c14]. Intestinal atresia means a section of bowel didn't form properly before birth, creating a blockage that requires surgery to reconnect the healthy parts [e296-c18, e821-c16]. Volvulus occurs when the bowel twists on itself, cutting off blood supply—this is a true emergency requiring immediate surgery . Doctors also talked about Hirschsprung disease, where nerve cells are missing from part of the colon, making it hard for stool to pass; surgery removes the affected segment and connects healthy bowel [e311-c1, e311-c11]. Recovery and long-term outcomes vary, but multidisciplinary teams now help many of these children grow and thrive [e296-c41, e4741-c20].
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Abdominal Wall Defects with Dr. Jacob Langer
The frequency and incidence of abdominal wall defects appears to be increasing
Host summaryThe host summarizes what Dr. Jack Langer said — not the host's own clinical position0:00 ↗
With gastroschisis, the main issue is that the bowel gets damaged through fetal life
clinicalJack Langer4:36 ↗
Most gastroschisis patients don't have any other associated anomalies, and it's pretty rare to have abnormal chromosomes
clinicalJack Langer4:46 ↗
Early papers showed a benefit to cesarean section in gastroschisis, but cesarean sections were usually done early at 36 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit
clinicalJack Langer5:46 ↗
Many studies have failed to show an advantage to cesarean section, and most people nowadays would not do routine cesarean section for gastroschisis
clinicalJack Langer6:13 ↗
There has not been any large randomized trial looking specifically at the issue of early delivery in gastroschisis
clinicalJack Langer6:29 ↗
Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor
clinicalJack Langer6:58 ↗
The mean gestational age of onset of labor is a lot earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by the inflamed bowel
clinicalJack Langer7:07 ↗
In gastroschisis pregnancies, labor can usually be successfully induced at 37 weeks, unlike regular pregnancies
clinicalJack Langer7:30 ↗
Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis
clinicalJack Langer8:36 ↗
During transport of gastroschisis patients, it's important for the baby to be nursed on his or her side, usually right side down, to prevent kinking of the mesentery and ischemia of the bowel
clinicalJack Langer10:01 ↗
For gastroschisis, bedside closure is the first choice if the bowel is not too thickened and there's not too much peel
clinicalJack Langer10:57 ↗
Adrian Bianchi first described bedside closure for gastroschisis
clinicalJack Langer11:21 ↗
Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby
clinicalJack Langer11:29 ↗
The current approach uses pre-formed silos, slowly pushing on them with fentanyl or morphine sedation in an awake baby, aiming to keep intraabdominal pressure below 20
clinicalJack Langer11:47 ↗
If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days
clinicalJack Langer12:27 ↗
The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord
Host summaryTodd Ponsky summarizes what Dr. Jack Langer said — not the host's own clinical position13:15 ↗
A study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair
Host summaryTodd Ponsky summarizes what Dr. Jack Langer said — not the host's own clinical position14:19 ↗
Umbilical hernias from plastic closure generally close by age 2 or 3 years, just like any umbilical hernia
clinicalJack Langer14:56 ↗
Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later
clinicalJack Langer16:12 ↗
The disadvantage of leaving a silo on for 24-48 hours is that the abdominal wall defect gets stretched out and bigger, taking longer to close with plastic closure
clinicalJack Langer17:25 ↗
Spring-loaded silos apply pressure outward as you push down, making the defect larger over time
clinicalTodd Ponsky18:10 ↗
The incidence of intestinal atresia in gastroschisis is between 5 and 10%
epidemiologicalJack Langer18:51 ↗
There are two types of intestinal atresia in gastroschisis: early-onset atresia where bowel gets very dilated but not thick-walled, and late atresia where the abdominal wall defect becomes very small causing ischemia and potentially vanishing gastroschisis
clinicalJack Langer19:01 ↗
The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years because of intestinal failure centers, better TPN that doesn't damage the liver as much, and control of sepsis
clinicalJack Langer20:15 ↗
For atresia in gastroschisis, there are three management choices: repair at time of closure, bring out stomas, or drop everything back in and repair the atresia later
clinicalJack Langer20:54 ↗
There's no good evidence for optimal management of atresia in gastroschisis because it's such a rare occurrence
opinionJack Langer21:15 ↗
If bowel looks good without much peel, primary repair of atresia at initial closure is appropriate; if there's concern, drop it back in and repair later
clinicalJack Langer21:35 ↗
Stomas are brought out only when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose
clinicalJack Langer22:01 ↗
The umbilicus is the preferred site for neonatal stomas because it results in a scar that would have been there anyway and is convenient for appliance placement
clinicalJack Langer22:50 ↗
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