Collection
Abdominal Wall Defects: Omphalocele & Gastroschisis
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
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 — Miguel Guelfand, EUPSA Webinar "GIANT OMPHALOCELE II" · 54:28
Giant Omphalocele2 items
Management of giant omphalocele with a simple and efficient nonsurgical silo
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The staged silo management of giant omphalocele in this series is safe and effective and reduces the time to closure and potential morbidity and mortality compared with traditional surgical or medical management.
article · Jun 2026
EUPSA Webinar "GIANT OMPHALOCELE II"
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Marlinde van den Kamp (The Netherlands)
Miguel Guelfand (USA)
Moderated by
Martin Lacher (Germany)
Augusto Zani (Canada)
video1:04:07 · Jul 2026
If the surgical technique for omphalocele closure involves exposing the intestines, it may be worth considering a Ladd procedure, but not worth going through the sac if the technique maintains the sac. Gastroschisis - Clinical Practice Updates · 10:31
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
Complex gastroschisis is almost a different disease from simple variety; everything is worse including hospital length of stay, requirement for further operations, and sepsis rates Update Course Rewind: Omphalocele & Gastroschisis 2020 · 12:25
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
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Giant omphalocele (≥5 cm or liver in sac) carries significant morbidity: prolonged time to full feeds, increased TPN dependence, higher rates of chromosomal anomalies and respiratory insufficiency compared to routine omphalocele. Pulmonary hypertension affects the majority (56/97 survivors), typically diagnosed within the first week, though delayed severe pulmonary hypertension can develop after sepsis even when initial echocardiography is normal. The sac-preserving active reduction technique using hydrocolloid dressing achieves closure in 97% within 30 days (92% within 15 days) when applied in the first 24 hours. Patients remain intubated and paralyzed during reduction, with compressions starting at 48 hours. Omphalocele carries higher midgut volvulus risk than gastroschisis due to non-rotation/malrotation; Ladd procedure merits consideration if intestines are exposed, though not if the sac is preserved. For massive defects without closable tissue, prolene mesh achieves closure in 80% within 2–3 months; component separation provides fascial closure in most cases, including neonates. Spring-loaded silos paradoxically enlarge giant defects through outward force vectors.
- Pulmonary hypertension in giant omphalocele can develop after sepsis even when initial echo is normal; maintain high suspicion beyond the first week of life.
- Hydrocolloid sac-preserving technique achieves 30-day closure in 97% when applied within 24 hours; patients require ICU ventilation and paralysis during active reduction.
- Omphalocele malrotation increases volvulus risk; perform Ladd procedure if exposing intestines, but not necessary if maintaining sac integrity during closure.
- Component separation achieves fascial closure in most giant defects (including neonates); spring-loaded silos worsen defect size through outward force vectors.
- For massive defects without closable tissue, prolene mesh protected by plastic achieves closure in 80% within 2–3 months.
For patients & families
Omphalocele and gastroschisis are conditions where a baby is born with abdominal organs outside the body. In omphalocele, organs are covered by a protective sac; in gastroschisis, they are not. [e2996-c1, e13507-c1] Giant omphaloceles—those larger than 5 centimeters or containing the liver—present greater challenges, with babies often needing breathing support and taking longer to tolerate feeds. [e2996-c1, e2996-c2] Some babies develop lung problems, including pulmonary hypertension, which can appear early or emerge later after infection. [e2996-c2, e2996-c3, e13507-c3, e13507-c4] Physicians discussed several approaches to closure. One technique uses a special hydrocolloid dressing applied within the first day of life to gently reduce the organs back into the abdomen over days to weeks, with most babies achieving closure within 15–30 days. [e2996-c6, e13651-c2, e13651-c9] Babies are kept sedated or paralyzed during this process and are not fed until reduction is complete. [e2996-c7, e13651-c18] For very large defects, surgeons may use mesh materials or component separation techniques—a surgical method that creates more room for closure. [e2996-c22, e13507-c15, e13507-c16] The doctors emphasized that each baby's treatment is individualized based on their specific anatomy and how well they tolerate each step.
Omphalocele and gastroschisis are conditions where a baby is born with abdominal organs outside the body. In omphalocele, organs are covered by a protective sac; in gastroschisis, they are not. [e2996-c1, e13507-c1] Giant omphaloceles—those larger than 5 centimeters or containing the liver—present greater challenges, with babies often needing breathing support and taking longer to tolerate feeds. [e2996-c1, e2996-c2] Some babies develop lung problems, including pulmonary hypertension, which can appear early or emerge later after infection. [e2996-c2, e2996-c3, e13507-c3, e13507-c4] Physicians discussed several approaches to closure. One technique uses a special hydrocolloid dressing applied within the first day of life to gently reduce the organs back into the abdomen over days to weeks, with most babies achieving closure within 15–30 days. [e2996-c6, e13651-c2, e13651-c9] Babies are kept sedated or paralyzed during this process and are not fed until reduction is complete. [e2996-c7, e13651-c18] For very large defects, surgeons may use mesh materials or component separation techniques—a surgical method that creates more room for closure. [e2996-c22, e13507-c15, e13507-c16] The doctors emphasized that each baby's treatment is individualized based on their specific anatomy and how well they tolerate each step.
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Gastroschisis - Clinical Practice Updates
Giant omphalocele (≥5 cm or liver in sac) patients had greater time to full feeds, required more TPN, had greater risk of respiratory insufficiency, and higher incidence of chromosomal anomalies compared to routine omphalocele in a two-center 20-year retrospective study of 97 survivors.
clinical0:00 ↗
56 of 97 giant omphalocele patients were identified as having pulmonary hypertension, with most diagnosed within the first week of life.
epidemiological0:00 ↗
Five patients with giant omphalocele had no signs of pulmonary hypertension on initial echo within first seven days but subsequently developed severe pulmonary hypertension after sepsis episodes, with two deaths and one requiring pulmonary vasodilator for more than a year.
clinical0:00 ↗
One patient developed severe pulmonary hypertension 52 days after initial echo showed no pulmonary hypertension, triggered by a single episode of sepsis.
clinical0:00 ↗
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.
clinicalMiguel Guelfand5:00 ↗
Using the sac-preserving technique with hydrocolloid dressing, 97% of patients achieved closure within 30 days and 92% within 15 days.
clinicalMiguel Guelfand5:00 ↗
All patients treated with the sac-preserving technique are kept in ICU, ventilated and completely paralyzed during the reduction process.
clinicalMiguel Guelfand5:00 ↗
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.
clinicalMiguel Guelfand6:47 ↗
Three patients with ruptured omphalocele sac at birth were sutured and then had the hydrocolloid dressing applied successfully.
clinicalMiguel Guelfand6:47 ↗
Compressions can usually start within 48 hours after hydrocolloid application once the baby is stable.
clinicalMiguel Guelfand8:01 ↗
In a study by Amy Wegner comparing omphalocele and gastroschisis, gastroschisis had higher risk of adhesive bowel obstruction, but omphalocele had higher risk of midgut volvulus.
clinical9:16 ↗
Patients with omphalocele have non-rotation or malrotation and will not have the same adhesions as gastroschisis patients.
clinical9:16 ↗
If the surgical technique for omphalocele closure involves exposing the intestines, it may be worth considering a Ladd procedure, but not worth going through the sac if the technique maintains the sac.
opinion10:31 ↗
During diaphragmatic hernia repair, the key move to decrease volvulus risk is to unroll the cecum and proximal bowel if they are rolled together like a scroll, ensuring small bowel is to the right, colon to the left, and anterior surface of mesentery is exposed.
clinical13:10 ↗
Non-rotation does not exclude the possibility of having anatomy with a narrow base of mesentery and the two ends being fairly close together, creating volvulus risk.
clinical14:33 ↗
In gastroschisis, the liver is not expected to be herniated outside the abdomen.
clinical17:52 ↗
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.
clinicalMiguel Guelfand19:10 ↗
With giant abdominal wall defects, when a spring-loaded (tech) silo is placed and pushed down, the forces go outward and can actually make the defect much bigger over time.
clinical20:24 ↗
Biologic mesh can be used as a scaffold that sticks to the bowel and allows skin to epithelialize over massive defects.
clinical21:23 ↗
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.
clinicalMiguel Guelfand23:21 ↗
Tissue expanders placed inside the belly without any domain would push all contents up and out rather than creating useful space, according to plastic surgery colleagues.
Host summaryThe host summarizing the discussion — not the host's own clinical position26:33 ↗
Component separation technique involves separating tissue at the external oblique about a centimeter beyond the rectus sheath bilaterally, then dissecting between external oblique and the transversus/internal oblique, which creates substantial room for closure.
clinical26:33 ↗
An incision on top of the anterior rectus sheath can provide another centimeter of advancement during component separation.
clinical26:33 ↗
A group from UT Houston (Cogen, Rich, and Recy) reported using component separation in nine children aged 7 days to 10 years, majority with omphalocele and giant defects, achieving fascial closure in almost every case, with some requiring mesh to bridge defects.
Host summaryThe host summarizing the discussion — not the host's own clinical position26:33 ↗
Update Course Rewind: Omphalocele & Gastroschisis 2020
Giant omphalocele is typically defined as five centimeters or greater or liver in the sac
clinical0:36 ↗
In a two-center retrospective study encompassing 20 years with 97 survivors of giant omphalocele, patients had greater time to full feeds, required more TPN, had more chromosomal anomalies, and had higher incidence of respiratory insufficiency
epidemiological0:36 ↗
56 patients of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within the first week of life
epidemiological1:14 ↗
Five patients out of 56 with pulmonary hypertension had no signs in their first echo within the first seven days of life, then subsequently developed severe pulmonary hypertension after an episode of sepsis; two died and one required pulmonary vasodilator for more than a year
clinical1:14 ↗
Even in omphalocele patients without signs of respiratory compromise early, sepsis later puts these patients at high risk for pulmonary hypertension
clinical1:14 ↗
Dr. Miguel Guelfand uses hydrocolloid dressing to make a silo for giant omphalocele without painting the sac, achieving closure in 97% within 30 days and 92% within 15 days in 40 patients
clinical3:46 ↗
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