# Anorectal Malformations and Colorectal Surgery — GCMD Library living collection

Updated: n/a · 23 episodes · 175 cited statements

## Episodes
### Anorectal Malformations
- [Routine Anal Dilations After PSARP: Questioning a Decades-Old Practice](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854) — podcast · 2:32 · [machine version](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854.md)
- [Perineal body-preserving PSARP versus classic approach: expert panel discussion](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855) — podcast · 2:13 · [machine version](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855.md)
- [Timing of PSARP for rectal vestibular fistulas: early versus delayed repair](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856) — podcast · 3:45 · [machine version](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856.md)
- [Pediatric Imperforate Anus (Anorectal Malformation) Treatment & Management: Approach Considerations, Surgical Care, Medical Care](https://library.globalcastmd.com/article/pediatric-imperforate-anus-treatment-management-approach-considerations-surgical-16874) — article · [machine version](https://library.globalcastmd.com/article/pediatric-imperforate-anus-treatment-management-approach-considerations-surgical-16874.md)
- [Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations.](https://library.globalcastmd.com/article/rectovaginal-fistula-a-common-diagnostic-error-with-significant-consequences-in-16886) — article · [machine version](https://library.globalcastmd.com/article/rectovaginal-fistula-a-common-diagnostic-error-with-significant-consequences-in-16886.md)

### Hirschsprung Disease
- [Diagnostic workup for Hirschsprung disease in newborns and children](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888) — video · 10:48 · [machine version](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888.md)
- [Botox injection during Hirschsprung pull-through: evidence and technique considerations](https://library.globalcastmd.com/watch/botox-injection-during-hirschsprung-pull-through-evidence-and-technique-consider-16852) — podcast · 1:55 · [machine version](https://library.globalcastmd.com/watch/botox-injection-during-hirschsprung-pull-through-evidence-and-technique-consider-16852.md)
- [Hirschsprung pull-through timing and the critical role of family irrigation training](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853) — podcast · 2:04 · [machine version](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853.md)
- [Hirschsprung disease and anorectal malformations: recognizing rare coexistence in trisomy 21](https://library.globalcastmd.com/watch/hirschsprung-disease-and-anorectal-malformations-recognizing-rare-coexistence-in-16851) — podcast · 1:52 · [machine version](https://library.globalcastmd.com/watch/hirschsprung-disease-and-anorectal-malformations-recognizing-rare-coexistence-in-16851.md)
- [Impact of Trisomy 21 on post pull-through enterocolitis and bowel function in children with Hirschsprung disease: A PCPLC analysis.](https://library.globalcastmd.com/article/impact-of-trisomy-21-on-post-pull-through-enterocolitis-and-bowel-function-in-ch-16878) — article · [machine version](https://library.globalcastmd.com/article/impact-of-trisomy-21-on-post-pull-through-enterocolitis-and-bowel-function-in-ch-16878.md)
- [Hirschsprung-Associated Enterocolitis at a Referral Institution: A Retrospective Review](https://library.globalcastmd.com/article/hirschsprung-associated-enterocolitis-at-a-referral-institution-a-retrospective-16881) — article · [machine version](https://library.globalcastmd.com/article/hirschsprung-associated-enterocolitis-at-a-referral-institution-a-retrospective-16881.md)
- [Hirschsprung-Associated Enterocolitis: Recognition and Treatment](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889) — video · 2:10 · [machine version](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889.md)

### Fecal Incontinence and Constipation
- [One-year outcomes for patients undergoing antegrade continence enema procedures without prior rectal enema therapy: A pediatric colorectal and pelvic learning consortium study](https://library.globalcastmd.com/article/one-year-outcomes-for-patients-undergoing-antegrade-continence-enema-procedures-16876) — article · [machine version](https://library.globalcastmd.com/article/one-year-outcomes-for-patients-undergoing-antegrade-continence-enema-procedures-16876.md)
- [What Happens Post-Malone? An Investigation of Long-Term Postoperative Management of Antegrade Continence Enemas](https://library.globalcastmd.com/article/what-happens-post-malone-an-investigation-of-long-term-postoperative-management-16884) — article · [machine version](https://library.globalcastmd.com/article/what-happens-post-malone-an-investigation-of-long-term-postoperative-management-16884.md)
- [Sacral nerve stimulation for refractory pediatric fecal incontinence](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842) — podcast · 2:37 · [machine version](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842.md)
- [Sacral Nerve Stimulation in Children with Medically Refractory Fecal Incontinence or Severe Constipation](https://library.globalcastmd.com/article/sacral-nerve-stimulation-in-children-with-medically-refractory-fecal-incontinenc-16880) — article · [machine version](https://library.globalcastmd.com/article/sacral-nerve-stimulation-in-children-with-medically-refractory-fecal-incontinenc-16880.md)

### Functional Outcomes and Long-Term Care
- [Beyond the pull-through: A multi-institutional study of long-term surgical and functional outcomes in total colonic Hirschsprung disease - A Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) study](https://library.globalcastmd.com/article/beyond-the-pull-through-a-multi-institutional-study-of-long-term-surgical-and-fu-16877) — article · [machine version](https://library.globalcastmd.com/article/beyond-the-pull-through-a-multi-institutional-study-of-long-term-surgical-and-fu-16877.md)
- [Differences in child opportunity index for pediatric patients who travel for subspecialty colorectal care: a pediatric colorectal and pelvic learning consortium (PCPLC) study](https://library.globalcastmd.com/article/differences-in-child-opportunity-index-for-pediatric-patients-who-travel-for-sub-16875) — article · [machine version](https://library.globalcastmd.com/article/differences-in-child-opportunity-index-for-pediatric-patients-who-travel-for-sub-16875.md)

### Pilonidal Disease
- [Update Course Rewind: Surgical Management of Pilonidal Disease 2024](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676.md)
- [Update Course Rewind: Patient Education and Non-Surgical Management of Pilonidal Disease 2024](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514.md)
- [Evaluation and management of pilonidal disease in adolescents](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890) — video · 43:49 · [machine version](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890.md)

### Colorectal Conference Updates
- [Colorectal Quiz Episode 50: Key Takeaways from the 16th European Pediatric Colorectal Conference](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859) — podcast · 24:17 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859.md)
- [Anal pathology in pediatric surgery with Dr. Nelson Rosen](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094) — podcast · 17:18 · [machine version](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=0) Introduction and Anal Anatomy Review (Ep 23)
- [2:14](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=134) Anal Fissures: Diagnosis and Management (Ep 23)
- [5:30](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=330) Hemorrhoids in Pediatric Patients (Ep 23)
- [7:20](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=440) Rectal Prolapse: Diagnosis and Treatment Algorithm (Ep 23)
- [10:23](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=623) Perianal Abscess in Infants: Non-operative Management (Ep 23)
- [12:41](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=761) Perianal Abscess and Fistula in Older Children (Ep 23)
- [15:07](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=907) Complex Fistulas and Differential Diagnosis (Ep 23)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=0) Introduction and Session Overview (Ep 20)
- [1:10](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=70) Case Presentation and Treatment Decision-Making (Ep 20)
- [3:29](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=209) Hair Removal as Primary Intervention (Ep 20)
- [4:46](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=286) Practical Hair Removal Techniques and Hygiene Adjuncts (Ep 20)
- [6:31](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=391) Conclusion and Key Takeaways (Ep 20)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=0) Introduction to Update Course Series and Pilonidal Disease Session (Ep 19)
- [0:50](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=50) Initial Management and Patient Presentation Patterns (Ep 19)
- [2:52](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=172) Minimally Invasive Surgical Approaches (Ep 19)
- [5:05](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=305) Technical Details and Evidence for Minimally Invasive Surgery (Ep 19)
- [6:48](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=408) Long-term Management and Graduated Treatment Approach (Ep 19)
- [0:01](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=1) Introduction and Clinical Question (Ep 15)
- [0:29](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=29) Case Presentation (Ep 15)
- [0:56](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=56) Sacral Nerve Stimulation Trial Results (Ep 15)
- [1:31](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=91) Complications and Technical Details (Ep 15)
- [2:06](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=126) Summary and Conclusion (Ep 15)
- [0:01](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=1) Introduction to Hirschsprung pull-through timing discussion (Ep 8)
- [0:23](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=23) Clinical scenario, audience poll results, and PCPLC study findings (Ep 8)
- [1:13](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=73) Expert opinions on delaying surgery for family irrigation training (Ep 8)
- [1:42](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=102) Summary and closing (Ep 8)
- [0:01](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=1) Introduction and Historical Context (Ep 1)
- [0:28](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=28) Evidence Against Routine Dilations (Ep 1)
- [1:12](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=72) Heineke-Mikulicz Anoplasty as Alternative (Ep 1)
- [1:44](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=104) Panel Perspectives and Summary (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=0) Introduction and Topic Overview (Ep 2)
- [0:32](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=32) Audience Poll Results and Early Outcome Data (Ep 2)
- [1:13](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=73) Technical Considerations and Expert Perspectives (Ep 2)
- [1:51](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=111) Summary and Closing (Ep 2)
- [0:01](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=1) Introduction and case presentation (Ep 3)
- [0:50](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=50) Initial management with dilations (Ep 3)
- [1:26](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=86) Timing preferences among surgeons (Ep 3)
- [1:56](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=116) Evidence from 2021 studies (Ep 3)
- [2:52](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=172) Practical considerations for timing (Ep 3)
- [3:22](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=202) Summary and conclusions (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In Hirschsprung's disease, the bottom part of the large intestine (colon) lacks half of the nerves needed to work normally. — Nelson Rosen (clinical) [Ep 12 · 0:13](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=13)
- In Hirschsprung's disease, the affected intestinal segment squeezes continuously while upstream intestine attempts to push contents through, resulting in functional obstruction. — Nelson Rosen (clinical) [Ep 12 · 0:25](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=25)
- Enterocolitis is a complication of Hirschsprung's disease that can occur before or after surgery. — Nelson Rosen (clinical) [Ep 12 · 0:35](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=35)
- Enterocolitis presents with bloating, pain, vomiting, diarrhea, and fever. — Nelson Rosen (clinical) [Ep 12 · 0:44](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=44)
- Enterocolitis is treated with oral antibiotics. — Nelson Rosen (clinical) [Ep 12 · 0:56](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=56)
- Metronidazole (trade name Flagyl) is the most commonly used antibiotic for enterocolitis, targeting bacteria in the large intestine. — Nelson Rosen (clinical) [Ep 12 · 1:01](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=61)
- Rectal irrigations are a primary treatment for enterocolitis, involving washing out the distal intestine to remove stool, gas, and bacteria from the intestinal lining. — Nelson Rosen (clinical) [Ep 12 · 1:11](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=71)
- Parents are taught to perform rectal irrigations at home. — Nelson Rosen (clinical) [Ep 12 · 1:11](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=71)
- Rectal irrigations reduce bloating and allow the child to resume drinking, eating, and normal activities. — Nelson Rosen (clinical) [Ep 12 · 1:11](https://library.globalcastmd.com/watch/hirschsprung-associated-enterocolitis-recognition-and-treatment-16889?t=71)
- Hirschsprung disease is a congenital condition that children are born with. — Nelson Rosen (clinical) [Ep 6 · 1:05](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=65)
- Hirschsprung disease usually affects the lowermost aspect of the intestine (the rectum or sigmoid). — Nelson Rosen (clinical) [Ep 6 · 1:11](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=71)
- In Hirschsprung disease, the system of nerves that allows the intestine to relax is missing in the rectum and lowest part of the colon. — Nelson Rosen (clinical) [Ep 6 · 1:46](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=106)
- In Hirschsprung disease, the rectum is always affected, and the question is how much proximal intestine is involved. — Nelson Rosen (clinical) [Ep 6 · 1:58](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=118)
- About 85% of Hirschsprung cases begin in the very end part of the sigmoid colon or beginning of the rectum. — Nelson Rosen (epidemiological) [Ep 6 · 2:17](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=137)
- In about 10% of Hirschsprung cases, the entire colon is affected. — Nelson Rosen (epidemiological) [Ep 6 · 2:25](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=145)
- 90 to 95% of Hirschsprung cases are recognized in the newborn period. — Patty Kern (epidemiological) [Ep 6 · 2:53](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=173)
- The first sign of Hirschsprung disease in newborns is usually failure to pass stool within the first 24 to 48 hours. — Patty Kern (clinical) [Ep 6 · 3:01](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=181)
- After failure to pass meconium, newborns with Hirschsprung disease will develop bloating, failure to pass stool, and vomiting. — Patty Kern (clinical) [Ep 6 · 3:17](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=197)
- In the newborn period with concern for Hirschsprung disease, a contrast enema exam is performed in radiology. — Nelson Rosen (clinical) [Ep 6 · 3:40](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=220)
- On contrast enema, a sign of Hirschsprung disease is when the rectum (lowest segment) is narrower and then dilates above that level. — Nelson Rosen (clinical) [Ep 6 · 3:53](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=233)
- If there is real concern for Hirschsprung disease, a biopsy is done where a tiny piece of the back wall of the rectum is examined for nerves. — Nelson Rosen (clinical) [Ep 6 · 4:05](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=245)
- In older children, Hirschsprung disease can be missed. — Nelson Rosen (clinical) [Ep 6 · 4:46](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=286)
- Children with Hirschsprung disease very rarely thrive and develop normally. — Nelson Rosen (clinical) [Ep 6 · 4:53](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=293)
- In older children with low-risk history for Hirschsprung disease (fine for first couple years then constipation worsened), biopsy should usually be done after routine management measures are tried. — Nelson Rosen (guideline) [Ep 6 · 5:32](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=332)
- At some centers with experienced gastroenterologists, anorectal manometry can be performed to evaluate for Hirschsprung disease. — Nelson Rosen (clinical) [Ep 6 · 6:25](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=385)
- In anorectal manometry, the gastroenterologist uses a balloon catheter to measure pressures in the anus and rectum, looking for the recto-anal inhibitory reflex. — Nelson Rosen (clinical) [Ep 6 · 6:44](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=404)
- The normal recto-anal inhibitory reflex is when you blow a balloon up in the rectum and stretch it, the sphincter should relax. — Nelson Rosen (clinical) [Ep 6 · 7:06](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=426)
- Anorectal manometry is not very sensitive for Hirschsprung disease; a normal manometry does not completely rule out Hirschsprung disease. — Nelson Rosen (clinical) [Ep 6 · 7:26](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=446)
- Nobody would operate on manometry findings alone; if there is suggestive manometry, a biopsy will still be done. — Nelson Rosen (guideline) [Ep 6 · 7:59](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=479)
- A suction biopsy can be done at the bedside for children in the newborn phase and up to a year old. — Patty Kern (clinical) [Ep 6 · 8:22](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=502)
- After a year of age, the child should be taken to the OR for biopsy under anesthesia to go up higher in the rectum. — Patty Kern (guideline) [Ep 6 · 8:32](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=512)
- People without Hirschsprung disease have no ganglion cells in the very first part of the rectum. — Patty Kern (clinical) [Ep 6 · 8:42](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=522)
- The suction biopsy tool works in babies because you don't need much tissue depth to reach the level where you look for nerves. — Nelson Rosen (clinical) [Ep 6 · 9:33](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=573)
- In older children after a year of age, you cannot get enough tissue depth with a suction biopsy tool because their tissue is thicker. — Nelson Rosen (clinical) [Ep 6 · 9:42](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=582)
- Operative rectal biopsy in older children is a simple procedure that takes about 20 minutes and patients go home the same day. — Nelson Rosen (clinical) [Ep 6 · 9:53](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=593)
- Pilonidal disease does not occur before adolescence — Nelson Rosen (clinical) [Ep 21 · 3:02](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=182)
- Occasionally pilonidal disease is seen in 10-year-olds who are starting puberty but not advanced on the Tanner scale — Nelson Rosen (clinical) [Ep 21 · 4:14](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=254)
- The Cincinnati center sees over 200 pilonidal patients per year — Nelson Rosen (epidemiological) [Ep 21 · 4:34](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=274)
- Most pilonidal patients present in middle to late adolescence — Nelson Rosen (epidemiological) [Ep 21 · 4:46](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=286)
- Pilonidal disease involves hairs from the outside working into tiny openings and getting stuck under the skin, not ingrown hairs — Nelson Rosen (clinical) [Ep 21 · 6:07](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=367)
- The most common pilonidal phenotype is an abscess cavity that drains spontaneously through a different location, usually at the top of the cleft on left or right, sometimes middle or bottom — Nelson Rosen (clinical) [Ep 21 · 6:44](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=404)
- Some patients present with acute abscess without spontaneous drainage, experiencing severe pain and inability to sit — Nelson Rosen (clinical) [Ep 21 · 7:13](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=433)
- Some patients drain too efficiently and develop open wounds in the cleft that don't cause pain, leading to delayed presentation with wounds that have been draining for months — Nelson Rosen (clinical) [Ep 21 · 7:32](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=452)
- Pilonidal disease involves mixed bacterial flora including gram positives, gram negatives, and always anaerobes — Paul Bunch (clinical) [Ep 21 · 10:45](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=645)
- Cultures are primarily useful for non-responders to initial treatment rather than for routine management — Paul Bunch (clinical) [Ep 21 · 10:52](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=652)
- In the pediatric population, pilonidal disease affects males and females equally (50/50 ratio) — Paul Bunch (epidemiological) [Ep 21 · 14:20](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=860)
- In the adult population, pilonidal disease affects approximately 75% men, likely because adult women are not presenting or being diagnosed — Paul Bunch (epidemiological) [Ep 21 · 14:22](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=862)
- Pilonidal disease affects all body types: hairy and non-hairy people, thin and heavy people, sweaty and dry people, those with poor and excellent hygiene — Paul Bunch (epidemiological) [Ep 21 · 14:37](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=877)
- Most pilonidal patients do not have a family history, but some do report affected family members — Paul Bunch (epidemiological) [Ep 21 · 15:17](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=917)
- A subset of patients have both pilonidal disease and Crohn's disease as separate but potentially related processes — Paul Bunch (clinical) [Ep 21 · 16:06](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=966)
- The two most important comorbidities for pilonidal management are inflammatory bowel disease and diabetes — Paul Bunch (clinical) [Ep 21 · 16:40](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1000)
- Pilonidal pits are visible pores in the direct midline that are larger than surrounding pores, typically 1-2 millimeters — Paul Bunch (clinical) [Ep 21 · 18:41](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1121)
- Pilonidal sinuses are holes in the midline that are 3 millimeters or larger, with visible depth — Paul Bunch (clinical) [Ep 21 · 20:35](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1235)
- Pilonidal wounds are openings 1 centimeter or larger where beefy raw surface is visible — Paul Bunch (clinical) [Ep 21 · 21:09](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1269)
- Patients whose pilonidal drainage opening tracks down near the anus can be misdiagnosed as having perianal fistula or Crohn's disease — Paul Bunch (clinical) [Ep 21 · 24:50](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1490)
- Examination under anesthesia may be needed to definitively distinguish pilonidal disease from perianal fistula when the drainage opening is very low — Paul Bunch (clinical) [Ep 21 · 25:51](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1551)
- Not all pilonidal patients require surgery; some can be managed with laser hair removal and conservative measures — Paul Bunch (clinical) [Ep 21 · 26:29](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1589)
- The cleft lift (modified Karydakis flap) is a wide excision with off-midline closure that has over 90% success rate — Paul Bunch (clinical) [Ep 21 · 30:17](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1817)
- The cleft lift procedure takes about 2.5 hours of anesthesia, requires narcotic pain medicine, and involves a drain for about 5 days — Paul Bunch (clinical) [Ep 21 · 30:55](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1855)
- The Gips procedure is a 20-minute outpatient procedure done under sedation — Paul Bunch (clinical) [Ep 21 · 31:31](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1891)
- Traditional wide excisions with midline closure have high failure rates and should be avoided — Paul Bunch (opinion) [Ep 21 · 32:10](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1930)
- For acute pilonidal abscess, needle aspiration with an 18-gauge needle can confirm presence of pus before making an incision — Paul Bunch (clinical) [Ep 21 · 36:04](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2164)
- First-line antibiotics for pilonidal abscess include Cipro and Flagyl, Augmentin, Clindamycin, or Bactrim with Metronidazole for anaerobic coverage — Paul Bunch (clinical) [Ep 21 · 37:36](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2256)
- Sitz baths are not emphasized because most patients will not comply with this time-intensive treatment — Paul Bunch (opinion) [Ep 21 · 38:20](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2300)
- After acute abscess drainage, patients should be seen back in 1-2 weeks to reassess and determine if minimally invasive procedure is needed — Paul Bunch (clinical) [Ep 21 · 39:11](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2351)
- Patients who present with acute abscess and no visible pits may show pits 3-4 weeks later after the infection clears and swelling resolves — Paul Bunch (clinical) [Ep 21 · 39:32](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2372)
- Sacral osteomyelitis in pilonidal disease is rare, occurring in approximately 1 in 1000 cases — Nelson Rosen (epidemiological) [Ep 21 · 40:45](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2445)
- There is no role for routine imaging (ultrasound or MRI) in pilonidal disease management — Nelson Rosen (opinion) [Ep 21 · 41:33](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2493)
- If imaging is being considered for pilonidal disease, that is an indication to refer to a specialist — Nelson Rosen (opinion) [Ep 21 · 42:56](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=2576)
- The anal verge is defined as the mucocutaneous junction where tissue stops being pink and wet and starts being skin. — Nelson Rosen (clinical) [Ep 23 · 1:23](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=83)
- Anal fissures are exquisitely painful. — Nelson Rosen (clinical) [Ep 23 · 2:32](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=152)
- A sentinel pile (heaped up lump of granulation covered with regular skin) is a sign of chronic inflammation in the area of a fissure. — Nelson Rosen (clinical) [Ep 23 · 2:40](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=160)
- Chemical sphincter relaxation for anal fissures started coming into vogue in the late 1990s. — Nelson Rosen (clinical) [Ep 23 · 3:40](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=220)
- Nitroglycerin allows for sphincter relaxation and healing in about 80% of patients but has a fairly high rate of causing headaches. (clinical) [Ep 23 · 3:56](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=236)
- Diltiazem gel has been used for the past 20 years with pretty reasonable results for anal fissure treatment. — Nelson Rosen (clinical) [Ep 23 · 4:12](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=252)
- Stooling physiology is complex, and it's not always the stool consistency that generates the push and the degree of pressures. — Nelson Rosen (clinical) [Ep 23 · 5:09](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=309)
- Dr. Rosen receives about 12 children referred per year for hemorrhoids, and maybe 1 to 2 of them might actually be hemorrhoids. — Nelson Rosen (epidemiological) [Ep 23 · 5:30](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=330)
- Hemorrhoids are one of the least common anal pathologies Dr. Rosen gets called about in pediatric patients. — Nelson Rosen (epidemiological) [Ep 23 · 5:41](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=341)
- The mainstay of hemorrhoid management is good constipation management. — Nelson Rosen (clinical) [Ep 23 · 6:02](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=362)
- Wet cleansing (bidets, washlets, wet wipes) is more efficient and less traumatic to perianal skin than dry paper wiping. — Nelson Rosen (clinical) [Ep 23 · 6:11](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=371)
- A rectal exam is essential to make sure you're not missing an intussusception, which can be from an anatomic lead point like a polyp in the upper rectum or distal sigmoid. — Nelson Rosen (clinical) [Ep 23 · 7:35](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=455)
- In a prolapse, a finger will go nowhere when trying to stick it around the prolapsed tissue, but in an intussusception, it will go right next to it between the anal canal and the prolapse. — Nelson Rosen (clinical) [Ep 23 · 8:00](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=480)
- In the era of universal cystic fibrosis screening, the yield of picking up a child with no history or concern for CF based solely on rectal prolapse is in the 3 to 3.5% range. — Nelson Rosen (epidemiological) [Ep 23 · 8:31](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=511)
- Injection sclerotherapy can be highly effective for recurrent rectal prolapse. — Nelson Rosen (clinical) [Ep 23 · 9:30](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=570)
- Laparoscopic rectopexy is a very effective procedure for rectal prolapse. — Nelson Rosen (clinical) [Ep 23 · 9:38](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=578)
- Pelvic floor physical therapy is beneficial for older patients with rectal prolapse because pelvic floor laxity won't improve with surgery but will improve with physical therapy. — Nelson Rosen (clinical) [Ep 23 · 9:59](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=599)
- Dr. James Warden, a highly respected pediatric surgeon from California, stopped draining perianal abscesses in infants because they all went away on their own. — Nelson Rosen (clinical) [Ep 23 · 11:11](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=671)
- Most infants with perianal abscess don't need to go to the operating room for a fistulotomy, and the abscess should not be drained; instead, try to cool off the abscess with antibiotics because doing so will dramatically decrease the likelihood of forming a fistula in ano. — Nelson Rosen (clinical) [Ep 23 · 11:41](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=701)
- If an infant persists with a fistula to age 2 and there are no other concerns, Dr. Rosen will do a fistulotomy. — Nelson Rosen (clinical) [Ep 23 · 12:25](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=745)
- The reason for avoiding surgery in infant perianal abscess is to avoid the anesthetic, not because surgery doesn't work. — Nelson Rosen (clinical) [Ep 23 · 12:35](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=755)
- Dr. Rosen is a big fan of the cruciate incision for draining perianal abscesses because it helps facilitate ongoing drainage. — Nelson Rosen (opinion) [Ep 23 · 12:48](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=768)
- Dr. Rosen is a big fan of not packing abscess cavities; he places just the corner of a 4x4 for initial hemostasis, tells patients to soak in the tub so it falls off, then use a top dressing. — Nelson Rosen (opinion) [Ep 23 · 12:56](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=776)
- Goodsall's rule is a generalization that is often true, but there are plenty of patients whose fistulas do not follow this rule. — Nelson Rosen (clinical) [Ep 23 · 13:38](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=818)
- In children under 18 who presented with a fistula, 12% developed Crohn's disease; 5% of those with abscesses and 2% of those with fissures developed Crohn's. — Nelson Rosen (epidemiological) [Ep 23 · 14:31](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=871)
- Children over 10 years of age presenting with perianal symptoms had a 13% likelihood of Crohn's disease, and if that symptom was a fistula, that group had a 35% likelihood of having Crohn's. — Nelson Rosen (epidemiological) [Ep 23 · 14:42](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=882)
- Looking back at children eventually diagnosed with Crohn's disease, 64% of them had abdominal symptoms that could be paired with their perianal symptom to identify high-risk patients. — Nelson Rosen (epidemiological) [Ep 23 · 14:55](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=895)
- The standard adult pathway is fistulotomy for superficial fistulas, but suprasphincteric or intersphincteric fistulas need a different treatment plan to avoid causing incontinence. — Nelson Rosen (clinical) [Ep 23 · 15:32](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=932)
- For complex fistulas, a bioprosthetic plug (Cook brand) is used by scrubbing the tract, placing the plug, and stitching it in place on the inside and outside, with about a 60-70% likelihood of healing. — Nelson Rosen (clinical) [Ep 23 · 15:55](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=955)
- The eye only sees what the mind suspects; clinicians must keep pilonidal disease in their thoughts at all times when evaluating perianal pathology. — Nelson Rosen (opinion) [Ep 23 · 16:41](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=1001)
- Wide excision and packing is probably the most common operation that happens worldwide for pilonidal disease, with most pilonidal work not done by people doing advanced pilonidal work. — Nelson Rosen (clinical) [Ep 19 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=100)
- Antibiotics are not used unless patients are coming in with an active infection. — Nelson Rosen (clinical) [Ep 19 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=100)
- Some patients with minimal external manifestation don't drain very effectively and experience severe pain with large, bulging abscesses, while others present with multiple draining abscesses but typically don't report pain or require antibiotics. — Nelson Rosen (clinical) [Ep 19 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=100)
- Wide excision with off midline closure goes back to the 1960s when Caris first described it, and the Limberg flap has been used since the 1940s. (clinical) [Ep 19 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=149)
- Lord and Millard described a minimally invasive approach in 1965 that is almost the same operation Dr. Gibbs described in 2008. — Nelson Rosen (clinical) [Ep 19 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=172)
- Current success rates are closer to 70-75% where one minimally invasive operation gets you to full healing and lasting recurrence-free healing. — Nelson Rosen (epidemiological) [Ep 19 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=172)
- Some institutions use laser tract ablation, phenol to sclerose the tracts, or fibrin glue, but none have been proven superior. — Nelson Rosen (clinical) [Ep 19 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=172)
- For a first abscess, the approach is to drain it and see what you're dealing with. (clinical) [Ep 19 · 3:42](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=222)
- Minimally invasive approaches are offered quickly because it is a 20-minute intervention under sedation with no activity restriction and no narcotic requirement. — Nelson Rosen (clinical) [Ep 19 · 4:02](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=242)
- In the Gibbs procedure, all pits are excised using circular punches, then the internal cavity is scraped out to remove inflammation, hair, and necrotic fat, leaving the wounds open to heal. — Nelson Rosen (clinical) [Ep 19 · 4:53](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=293)
- The Ebzi procedure was described in 2013, doing everything through a small incision with a large scope that is not available in the United States. (clinical) [Ep 19 · 5:25](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=325)
- In the hybrid Gibbs approach, an eight French cystoscope is put into the openings after cleaning to make sure all hair is removed, and this has been done for the past five years with satisfaction. — Nelson Rosen (clinical) [Ep 19 · 5:42](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=342)
- If not starting with minimally invasive as the first surgical intervention for most people, you're doing it wrong. (opinion) [Ep 19 · 6:07](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=367)
- All patients should get laser hair removal once they're healed. — Nelson Rosen (opinion) [Ep 19 · 6:48](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=408)
- Patients need to be attentive to hair removal (waxing or laser) throughout adolescence and into adulthood, with the longer they can sustain it, the better. — Nelson Rosen (clinical) [Ep 19 · 6:48](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=408)
- Laser is not permanent but knocks hair down to a lower level. (clinical) [Ep 19 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=434)
- For patients where one or two minimally invasive approaches did not work and they have significant ongoing symptoms, the treatment moves to off-midline closure with the Bascom cleft lift as the preferred choice. (clinical) [Ep 19 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=434)
- Patients presenting with wounds as their initial presentation for pilonidal tend to not always get to the finish line fully healed with a minimally invasive approach — M. Godi (clinical) [Ep 20 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=132)
- 60 to 70% of pilonidal cases respond successfully to non-surgical management — Nelson Rosen (clinical) [Ep 20 · 2:54](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=174)
- If you're not pushing hair removal and meticulous hygiene to do the best that you can, you're probably going to end up operating on some people that might not need an operation — Nelson Rosen (opinion) [Ep 20 · 3:29](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=209)
- Many patients have come from multiple hospitals full of hair with nobody clipping them in the office or mentioning hair removal — Nelson Rosen (clinical) [Ep 20 · 4:20](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=260)
- Clipping is probably the easiest and simplest approach for hair removal when a parent or active caregiver is involved (opinion) [Ep 20 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=286)
- Having someone clip the area once a week is recommended — Nelson Rosen (guideline) [Ep 20 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=286)
- For college students living alone without caregivers, depilatory agents (Nair) are recommended as an alternative to clipping — Nelson Rosen (guideline) [Ep 20 · 5:11](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=311)
- Wax strips can be used intraoperatively during general anesthesia to remove hair from the natal cleft and buttocks area (clinical) [Ep 20 · 5:37](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=337)
- Proper showering with a hand shower to actually put water in the affected area is important for healing — Nelson Rosen (guideline) [Ep 20 · 6:03](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=363)
- Many patients report being told they couldn't bathe, which is problematic because without washing, healing is unlikely — Nelson Rosen (clinical) [Ep 20 · 6:03](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=363)
- Staging systems for pilonidal disease have been introduced previously, but not all classifications correlate with how cases are managed — Nelson Rosen (clinical) [Ep 20 · 1:34](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=94)
- Treatment decisions should be tailored to patient context, such as a 16-year-old baseball player who is miserable may proceed directly to operating room — Nelson Rosen (opinion) [Ep 20 · 2:54](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=174)
- Non-surgical management allows patients to return to activities of daily living immediately, though partial healing may occur depending on disease severity (clinical) [Ep 20 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=185)
- In a sacral nerve stimulator trial, the rate of wearing a diaper during the day decreased from 19% to 2%. — Ben Hamm (clinical) [Ep 15 · 1:03](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=63)
- Sacral nerve stimulation is not FDA approved in kids. — Ben Hamm (guideline) [Ep 15 · 1:20](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=80)
- Side effects of sacral nerve stimulation include pain and neurological symptoms. — Ben Hamm (clinical) [Ep 15 · 1:37](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=97)
- About 40% of patients require re-operation within about 3 years for dead battery of the stimulator. — Ben Hamm (clinical) [Ep 15 · 1:37](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=97)
- The stimulator is placed through the 3rd sacral foramen and sends signals to the sacral nerves. — Ben Hamm (clinical) [Ep 15 · 1:52](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=112)
- After placement, the patient is observed for a couple of weeks to assess symptom improvement. — Ben Hamm (clinical) [Ep 15 · 1:58](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=118)
- In the literature, there is not really evidence of good timing to perform a pull-through procedure for Hirschsprung disease. (clinical) [Ep 8 · 0:44](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=44)
- A 2021 PCPLC retrospective study compared outcomes of neonatal pull-through versus delayed primary pull-through for Hirschsprung disease. (epidemiological) [Ep 8 · 0:50](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=50)
- One surgeon delays Hirschsprung pull-through at least 1 month, sometimes 3 months, depending on when the family can return, because they want families to demonstrate they can do irrigations at home. (opinion) [Ep 8 · 1:13](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=73)
- Family competence in performing irrigations is an important skill for Hirschsprung management. (opinion) [Ep 8 · 1:21](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=81)
- A family who is really good at irrigations will save a Hirschsprung baby's life. (opinion) [Ep 8 · 1:25](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=85)
- Hirschsprung patients whose families cannot perform adequate washouts do not go home, are not adequately decompressed, and end up hospitalized with colitis or perforation. (clinical) [Ep 8 · 1:29](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=89)
- Perineal body–preserving PSARP technique is essentially the same approach used for bulbar fistula but applied to vestibular fistula, cleaning up lateral planes before coming around the front. (clinical) [Ep 2 · 1:13](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=73)
- Perineal body–preserving PSARP allows earlier discharge because surgeons are not concerned about perineal body breakdown postoperatively. (clinical) [Ep 2 · 1:32](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=92)
- Perineal body–preserving PSARP is technically harder than opening all the way anteriorly in classic PSARP. (opinion) [Ep 2 · 1:38](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=98)
- If uncertain about the location of the anterior rectal wall or vagina during perineal body–preserving PSARP, conversion to standard PSARP is appropriate. (clinical) [Ep 2 · 1:38](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=98)
- There are data that support parental anxiety and PTSD for both the patients and the caregivers associated with anal dilations (epidemiological) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=30)
- Families are worried that they're going to hurt their babies and they're going to hurt this repair (clinical) [Ep 1 · 0:37](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=37)
- A single institution review in kids under 2 years of age showed half with dilations versus half without dilations (clinical) [Ep 1 · 0:53](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=53)
- Two kids in each group (dilations vs no dilations) had to have a re-operation for neoanal stricture (clinical) [Ep 1 · 1:02](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=62)
- About 15% of the kids required a Heineke-Mikulicz anoplasty (clinical) [Ep 1 · 1:02](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=62)
- For neonates, one panelist dilates; for older kids, redo cases, or ambulatory patients where dilation would be traumatic, they hold off (opinion) [Ep 1 · 1:46](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=106)
- One panelist usually dilates for neonatal cases (opinion) [Ep 1 · 1:57](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=117)
- In Canada, lack of easy access to schedule elective cases is a concern, which is why one panelist prefers to dilate all cases up front (opinion) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=120)
- A 2021 multi-institutional retrospective study through PCPLC defined early repair as within 14 days versus late after 14 days, examining 30-day outcomes — Jamie Harris (epidemiological) [Ep 3 · 2:12](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=132)
- Initial dilations should be limited to 7 Hegar to decrease potential scarring along the fistula tract for future PSARP — Jamie Harris (clinical) [Ep 3 · 0:59](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=59)
- Dilations need only keep the fistula open enough for soft stool to pass through, with no reason to drive dilation up large — Nelson (clinical) [Ep 3 · 1:12](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=72)
- Theoretical fibrosis of the fistula tract from delayed repair may make dissection more difficult during PSARP — Jamie Harris (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=175)
- Incomplete decompression can cause rectal distension, making PSARP technically more difficult — Jamie Harris (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=180)
- Social determinants of health affect families' ability to make multiple trips for care, with long distances and expense being barriers — Jamie Harris (clinical) [Ep 3 · 3:14](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=194)
- There is no consensus in the literature on the right timing for delayed PSARP repair, with definitions ranging from a couple of months to multiple months of age — Jamie Harris (epidemiological) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=160)
- Performing dilations alone is probably not correct management for rectal vestibular fistula, though dilations initially allow for decompression — Jamie Harris (clinical) [Ep 3 · 0:59](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=59)
- Many centers are starting irrigation competency training even with an ostomy in place, particularly for total colonic Hirschsprung patients who may have delayed takedown. — Lindsey Clarke (clinical) [Ep 22 · 1:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=77)
- Starting irrigations 1-2 times per week early on in patients with stomas helps children and parents adapt, making the transition after takedown much easier. — Lindsey Clarke (clinical) [Ep 22 · 1:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=113)
- Patients with total colonic Hirschsprung and stomas represent the highest risk group for enterocolitis and must receive irrigation training before pull-through. — Marc Levitt (clinical) [Ep 22 · 2:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=165)
- Diet management for Hirschsprung patients is not one size fits all; families must identify individual food triggers through pattern recognition. — Lindsey Clarke (clinical) [Ep 22 · 4:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=288)
- ICG (indocyanine green fluorescence imaging) is used to check blood supply of pull-throughs and can reduce the risk of leaks and ischemia. — Felipe Jali (clinical) [Ep 22 · 5:32](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=332)
- Most pull-throughs that decompensate had good original pathology but were not aggressively managed post-operatively with laxatives and Botox when needed. — Marc Levitt (clinical) [Ep 22 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=579)
- Proactive monitoring for obstructive behavior and early intervention with laxatives and Botox prevents pull-through decompensation. — Marc Levitt (clinical) [Ep 22 · 10:03](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=603)
- Without good nursing care, patients with anatomically elegant reconstructions may have poor functional outcomes. — Marc Levitt (opinion) [Ep 22 · 11:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=705)
- More than an adult surgeon, transition patients often need a sexologist, gynecologist, or urologist rather than a colorectal surgeon. — Felipe Jali (opinion) [Ep 22 · 14:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=848)
- Adult colorectal surgeons need training to understand what Hirschsprung disease and anorectal malformation patients might need when they are 50 years old with complications like rectal prolapse. — Marc Levitt (opinion) [Ep 22 · 15:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=925)
- In vestibular fistula repair, dissection does not need to reach the areolar plane between anterior rectum and posterior vagina; the key is ensuring no tension on the rectum during anoplasty. — Marc Levitt (clinical) [Ep 22 · 17:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1051)
- Cloaca patients need long-term follow-up through puberty to avoid menstrual obstruction, incapacity for egress, and consequent risk of endometriosis and damage to uterus and fallopian tubes. — Felipe Jali (clinical) [Ep 22 · 18:44](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1124)
- Mullerian structures that appear atretic may grow into useful structures over time. — Marc Levitt (clinical) [Ep 22 · 19:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1164)
- In most cloaca cases after urogenital separation, the native vagina will reach the perineum; if it does not, a bowel neovagina can bridge the gap and be removed later when the native vagina is pulled through after puberty. — Marc Levitt (clinical) [Ep 22 · 19:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1182)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The missing nerves in Hirschsprung disease are the ganglion cells in the submucosal and myenteric plexus. — Rod Gerardo summarizing the discussion [Ep 6 · 1:41](https://library.globalcastmd.com/watch/diagnostic-workup-for-hirschsprung-disease-in-newborns-and-children-16888?t=101)
- John Bascom's theory: pilonidal develops from infection around hair follicle, hair falls out leaving a large pore called a pit, then hairs from outside work into that opening — Nelson Rosen summarizing a resource [Ep 21 · 5:20](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=320)
- John Armstrong's military study showed that shaving pilonidal patients once a week led to resolution over time in many cases without surgery — Paul Bunch summarizes what Dr. Nelson Rosen said [Ep 21 · 21:38](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1298)
- Clipping hair before surgery results in lower wound infection rates compared to shaving — Paul Bunch summarizes what Dr. Nelson Rosen said [Ep 21 · 22:41](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1361)
- The Gips procedure is a minimally invasive technique that uses small punches to remove pits and sinuses, then cleans out the inside through these openings — Paul Bunch summarizes what Dr. Nelson Rosen said [Ep 21 · 29:14](https://library.globalcastmd.com/watch/evaluation-and-management-of-pilonidal-disease-in-adolescents-16890?t=1754)
- Rectal prolapse occurs most commonly in children between age 2 and 4 when they're potty training. — Rod summarizing the discussion [Ep 23 · 7:23](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=443)
- Perianal abscess in infants has a strong male predominance. — Rod summarizing the discussion [Ep 23 · 10:55](https://library.globalcastmd.com/watch/anal-pathology-in-pediatric-surgery-with-dr-nelson-rosen-5094?t=655)
- In Dr. Gibbs's study, they had a 15% recurrence rate over 10 years. — Nelson Rosen summarizing the discussion [Ep 19 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=172)
- A Swedish study by Roland Anderson in 2017 with 113 patients used a minimally invasive approach with suture closure of all but one hole (left open to drain) and had excellent results. — The host summarizing the discussion [Ep 19 · 6:07](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=367)
- A large prospective study by Nationwide Children's on laser hair removal after surgery found it significantly reduced recurrent disease, representing the first randomized prospective study on this subject. — The host summarizing the discussion [Ep 19 · 6:07](https://library.globalcastmd.com/watch/update-course-rewind-surgical-management-of-pilonidal-disease-2024-9676?t=367)
- John Armstrong in the United States Army had a clinic where patients were shaved weekly and closely monitored, leading to dramatic improvement and a reduced need for surgery — M. Godi summarizing the discussion [Ep 20 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=234)
- A large percentage of patients will be healed with non-surgical measures alone — M. Godi summarizing the discussion [Ep 20 · 3:54](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=234)
- Washlets can be helpful adjuncts for patients who struggle to clean themselves after bowel movements — M. Godi summarizing the discussion [Ep 20 · 6:31](https://library.globalcastmd.com/watch/update-course-rewind-patient-education-and-non-surgical-management-of-pilonidal-9514?t=391)
- Antegrade colonic enema procedures or cecostomy tubes are a reasonable next step for pediatric fecal incontinence refractory to medical management. — Jill Knepprath summarizes what Dr. Ben Hamm said [Ep 15 · 0:56](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=56)
- Overnight, the rate of the child needing a diaper went from 33% to 11% with sacral nerve stimulation. — Jill Knepprath summarizes what Dr. Ben Hamm said [Ep 15 · 1:14](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=74)
- A Cochrane review in adults suggests that sacral nerve stimulation can help with fecal incontinence and avoid an ACE procedure. — Ben Hamm summarizing a resource [Ep 15 · 1:23](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=83)
- A 2023 study showed an improvement in involuntary daytime and nighttime bowel movements with sacral nerve stimulation. — Jill Knepprath summarizes what Dr. Ben Hamm said [Ep 15 · 1:31](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=91)
- If symptoms improve during the trial period, the stimulator can be implanted long-term. — Jill Knepprath summarizes what Dr. Ben Hamm said [Ep 15 · 2:02](https://library.globalcastmd.com/watch/sacral-nerve-stimulation-for-refractory-pediatric-fecal-incontinence-16842?t=122)
- In the PCPLC study, the median age of the neonatal pull-through group was 11 days at time of surgery compared to 98 days for the delayed group. — Jill Knepprath summarizing the discussion [Ep 8 · 0:59](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=59)
- The PCPLC study found no difference in preoperative and postoperative enterocolitis or fecal incontinence at follow-up between neonatal and delayed pull-through groups. — Jill Knepprath summarizing the discussion [Ep 8 · 1:06](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=66)
- Studies show no difference in complications between neonatal and delayed pull-through procedures for Hirschsprung patients. — Jill Knepprath summarizing the discussion [Ep 8 · 1:42](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=102)
- Decisions on Hirschsprung pull-through timing should factor in the family's ability to perform irrigations. — Jill Knepprath summarizing the discussion [Ep 8 · 1:50](https://library.globalcastmd.com/watch/hirschsprung-pull-through-timing-and-the-critical-role-of-family-irrigation-trai-16853?t=110)
- 2023 publications on perineal body–preserving PSARP demonstrated at one-year follow-up: no dehiscence, no prolapse, and only 13% of patients required revision of anal stricture. — The host summarizing the discussion [Ep 2 · 0:46](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=46)
- Two-thirds of patients undergoing perineal body–preserving PSARP went home on postoperative day one. — Jill Knepprath summarizing the discussion [Ep 2 · 1:01](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=61)
- Audience poll showed many surgeons performing perineal body–preserving PSARP, with classic PSARP a close second, and some still using anterior sagittal approach. — The host summarizing the discussion [Ep 2 · 0:32](https://library.globalcastmd.com/watch/perineal-body-preserving-psarp-versus-classic-approach-expert-panel-discussion-16855?t=32)
- For decades, every child received anal dilations after PSARP — Jill Knepprath summarizing the discussion [Ep 1 · 0:21](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=21)
- A study from Spain followed the historical dilation protocol starting two weeks after PSARP, doing dilations twice a day, increasing the Hagar size by 1 millimeter each week until reaching optimal size — Jill Knepprath summarizing the discussion [Ep 1 · 0:40](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=40)
- The Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients — Jill Knepprath summarizing the discussion [Ep 1 · 1:12](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=72)
- Heineke-Mikulicz anoplasty is done by making incisions at the 12, 3, 6, and 9 o'clock positions, making a rhomboid shape that opens up the strictured area — Jill Knepprath summarizing the discussion [Ep 1 · 1:20](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=80)
- Heineke-Mikulicz anoplasty does not require flaps or any mobilization of the rectum — Jill Knepprath summarizing the discussion [Ep 1 · 1:30](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=90)
- Heineke-Mikulicz anoplasty is safe, effective, and minimally invasive — Jill Knepprath summarizing the discussion [Ep 1 · 1:34](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=94)
- Heineke-Mikulicz anoplasty can be done outpatient as an alternative to long-term dilations after PSARP — Jill Knepprath summarizing the discussion [Ep 1 · 1:38](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=98)
- There isn't strong evidence to support mandatory anal dilation after PSARP — Jill Knepprath summarizing the discussion [Ep 1 · 2:09](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=129)
- Anal dilations can cause stress for the families — Jill Knepprath summarizing the discussion [Ep 1 · 2:09](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=129)
- Age of the patient and access to returning for an outpatient procedure are things to consider when making dilation decisions — Jill Knepprath summarizing the discussion [Ep 1 · 2:17](https://library.globalcastmd.com/watch/routine-anal-dilations-after-psarp-questioning-a-decades-old-practice-16854?t=137)
- A 2021 NSQIP study defined early PSARP repair as within 7 days and delayed repair as between 6 weeks and 8 months, finding no difference in overall outcomes including re-operations and readmissions — Jill Knepprath summarizing the discussion [Ep 3 · 1:56](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=116)
- Wound breakdown and dehiscence was the most common complication for both early and delayed PSARP repair groups, with no significant difference in post-operative complications between groups — Jill Knepprath summarizing the discussion [Ep 3 · 2:26](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=146)
- Early repair during the newborn period avoids an additional hospital admission for surgery — Jill Knepprath summarizing the discussion [Ep 3 · 3:08](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=188)
- Both early and delayed PSARP repairs are safe for patients with rectal vestibular fistulas — Jill Knepprath summarizing the discussion [Ep 3 · 3:23](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=203)
- Timing of PSARP should be determined by family circumstances, patient size, and surgeon comfort and experience — Jill Knepprath summarizing the discussion [Ep 3 · 3:29](https://library.globalcastmd.com/watch/timing-of-psarp-for-rectal-vestibular-fistulas-early-versus-delayed-repair-16856?t=209)
- Enterocolitis remains a risk for Hirschsprung patients even after pull-through, at about a rate of 20% of all patients. — The host summarizing the discussion [Ep 22 · 2:13](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=133)
- Regular irrigations minimize enterocolitis risk. — The host summarizing the discussion [Ep 22 · 2:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=141)
- Most centers still do some kind of crusting, putting stool on the baby's bottom while they have a stoma for small periods of time to help get their bottom used to it. — Meghan Mesa summarizing the discussion [Ep 22 · 3:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=215)
- Betel leaf used for peristomal skin in Bangladesh produced pristine skin as an effective barrier. — Marc Levitt summarizing the discussion [Ep 22 · 3:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=239)
- High frequency ultrasound measurement of internal muscle thickness can help determine the segment of aganglionic bowel and may be used together with biopsies. — Felipe Jali summarizing the discussion [Ep 22 · 5:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=349)
- Improved instrumentation is making robotic colorectal surgery feasible in children less than 10 kg. — Marc Levitt summarizing the discussion [Ep 22 · 6:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=400)
- Robotic surgery expenses have become almost equivalent to other techniques. — Felipe Jali summarizing the discussion [Ep 22 · 6:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=411)
- Goblet cells increase from proximal to distal colon, producing more mucus distally, which may explain why more extensive resection increases enterocolitis risk due to less mucosal protection. — Marc Levitt summarizing the discussion [Ep 22 · 7:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=460)
- Mechanical stress and distension on the bowel wall leads to increased gut microbial dysbiosis and breakdown of the mucosal barrier, with upregulation of pro-inflammatory factors affecting immune response. — Marc Levitt summarizing the discussion [Ep 22 · 8:37](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=517)
- The Ready, Steady Go program uses patient questionnaires to assess knowledge of disease, symptoms, and readiness for transition. — The host summarizing the discussion [Ep 22 · 14:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=880)
- The PPP (perineal preserving PSARP) avoids perineal body dissection and the risk of dehiscence, potentially eliminating the need for colostomies in many patients. — Marc Levitt summarizing the discussion [Ep 22 · 16:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=985)
- The PRAA (posterectal advancement anoplasty) mobilizes only the posterior rectal wall in males with perineal fistula and some females when the fistula is in the anteriormost extent of the sphincteric ellipse. — Marc Levitt summarizing the discussion [Ep 22 · 16:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1017)
- Delaying vaginal reconstruction in cloaca may allow for other surgical options with less morbidity and potentially avoid bowel vaginoplasty. — Felipe Jali summarizing the discussion [Ep 22 · 18:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1087)
- A bowel neovagina can hold the spot in cloaca patients and may be resected later in life when the patient is older. — Felipe Jali summarizing the discussion [Ep 22 · 18:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1107)
- Removal of the skin tag in chronic anal fissure, along with injection of 20-50 units of Botox, can lead to better long-term healing. — Felipe Jali summarizing the discussion [Ep 22 · 21:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1262)
- There is a higher incidence of perianal disease in children with Crohn's disease, and this can be the first hint that the patient will develop Crohn's disease. — Marc Levitt summarizing the discussion [Ep 22 · 21:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1295)
- Enteral nutrition is as effective as steroids in treating transmural inflammation or stenosis of the small bowel in Crohn's disease. — Marc Levitt summarizing the discussion [Ep 22 · 21:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1313)

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