Bilious Emesis
Everything in the library about bilious emesis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Surgical Management
3 items
The Colorectal Quiz Episode 4: Classic Hirschsprung disease - Surgical Technique
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In this episode of the Colorectal Quiz, Dr. Marc Levitt and Dr. Jason Frischer discuss considerations when operating on a patient with classic distal sigmoid Hirschsprung disease with special guests Dr. Aaron Garrison and Dr. Andrea Badillo
podcast19:28 · Feb 2021
The Colorectal Quiz Episode 4
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In this episode of the Colorectal Quiz, Dr. Marc Levitt and Dr. Jason Frischer discuss considerations when operating on a patient with classic distal sigmoid Hi
podcast19:28 · Jul 2026
The Colorectal Quiz Episode 4
Listen →
In this episode of the Colorectal Quiz, Dr. Marc Levitt and Dr. Jason Frischer discuss considerations when operating on a patient with classic distal sigmoid Hi
podcast19:28 · Jul 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
The Colorectal Quiz Episode 4
Suction rectal biopsy confirms the diagnosis of Hirschsprung's disease
clinical1:37 ↗
Two different operative approaches exist for Hirschsprung disease depending on whether transition zone is proximal and complicated versus distal
clinical1:37 ↗
For non-rectosigmoid transition zones, combined laparoscopy and transanal approach is preferred
clinicalAndrea Frischer5:03 ↗
Deep laparoscopic dissection into pelvis minimizes transanal work needed
clinicalAndrea Badillo5:56 ↗
Overstretching of sphincters during extensive transanal dissection is a morbidity that needs to be avoided
clinicalAndrea Badillo5:56 ↗
Transanal dissection should take under one hour in a primary pull-through
clinicalMarc Levitt6:33 ↗
Full thickness biopsy must include seromuscular side same size as mucosal side, cut as a square cube
clinicalAaron Garrison7:09 ↗
Port placement includes umbilical port, right lower and upper quadrant ports, with camera switched to right upper quadrant
clinicalMarc Levitt8:16 ↗
Should wait for frozen section before taking mesentery
clinicalAndrea Badillo9:30 ↗
Pathology must confirm ganglion cells and nerves less than 40 microns
clinicalAndrea Badillo10:00 ↗
Biopsy must include submucosa to avoid finding ganglion cells in seromuscular layer but hypertrophic nerves in submucosal layer
clinicalAndrea Frischer10:19 ↗
Mesenteric dissection should stay close to bowel wall, not deep in mesentery, to reduce bleeding
clinicalAndrea Frischer11:00 ↗
Must stay right on the bowel during dissection because too wide dissection of distal rectum causes incontinence and urinary retention from nerve injury
clinicalMarc Levitt11:42 ↗
Must preserve arcade along left colon and sigmoid to get enough distance to reach pelvis
clinicalAndrea Frischer12:26 ↗
For distal disease, can take just distal branches of IMA; for left colon involvement may need to take IMA to get reach
clinicalMarc Levitt12:35 ↗
Transanal dissection should identify dentate line and mark about one centimeter above into anal canal for division line
clinicalAndrea Badillo13:02 ↗
Preference is Swenson full thickness dissection in areolar plane which is bloodless, not submucosal dissection with cuff
opinionMarc Levitt14:12 ↗
If doing a cuff, make it very short (about one centimeter) and must split the cuff
clinicalMarc Levitt14:12 ↗
Patient can be kept supine with legs wrapped and fastened to ether screen for standard cases
clinicalAndrea Frischer15:04 ↗
Should go about five centimeters above biopsy site for safe margin
clinicalAndrea Frischer16:06 ↗
Tacking sutures on serosa to sidewall at three and six o'clock positions anchor bowel in place
clinicalAaron Garrison16:30 ↗
Reinforcement layer is critical to line up mucosa edge to mucosa edge
clinicalRod Gerardo17:00 ↗
Laparoscopic approach allows deep pelvic dissection minimizing transanal work and avoiding sphincter overstretching
clinicalAaron Garrison6:00 ↗
Transanal dissection in primary pull-through should take under one hour when adequate laparoscopic dissection is performed
clinicalJason Frischer6:33 ↗
Full-thickness biopsy should be a cube with seromuscular side matching mucosal side dimensions
clinicalAaron Garrison7:09 ↗
Frozen section must confirm ganglion cells and nerves less than 40 microns
clinicalAndrea Badillo10:00 ↗
Frozen section biopsy must include submucosa to avoid missing hypertrophic nerves in submucosal layer
clinicalMarc Levitt10:19 ↗
Mesenteric dissection should stay close to bowel wall to minimize bleeding and avoid injury to nerves
clinicalAaron Garrison11:00 ↗
Historical Swenson operations done through abdomen with wide distal rectal dissection caused incontinence and urinary retention from nerve injury
clinicalMarc Levitt11:42 ↗
Marginal arcade along left colon and sigmoid must be preserved to achieve adequate length for pelvic reach
clinicalAndrea Badillo12:26 ↗
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