# Rectal Vestibular Fistula — GCMD Library living collection

Everything in the library about rectal vestibular fistula — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 62 cited statements

## Episodes
### Evidence & Research
- [Update Course Rewind 2025: Timing of PSARP: Early vs. Delayed—Does It Really Matter?](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860) — video · 3:45 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860.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)

### Case-Based Learning
- [Colorectal Quiz Episode 38: Transitional Care in Colorectal Surgery](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049) — video · 25:39 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=0) Case Presentation: 27-Year-Old with Lifelong Incontinence After ARM Repair (Ep 1)
- [3:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=196) Physical Examination Strategy and Findings in ARM Redo Cases (Ep 1)
- [7:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=470) Redo PSARP: Surgical Technique and Postoperative Management (Ep 1)
- [11:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=696) Transitional Care Model: Joint Clinics and Collaborative Surgery (Ep 1)
- [17:56](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1076) Systemic Barriers: Credentialing, ICU Care, and Financial Incentives (Ep 1)
- [21:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1303) Patient Empowerment: Medical Passports and Parent Associations (Ep 1)
- [24:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1470) Closing Remarks and Surgical Humor (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=0) Introduction and Case Presentation (Ep 2)
- [0:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=50) Initial Management: Dilations (Ep 2)
- [1:26](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=86) Timing Debate: Early vs. Delayed PSARP (Ep 2)
- [1:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=116) Evidence Review: 2021 Studies (Ep 2)
- [2:52](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=172) Practical Considerations (Ep 2)
- [3:22](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=202) Summary and Conclusions (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.
- A 27-year-old female presented with lifelong fecal incontinence following newborn repair of rectal vestibular fistula; she had been told her incontinence was normal and unavoidable until puberty when daily irrigations were introduced, which restored her social life. — Mark Malota (clinical) [Ep 1 · 1:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=85)
- The patient had rectal prolapse 2–3 years prior to presentation, which was repaired by an adult colorectal surgeon. — Mark Malota (clinical) [Ep 1 · 2:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=142)
- Original operation reports from the early 1990s were incomplete, making it difficult to evaluate the initial surgical situation. — Mark Malota (clinical) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=165)
- Examination under anesthesia is a valuable maneuver for ARM patients with previous surgery, allowing assessment of anoplasty prolapse, stricture, and proper location via electrical stimulation. — Marc Levitt (clinical) [Ep 1 · 3:37](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=217)
- MRI with specific protocols and endorectal ultrasound can help determine whether the anoplasty is within the muscle complex. — Jason Frischer (clinical) [Ep 1 · 3:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=239)
- In males, cystoscopy is added to evaluation to rule out remnant fistula and assess bladder mucosa and emptying; in females, cystoscopy can identify inappropriate fistulas. — Marc Levitt (clinical) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=255)
- The patient's anus was too ventrally located; a dimple posterior to the current anus marked where the anus should be, and electrical stimulation of the external sphincter showed the proper limits. — Stuart Hosie (clinical) [Ep 1 · 4:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=292)
- The functional problem is absence of sphincter anterior to the anoplasty: when the patient squeezes, the sphincter cannot close the anterior aspect and stool slips out, whereas proper concentric sphincter placement would successfully close the hole. — Marc Levitt (clinical) [Ep 1 · 5:28](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=328)
- The most common problem in females requiring redo surgery is absence of a circular sphincter (an O), either from improper initial placement or dehiscence of the perineal body leaving a C-shaped sphincter; the surgical goal is to get muscle in front of the anus. — Marc Levitt (clinical) [Ep 1 · 5:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=354)
- Examination under anesthesia with electrical stimulation and anal ultrasound confirmed a C-shaped sphincter with the anterior part not surrounded by sphincter muscle. — Mark Malota (clinical) [Ep 1 · 6:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=402)
- The rectal prolapse treated by the adult surgeon (mucosal plication) was interpreted as a late sign of the missing sphincter complex. — Mark Malota (clinical) [Ep 1 · 7:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=432)
- The patient learned to manage daily life despite significant incontinence and felt her quality of life was not bad, though she recognized not everything was fine and improvement was possible. — Stuart Hosie (clinical) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=478)
- Redo PSARP was performed with formal colon prep, preoperative antibiotics continued for a few days, and no diversion. — Stuart Hosie (clinical) [Ep 1 · 8:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=516)
- The redo PSARP was performed collaboratively with adult general surgeons who had never seen such a procedure, providing an opportunity to show them pediatric ARM surgery techniques. — Stuart Hosie (clinical) [Ep 1 · 9:01](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=541)
- Postoperatively, the patient was kept NPO for 5 days then started feeding; everything healed well. — Stuart Hosie (clinical) [Ep 1 · 9:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=558)
- The strategy of non-diversion with postoperative clear liquids (not NPO/TPN) produces soft watery stool that does not harm the perineal repair, whereas real food produces harder stool that can disrupt the repair; patients and families are much happier avoiding PICC lines and TPN. — Marc Levitt (clinical) [Ep 1 · 9:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=592)
- At 5 days, if perineal healing looks good, diet is advanced with laxatives to keep stool liquidy; the problem is hard stool going through the repair, not stool itself, as long as the wound is kept clean. — Marc Levitt (clinical) [Ep 1 · 10:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=655)
- In Germany, pediatric surgeons are not allowed to treat patients over age 18, necessitating transition to adult care. — Mark Malota (guideline) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=720)
- The German transition model begins at age 12 by informing parents that the patient cannot stay in pediatric surgery forever; a network is built with adult colorectal surgeons interested in pediatric procedures, and connections are made to adult physiotherapists, urologists, and gynecologists. — Mark Malota (clinical) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=720)
- During annual visits, the adult surgeon is present so both patient and surgeon get to know each other; the adult surgeon learns the patient's past medical history and the pediatric surgeon explains procedures. This 'soft transition' lasts 3–4 years with the goal that the patient eventually sees only the adult colorectal surgeon. — Mark Malota (clinical) [Ep 1 · 13:04](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=784)
- The transition model includes joint clinic visits and collaborative operating, which is key to successful handoff. — Jason Frischer (opinion) [Ep 1 · 14:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=845)
- The German hospital is a general hospital with both adult and pediatric departments and separate operating theaters; this 27-year-old patient was operated on in the adult OR with adult surgeons and stayed in the adult surgical ward. — Stuart Hosie (clinical) [Ep 1 · 14:26](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=866)
- Freestanding children's hospitals face greater challenges than integrated hospitals because they are completely separate entities both physically and financially. — Jason Frischer (opinion) [Ep 1 · 14:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=894)
- In Cincinnati, ARM patients still come to the colorectal center at the children's hospital whether they are 12 or 40 years old, partnering with an adult colorectal surgeon; collaborative operating occurs at the University of Cincinnati with adult colorectal surgeons, adult neurologists for urology, and pediatric urologists who have privileges at the university. — Jason Frischer (clinical) [Ep 1 · 15:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=914)
- The ideal transition model begins psychologic discussion in early teenage years, engages friendly adult colleagues, and involves joint clinic visits and collaborative operating; most pediatric surgeons understand this because they have received calls from adult surgeons encountering unfamiliar pediatric conditions like malrotation. — Marc Levitt (opinion) [Ep 1 · 16:03](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=963)
- Not all pediatric colorectal surgeons need to physically operate in the adult setting if there are interested adult colleagues; in Jason Frischer's model, he has privileges at the adult hospital but functions primarily as an assistant while the adult surgeon (Ian Piquette) provides adult care expertise. — Marc Levitt (opinion) [Ep 1 · 17:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1036)
- In the United States, the age line for pediatric vs. adult care is very blurry, which is problematic; patients over age 21 (or possibly 18) at children's hospitals face credentialing issues where pediatric nurse practitioners cannot write orders due to licensing restrictions. — Marc Levitt (clinical) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1080)
- If a 40-year-old at a children's hospital needs ICU care, the intensivists are pediatric-trained, not adult-trained, creating a safety concern. — Marc Levitt (clinical) [Ep 1 · 18:46](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1126)
- Adult hospitals are much more adept and skilled at managing perioperative complications like pulmonary embolism or myocardial infarction; such events in a children's hospital lead to many meetings and potential for poor outcomes. — Jason Frischer (opinion) [Ep 1 · 18:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1138)
- Physicians and surgeons are making progress on transition, but the greater struggle is providing intensive bowel management training for 35-year-old patients; pediatric centers are adept at bowel management for patients of any age, but currently adult patients requiring intensive outpatient bowel management are still being seen at children's hospitals. — Jason Frischer (clinical) [Ep 1 · 19:33](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1173)
- Bowel management expertise needs to be passed not just doctor-to-doctor but also nurse-to-nurse and advanced practice provider (NP/PA) to advanced practice provider. — Marc Levitt (opinion) [Ep 1 · 20:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1211)
- Adult colleagues should be introduced to the Malone appendicostomy (which many have never heard of) and the use of Peristeen for self-controlled enemas in adults; these are tricks learned in the pediatric population. — Marc Levitt (opinion) [Ep 1 · 20:23](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1223)
- In the United States, financial pressures favor operations, but many ARM patients do not require operations—they just need medical management that can change their life positively; one week of bowel management can achieve continence in a patient who has been soiling for decades. — Marc Levitt (opinion) [Ep 1 · 20:46](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1246)
- The presented case converted a patient with 27 years of fecal incontinence to normal bowel control by changing anatomy, but this is not always an option; medical management is important, and transition will require devoted colleagues not solely motivated by procedures. — Marc Levitt (opinion) [Ep 1 · 21:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1271)
- Mark Malota has seen over 100 adult patients with ARM-related problems in his outpatient clinic, which represents a failure of transition—these are adults who discover problems after many years and seek help; structured transition from childhood into adulthood would solve most problems before they appear. — Stuart Hosie (opinion) [Ep 1 · 21:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1303)
- Patient and parent associations are important; Germany has a very active association, as do the US, France, and Italy. Together with interested surgeons, they created a booklet for patients and families documenting all information from the newborn period: surgeries performed, malformations, examinations, and follow-up exams. — Stuart Hosie (clinical) [Ep 1 · 22:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1349)
- Structured follow-up is important even though surgeons do not like doing it; if families and patients have all information documented, transition will be much easier. — Stuart Hosie (opinion) [Ep 1 · 23:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1392)
- A patient-held 'passport' template documenting all previous surgical procedures, dates, and medical history should be created and distributed to parent organizations so each family is responsible for maintaining their own record to hand to any new care provider. — Marc Levitt (opinion) [Ep 1 · 23:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1405)
- Transitional care is being done well in several places worldwide, including Paris where pediatric and adult surgeons join each other's clinics for the first couple of visits. — Marc Levitt (clinical) [Ep 1 · 24:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-38-transitional-care-in-colorectal-surgery-8049?t=1447)
- Doing dilations alone is probably not the correct management for rectal vestibular fistula for a number of different reasons. — Jamie Harris (opinion) [Ep 2 · 0:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=59)
- Dilations initially will allow for decompression in rectal vestibular fistula. — Jamie Harris (clinical) [Ep 2 · 0:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=59)
- It is recommended to dilate only to a 7 Hegar to decrease the potential scarring along the track for future PARPs. — Jamie Harris (clinical) [Ep 2 · 1:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=66)
- If trying to keep the fistula open, you only need to keep it open enough for soft stool to pass through, with no reason to drive the dilation up big. (clinical) [Ep 2 · 1:12](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=72)
- One surgeon prefers to do PSARP at one month of age so the baby could grow a little bit bigger. — Nelson (opinion) [Ep 2 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=91)
- Nelson and another panelist disagree on timing, with Nelson liking to do repairs up front while the other prefers getting babies a little older and letting them go home. (opinion) [Ep 2 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=96)
- One surgeon likes to get PSARP done on the neonatal admission, though it doesn't have to be the next day. (opinion) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=105)
- Two important studies on PSARP timing both came out in 2021. — Jamie Harris (clinical) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=116)
- Another 2021 study looked at 30-day outcomes comparing neonatal versus delayed anoplasty in a multi-institutional retrospective study through the PCPLC. — Jamie Harris (clinical) [Ep 2 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=132)
- The PCPLC study defined early repair as within 14 days versus late as after 14 days. — Jamie Harris (clinical) [Ep 2 · 2:22](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=142)
- The PCPLC study concluded the same thing as the NSQIP study regarding safety of early versus delayed repair. — Jamie Harris (clinical) [Ep 2 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=158)
- There is discrepancy in the literature regarding the definition of delayed repair, ranging from a couple of months to multiple months of age, with no right timing of delayed repair established. — Jamie Harris (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=160)
- One drawback to delayed repair is theoretical fibrosis of the fistula tract, making dissection a little bit more difficult on the PSARP. — Jamie Harris (clinical) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=175)
- If the fistula is not completely decompressed, the rectum can get distended and make it technically more difficult to perform the PSARP. — Jamie Harris (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=180)
- With social determinants of health, it's not always easy for families to make multiple trips for care, as it can be a long distance and expensive. — Jamie Harris (clinical) [Ep 2 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=194)
- 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)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- For patients with rectal vestibular fistulas, some surgeons perform anal rectoplasties immediately while others wait until after discharge. — Jill Knepprath summarizing the discussion [Ep 2 · 0:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=23)
- Dr. Jamie Harris presents a case of a full-term newborn baby girl with rectal vestibular fistula weighing 3 kg with completely negative VACTERL workup. — Jill Knepprath summarizes what Dr. Jamie Harris said [Ep 2 · 0:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=37)
- The panel agreed that it's safe to perform the PSARP either early before discharge or later around 1 to 3 months of age. — Jill Knepprath summarizing the discussion [Ep 2 · 1:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=109)
- The NSQIP study defined early repair as 7 days and delayed repair as between 6 weeks and 8 months. — Jill Knepprath summarizing the discussion [Ep 2 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=120)
- The NSQIP study found no difference in overall outcomes, including re-operations and readmissions, between early and delayed PSARP. — Jill Knepprath summarizing the discussion [Ep 2 · 2:07](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=127)
- Wound breakdown and dehiscence was the most common complication for both early and delayed repair groups in the PCPLC study. — Jill Knepprath summarizing the discussion [Ep 2 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=146)
- There was no significant difference in postoperative complications between early and delayed repair groups in the PCPLC study. — Jill Knepprath summarizing the discussion [Ep 2 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=153)
- Early repair during the newborn period avoids an additional admission for the surgery. — Jill Knepprath summarizing the discussion [Ep 2 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=187)
- Both early and delayed PSARP repairs are safe for patients with rectal vestibular fistulas. — Jill Knepprath summarizing the discussion [Ep 2 · 3:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=203)
- What matters most in timing PSARP is the circumstances, family access to care, patient size, and the surgeon's comfort and experience. — Jill Knepprath summarizing the discussion [Ep 2 · 3:29](https://library.globalcastmd.com/watch/update-course-rewind-2025-timing-of-psarp-early-vs-delayed-does-it-really-matter-11860?t=209)
- 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)

## Changelog
- Nov 11: 3 items added automatically

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