Caitlin Smith

324 timestamped statements across 5 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Colorectal / ARM & Hirschsprung · guest expert

Featured diaries

▶ Ep 45 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Anorectal Malformation
▶ Ep 123 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 123 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 52 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Hirschsprung disease
▶ Ep 52 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Hirschsprung disease
▶ Ep 2 · 17:39
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote · Rectal Bladder Neck Fistula

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Anorectal Malformation 41 entries

Update Course Rewind: Pediatric Colorectal Consortium 2021

▶ Ep 44 · 5:40
host_summary 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. ↗
▶ Ep 44 · 5:45
host_summary A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. ↗
▶ Ep 44 · 6:22
opinion Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. ↗
▶ Ep 44 · 6:32
clinical Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. ↗
▶ Ep 44 · 6:47
clinical Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. ↗
▶ Ep 44 · 10:36
host_summary A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. ↗
▶ Ep 44 · 10:45
host_summary Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. ↗
▶ Ep 44 · 11:14
host_summary The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. ↗
▶ Ep 44 · 12:15
host_summary A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. ↗
▶ Ep 44 · 12:40
opinion Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. ↗

Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS

▶ Ep 45 · 14:55
host_summary An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 45 · 15:53
host_summary A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 45 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 45 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 45 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 45 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 45 · 28:16
host_summary Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 45 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 45 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 45 · 28:58
host_summary A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 45 · 29:18
host_summary In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 45 · 32:12
host_summary In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 45 · 32:32
host_summary A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗

Update Course 2023 - Updates in Colorectal Pathology

▶ Ep 46 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 46 · 3:27
host_summary A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 46 · 4:13
host_summary In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 46 · 4:24
host_summary In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 46 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 46 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 46 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 46 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 46 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 46 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 46 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 46 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 46 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 46 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 46 · 25:48
host_summary Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 46 · 26:01
host_summary The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 46 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 46 · 26:54
host_summary The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗
Colorectal / ARM & Hirschsprung 132 entries

Update Course Rewind: Pediatric Colorectal Consortium 2021

▶ Ep 122 · 5:40
clinical 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. ↗
▶ Ep 122 · 5:40
host_summary 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. ↗
▶ Ep 122 · 5:45
host_summary A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. ↗
▶ Ep 122 · 5:45
clinical A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. ↗
▶ Ep 122 · 6:22
opinion Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. ↗
▶ Ep 122 · 6:22
opinion Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. ↗
▶ Ep 122 · 6:32
clinical Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. ↗
▶ Ep 122 · 6:32
clinical Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. ↗
▶ Ep 122 · 6:47
clinical Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. ↗
▶ Ep 122 · 6:47
clinical Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. ↗
▶ Ep 122 · 10:36
host_summary A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. ↗
▶ Ep 122 · 10:36
epidemiological A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. ↗
▶ Ep 122 · 10:45
clinical Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. ↗
▶ Ep 122 · 10:45
host_summary Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. ↗
▶ Ep 122 · 11:14
host_summary The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. ↗
▶ Ep 122 · 11:14
epidemiological The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. ↗
▶ Ep 122 · 12:15
epidemiological A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. ↗
▶ Ep 122 · 12:15
host_summary A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. ↗
▶ Ep 122 · 12:40
opinion Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. ↗
▶ Ep 122 · 12:40
opinion Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. ↗

Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS

▶ Ep 123 · 14:55
host_summary An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 123 · 14:55
clinical An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 123 · 15:53
clinical A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 123 · 15:53
host_summary A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 123 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 123 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 123 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 123 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 123 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 123 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 123 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 123 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 123 · 28:16
clinical Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 123 · 28:16
host_summary Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 123 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 123 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 123 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 123 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 123 · 28:58
host_summary A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 123 · 28:58
epidemiological A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 123 · 29:18
epidemiological In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 123 · 29:18
host_summary In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 123 · 32:12
host_summary In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 123 · 32:12
epidemiological In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 123 · 32:32
epidemiological A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗
▶ Ep 123 · 32:32
host_summary A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗

Update Course 2023 - Updates in Colorectal Pathology

▶ Ep 145 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 145 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 145 · 3:27
host_summary A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 145 · 3:27
clinical A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 145 · 4:13
clinical In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 145 · 4:13
host_summary In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 145 · 4:24
clinical In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 145 · 4:24
host_summary In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 145 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 145 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 145 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 145 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 145 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 145 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 145 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 145 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 145 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 145 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 145 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 145 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 145 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 145 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 145 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 145 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 145 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 145 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 145 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 145 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 145 · 25:48
clinical Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 145 · 25:48
host_summary Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 145 · 26:01
host_summary The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 145 · 26:01
clinical The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 145 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 145 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 145 · 26:54
host_summary The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗
▶ Ep 145 · 26:54
clinical The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗

Update Course Rewind: Botox in Hirschsprung Disease 2023

▶ Ep 157 · 1:08
quote You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease. ↗
▶ Ep 157 · 1:08
quote You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease. ↗
▶ Ep 157 · 1:14
clinical Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease. ↗
▶ Ep 157 · 1:14
clinical Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease. ↗
▶ Ep 157 · 1:33
clinical Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations. ↗
▶ Ep 157 · 1:33
host_summary Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations. ↗
▶ Ep 157 · 1:33
quote In reading every paper that was ever written on Botox in the anus in the last couple of months, people are doing any amount of Botox in any aloquats in any number of locations. ↗
▶ Ep 157 · 1:33
quote In reading every paper that was ever written on Botox in the anus in the last couple of months, people are doing any amount of Botox in any aloquats in any number of locations. ↗
▶ Ep 157 · 1:45
quote I am 100 units in 1 mL. I'm usually more like 34 in the dentate line. ↗
▶ Ep 157 · 1:45
clinical Dr. Smith uses 100 units in 1 mL, usually 3-4 injections in the dentate line. ↗
▶ Ep 157 · 1:45
quote I am 100 units in 1 mL. I'm usually more like 34 in the dentate line. ↗
▶ Ep 157 · 1:45
clinical Dr. Smith uses 100 units in 1 mL, usually 3-4 injections in the dentate line. ↗
▶ Ep 157 · 2:17
quote In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of a ganglion. Internal sphincter, and I think that babies outgrow it because their external sphincter is able to overcome their internal sphincter, and I think that takes time for their body to mature, but I don't know that we have pinpointed the actual pathophysiology. ↗
▶ Ep 157 · 2:17
clinical To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left. ↗
▶ Ep 157 · 2:17
clinical To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left. ↗
▶ Ep 157 · 2:17
quote In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of a ganglion. Internal sphincter, and I think that babies outgrow it because their external sphincter is able to overcome their internal sphincter, and I think that takes time for their body to mature, but I don't know that we have pinpointed the actual pathophysiology. ↗
▶ Ep 157 · 2:23
clinical The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed. ↗
▶ Ep 157 · 2:23
opinion Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures. ↗
▶ Ep 157 · 2:23
clinical The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed. ↗
▶ Ep 157 · 2:23
opinion Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures. ↗
▶ Ep 157 · 3:06
epidemiological There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease. ↗
▶ Ep 157 · 3:06
quote Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me. ↗
▶ Ep 157 · 3:06
epidemiological There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease. ↗
▶ Ep 157 · 3:06
quote Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me. ↗
▶ Ep 157 · 3:21
quote And also much higher rate of enterocolitis in children with trisomy 21. ↗
▶ Ep 157 · 3:21
quote And also much higher rate of enterocolitis in children with trisomy 21. ↗
▶ Ep 157 · 3:21
epidemiological Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease. ↗
▶ Ep 157 · 3:21
epidemiological Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease. ↗
▶ Ep 157 · 3:35
quote There is discussion of whether or not when you're, when you make the diagnosis of total colon Hirschprung at that time, should you do the colectomy because of the risk of enterocolitis, and I don't have a strong opinion on that. ↗
▶ Ep 157 · 3:35
clinical There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk. ↗
▶ Ep 157 · 3:35
clinical There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk. ↗
▶ Ep 157 · 3:35
quote There is discussion of whether or not when you're, when you make the diagnosis of total colon Hirschprung at that time, should you do the colectomy because of the risk of enterocolitis, and I don't have a strong opinion on that. ↗
▶ Ep 157 · 3:49
quote The thing about Hirschhorn disease, I think we all realize is that there's so much phenotypic variance. So in studying the use of Botox in postpo through enterocolitis, the data is not perfect. ↗
▶ Ep 157 · 3:49
quote The thing about Hirschhorn disease, I think we all realize is that there's so much phenotypic variance. So in studying the use of Botox in postpo through enterocolitis, the data is not perfect. ↗
▶ Ep 157 · 3:49
clinical There is significant phenotypic variance in Hirschsprung disease, making study data imperfect. ↗
▶ Ep 157 · 3:49
clinical There is significant phenotypic variance in Hirschsprung disease, making study data imperfect. ↗
▶ Ep 157 · 4:13
quote Some of the data suggest that prophylactic Botox has not been shown to decrease the risk of enterocolitis, but has been shown to decrease the length of stay in patients who have been admitted for enterocolitis. ↗
▶ Ep 157 · 4:13
clinical Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis. ↗
▶ Ep 157 · 4:13
host_summary Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis. ↗
▶ Ep 157 · 4:13
quote Some of the data suggest that prophylactic Botox has not been shown to decrease the risk of enterocolitis, but has been shown to decrease the length of stay in patients who have been admitted for enterocolitis. ↗
▶ Ep 157 · 4:14
clinical Botox has been shown to decrease the length of stay in patients admitted for enterocolitis. ↗
▶ Ep 157 · 4:14
host_summary Botox has been shown to decrease the length of stay in patients admitted for enterocolitis. ↗
▶ Ep 157 · 4:26
host_summary Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 157 · 4:26
quote Also has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 157 · 4:26
clinical Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 157 · 4:26
quote Also has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 157 · 4:34
quote Maybe not everyone needs it at the time of pull through, but maybe there is a subset of patients who really do have some predisposition to enterocolitis. And using Botox as part of that treatment strategy would be beneficial. ↗
▶ Ep 157 · 4:34
opinion Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy. ↗
▶ Ep 157 · 4:34
opinion Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy. ↗
▶ Ep 157 · 4:34
quote Maybe not everyone needs it at the time of pull through, but maybe there is a subset of patients who really do have some predisposition to enterocolitis. And using Botox as part of that treatment strategy would be beneficial. ↗
Hirschsprung disease 54 entries

Update Course Rewind: Pediatric Colorectal Consortium 2021

▶ Ep 51 · 5:40
clinical 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. ↗
▶ Ep 51 · 5:45
clinical A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. ↗
▶ Ep 51 · 6:22
opinion Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. ↗
▶ Ep 51 · 6:32
clinical Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. ↗
▶ Ep 51 · 6:47
clinical Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. ↗
▶ Ep 51 · 10:36
epidemiological A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. ↗
▶ Ep 51 · 10:45
clinical Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. ↗
▶ Ep 51 · 11:14
epidemiological The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. ↗
▶ Ep 51 · 12:15
epidemiological A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. ↗
▶ Ep 51 · 12:40
opinion Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. ↗

Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS

▶ Ep 52 · 14:55
clinical An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 52 · 14:55
host_summary An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 52 · 15:53
clinical A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 52 · 15:53
host_summary A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 52 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 52 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 52 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 52 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 52 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 52 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 52 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 52 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 52 · 28:16
clinical Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 52 · 28:16
host_summary Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 52 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 52 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 52 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 52 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 52 · 28:58
host_summary A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 52 · 28:58
epidemiological A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 52 · 29:18
epidemiological In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 52 · 29:18
host_summary In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 52 · 32:12
host_summary In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 52 · 32:12
epidemiological In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 52 · 32:32
epidemiological A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗
▶ Ep 52 · 32:32
host_summary A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗

Update Course 2023 - Updates in Colorectal Pathology

▶ Ep 61 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 61 · 3:27
clinical A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 61 · 4:13
clinical In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 61 · 4:24
clinical In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 61 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 61 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 61 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 61 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 61 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 61 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 61 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 61 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 61 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 61 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 61 · 25:48
clinical Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 61 · 26:01
clinical The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 61 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 61 · 26:54
clinical The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗
Hirschsprung's-associated Enterocolitis 25 entries

Update Course Rewind: Botox in Hirschsprung Disease 2023

▶ Ep 4 · 1:08
quote You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease. ↗
▶ Ep 4 · 1:14
clinical Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease. ↗
▶ Ep 4 · 1:33
host_summary Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations. ↗
▶ Ep 4 · 1:33
quote In reading every paper that was ever written on Botox in the anus in the last couple of months, people are doing any amount of Botox in any aloquats in any number of locations. ↗
▶ Ep 4 · 1:45
clinical Dr. Smith uses 100 units in 1 mL, usually 3-4 injections in the dentate line. ↗
▶ Ep 4 · 1:45
quote I am 100 units in 1 mL. I'm usually more like 34 in the dentate line. ↗
▶ Ep 4 · 2:17
quote In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of a ganglion. Internal sphincter, and I think that babies outgrow it because their external sphincter is able to overcome their internal sphincter, and I think that takes time for their body to mature, but I don't know that we have pinpointed the actual pathophysiology. ↗
▶ Ep 4 · 2:17
clinical To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left. ↗
▶ Ep 4 · 2:23
clinical The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed. ↗
▶ Ep 4 · 2:23
opinion Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures. ↗
▶ Ep 4 · 3:06
epidemiological There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease. ↗
▶ Ep 4 · 3:06
quote Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me. ↗
▶ Ep 4 · 3:21
epidemiological Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease. ↗
▶ Ep 4 · 3:21
quote And also much higher rate of enterocolitis in children with trisomy 21. ↗
▶ Ep 4 · 3:35
clinical There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk. ↗
▶ Ep 4 · 3:35
quote There is discussion of whether or not when you're, when you make the diagnosis of total colon Hirschprung at that time, should you do the colectomy because of the risk of enterocolitis, and I don't have a strong opinion on that. ↗
▶ Ep 4 · 3:49
clinical There is significant phenotypic variance in Hirschsprung disease, making study data imperfect. ↗
▶ Ep 4 · 3:49
quote The thing about Hirschhorn disease, I think we all realize is that there's so much phenotypic variance. So in studying the use of Botox in postpo through enterocolitis, the data is not perfect. ↗
▶ Ep 4 · 4:13
host_summary Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis. ↗
▶ Ep 4 · 4:13
quote Some of the data suggest that prophylactic Botox has not been shown to decrease the risk of enterocolitis, but has been shown to decrease the length of stay in patients who have been admitted for enterocolitis. ↗
▶ Ep 4 · 4:14
host_summary Botox has been shown to decrease the length of stay in patients admitted for enterocolitis. ↗
▶ Ep 4 · 4:26
quote Also has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 4 · 4:26
host_summary Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis. ↗
▶ Ep 4 · 4:34
opinion Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy. ↗
▶ Ep 4 · 4:34
quote Maybe not everyone needs it at the time of pull through, but maybe there is a subset of patients who really do have some predisposition to enterocolitis. And using Botox as part of that treatment strategy would be beneficial. ↗
Rectal Bladder Neck Fistula 72 entries

Update Course Rewind: Pediatric Colorectal Consortium 2021

▶ Ep 1 · 5:40
clinical 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. ↗
▶ Ep 1 · 5:45
clinical A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. ↗
▶ Ep 1 · 6:22
opinion Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. ↗
▶ Ep 1 · 6:32
clinical Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. ↗
▶ Ep 1 · 6:47
clinical Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. ↗
▶ Ep 1 · 10:36
epidemiological A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. ↗
▶ Ep 1 · 10:45
clinical Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. ↗
▶ Ep 1 · 11:14
epidemiological The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. ↗
▶ Ep 1 · 12:15
epidemiological A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. ↗
▶ Ep 1 · 12:40
opinion Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. ↗

Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS

▶ Ep 2 · 14:55
clinical An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 2 · 14:55
host_summary An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. ↗
▶ Ep 2 · 15:53
clinical A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 2 · 15:53
host_summary A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. ↗
▶ Ep 2 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 2 · 17:39
opinion Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. ↗
▶ Ep 2 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 2 · 17:39
quote I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well. ↗
▶ Ep 2 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 2 · 18:54
clinical Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. ↗
▶ Ep 2 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 2 · 19:17
quote You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult. ↗
▶ Ep 2 · 28:16
clinical Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 2 · 28:16
host_summary Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. ↗
▶ Ep 2 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 2 · 28:34
quote I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age. ↗
▶ Ep 2 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 2 · 28:52
quote I think that was really important information, um, that we gained, um. ↗
▶ Ep 2 · 28:58
epidemiological A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 2 · 28:58
host_summary A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. ↗
▶ Ep 2 · 29:18
epidemiological In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 2 · 29:18
host_summary In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. ↗
▶ Ep 2 · 32:12
host_summary In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 2 · 32:12
epidemiological In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. ↗
▶ Ep 2 · 32:32
epidemiological A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗
▶ Ep 2 · 32:32
host_summary A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. ↗

Update Course 2023 - Updates in Colorectal Pathology

▶ Ep 3 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 3 · 3:00
quote Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety. ↗
▶ Ep 3 · 3:27
clinical A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 3 · 3:27
host_summary A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. ↗
▶ Ep 3 · 4:13
clinical In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 3 · 4:13
host_summary In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. ↗
▶ Ep 3 · 4:24
host_summary In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 3 · 4:24
clinical In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. ↗
▶ Ep 3 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 3 · 5:31
clinical Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. ↗
▶ Ep 3 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 3 · 8:23
clinical A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. ↗
▶ Ep 3 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 3 · 9:09
clinical Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. ↗
▶ Ep 3 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 3 · 10:44
clinical Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. ↗
▶ Ep 3 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 3 · 17:18
clinical Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. ↗
▶ Ep 3 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 3 · 17:31
clinical Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. ↗
▶ Ep 3 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 3 · 20:11
clinical The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. ↗
▶ Ep 3 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 3 · 20:42
clinical Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. ↗
▶ Ep 3 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 3 · 20:42
quote I like to think of my Hirschru's patients as having a colon like a river rather than a pond. ↗
▶ Ep 3 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 3 · 23:12
clinical A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. ↗
▶ Ep 3 · 25:48
host_summary Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 3 · 25:48
clinical Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. ↗
▶ Ep 3 · 26:01
host_summary The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 3 · 26:01
clinical The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. ↗
▶ Ep 3 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 3 · 26:22
clinical The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. ↗
▶ Ep 3 · 26:54
clinical The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗
▶ Ep 3 · 26:54
host_summary The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. ↗