Doing dilations alone is probably not the correct management of this for a number of different reasons, but certainly dilations initially will allow for decompression.
I think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.
I think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.
I think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.
I think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 60 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 60 · 2:33
clinicalFor vestibular fistula dilations, recommend only dilating to 7 Hegar to decrease potential scarring along the tract for future PSARP↗
▶Ep 60 · 5:14
clinicalTwo studies in 2021 found no difference in wound complications, re-operations, or readmissions between early (less than 7-14 days) and delayed (6 weeks to 8 months) PSARP for vestibular fistulas↗
▶Ep 60 · 6:00
clinicalWound breakdown and dehiscence was the most common complication in both neonatal and delayed PSARP groups, occurring in approximately 5-6% with no significant difference between groups↗
▶Ep 60 · 13:09
clinicalPerineal body-preserving PSARP can be converted to standard PSARP by extending the incision if visualization is inadequate↗
▶Ep 60 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 60 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP↗
▶Ep 60 · 21:10
quoteI think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.↗
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 180 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 180 · 2:33
clinicalFor vestibular fistula dilations, recommend only dilating to 7 Hegar to decrease potential scarring along the tract for future PSARP↗
▶Ep 180 · 5:14
clinicalTwo studies in 2021 found no difference in wound complications, re-operations, or readmissions between early (less than 7-14 days) and delayed (6 weeks to 8 months) PSARP for vestibular fistulas↗
▶Ep 180 · 6:00
clinicalWound breakdown and dehiscence was the most common complication in both neonatal and delayed PSARP groups, occurring in approximately 5-6% with no significant difference between groups↗
▶Ep 180 · 13:09
clinicalPerineal body-preserving PSARP can be converted to standard PSARP by extending the incision if visualization is inadequate↗
▶Ep 180 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 180 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP↗
▶Ep 180 · 21:10
quoteI think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.↗
Update Course Rewind 2025: Timing of PSARP: Early vs. Delayed—Does It Really Matter?
▶Ep 194 · 0:59
opinionDoing dilations alone is probably not the correct management for rectal vestibular fistula for a number of different reasons.↗
▶Ep 194 · 0:59
quoteDoing dilations alone is probably not the correct management of this for a number of different reasons, but certainly dilations initially will allow for decompression.↗
▶Ep 194 · 0:59
clinicalDilations initially will allow for decompression in rectal vestibular fistula.↗
▶Ep 194 · 1:06
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future Parps.↗
▶Ep 194 · 1:06
clinicalIt is recommended to dilate only to a 7 Hegar to decrease the potential scarring along the track for future PARPs.↗
▶Ep 194 · 1:56
clinicalTwo important studies on PSARP timing both came out in 2021.↗
▶Ep 194 · 2:12
clinicalAnother 2021 study looked at 30-day outcomes comparing neonatal versus delayed anoplasty in a multi-institutional retrospective study through the PCPLC.↗
▶Ep 194 · 2:22
clinicalThe PCPLC study defined early repair as within 14 days versus late as after 14 days.↗
▶Ep 194 · 2:38
clinicalThe PCPLC study concluded the same thing as the NSQIP study regarding safety of early versus delayed repair.↗
clinicalThere 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.↗
▶Ep 194 · 2:55
clinicalOne drawback to delayed repair is theoretical fibrosis of the fistula tract, making dissection a little bit more difficult on the PSARP.↗
▶Ep 194 · 3:00
clinicalIf the fistula is not completely decompressed, the rectum can get distended and make it technically more difficult to perform the PSARP.↗
▶Ep 194 · 3:14
clinicalWith 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.↗
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 78 · 2:33
clinicalFor vestibular fistula dilations, recommend only dilating to 7 Hegar to decrease potential scarring along the tract for future PSARP↗
▶Ep 78 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 78 · 5:14
clinicalTwo studies in 2021 found no difference in wound complications, re-operations, or readmissions between early (less than 7-14 days) and delayed (6 weeks to 8 months) PSARP for vestibular fistulas↗
▶Ep 78 · 6:00
clinicalWound breakdown and dehiscence was the most common complication in both neonatal and delayed PSARP groups, occurring in approximately 5-6% with no significant difference between groups↗
▶Ep 78 · 13:09
clinicalPerineal body-preserving PSARP can be converted to standard PSARP by extending the incision if visualization is inadequate↗
▶Ep 78 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 78 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP↗
▶Ep 78 · 21:10
quoteI think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.↗
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 3 · 2:33
clinicalFor vestibular fistula dilations, recommend only dilating to 7 Hegar to decrease potential scarring along the tract for future PSARP↗
▶Ep 3 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 3 · 5:14
clinicalTwo studies in 2021 found no difference in wound complications, re-operations, or readmissions between early (less than 7-14 days) and delayed (6 weeks to 8 months) PSARP for vestibular fistulas↗
▶Ep 3 · 6:00
clinicalWound breakdown and dehiscence was the most common complication in both neonatal and delayed PSARP groups, occurring in approximately 5-6% with no significant difference between groups↗
▶Ep 3 · 13:09
clinicalPerineal body-preserving PSARP can be converted to standard PSARP by extending the incision if visualization is inadequate↗
▶Ep 3 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 3 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP↗
▶Ep 3 · 21:10
quoteI think that's such an important skill for them to have. And the rate of enterocolitis after pull-through is obviously not zero despite our best efforts.↗
