Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Do we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?
Update Course 2023 - Updates in Colorectal Pathology
▶Ep 46 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 46 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 46 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 46 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 46 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 46 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 46 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 46 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 46 · 12:10
host_summaryKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 46 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 46 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 46 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 46 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 46 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 46 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 46 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 46 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 46 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 46 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 46 · 23:35
host_summaryMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 46 · 24:14
host_summaryData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 46 · 24:25
host_summaryBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 46 · 24:41
opinionNot all patients need prophylactic 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 46 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
Update Course 2023 - Updates in Colorectal Pathology
▶Ep 145 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 145 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 145 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 145 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 145 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 145 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 145 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 145 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 145 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 145 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 145 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 145 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 145 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 145 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 145 · 12:10
clinicalKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 145 · 12:10
host_summaryKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 145 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 145 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 145 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 145 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 145 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 145 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 145 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 145 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 145 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 145 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 145 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 145 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 145 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 145 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 145 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 145 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 145 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 145 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 145 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 145 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 145 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 145 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 145 · 23:35
host_summaryMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 145 · 23:35
clinicalMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 145 · 24:14
clinicalData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 145 · 24:14
host_summaryData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 145 · 24:25
host_summaryBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 145 · 24:25
clinicalBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 145 · 24:41
opinionNot all patients need prophylactic 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 145 · 24:41
opinionNot all patients need prophylactic 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 145 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
▶Ep 145 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
Update Course 2023 - Updates in Colorectal Pathology
▶Ep 61 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 61 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 61 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 61 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 61 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 61 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 61 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 61 · 12:10
clinicalKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 61 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 61 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 61 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 61 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 61 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 61 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 61 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 61 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 61 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 61 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 61 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 61 · 23:35
clinicalMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 61 · 24:14
clinicalData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 61 · 24:25
clinicalBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 61 · 24:41
opinionNot all patients need prophylactic 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 61 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
Update Course 2023 - Updates in Colorectal Pathology
▶Ep 3 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 3 · 1:57
quoteI used to be an A, a protocol driven Hagar dilation sort of gal, um, and over time based on actually this day that we're about to present. Um, I realized that it wasn't always necessary and that it was in for many families, a really big source of stress.↗
▶Ep 3 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 3 · 2:17
quoteThe worst thing that they would hear is my baby is born without an anus. You're gonna do this operation, but I saw online that they're gonna have to have these dilations and they would freak out about it.↗
▶Ep 3 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 3 · 5:02
quoteDo we have any sense of the impact of doing a strictureplasty or a nanoplasty on long-term continent? Like, I think one of my hesitations around saying, OK, great, we're not going to dilate, and we just move to a place where if they end up with a persistent stricture, they get a nanoplasty. But how does that impact continence?↗
▶Ep 3 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 3 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 3 · 6:29
quoteIt is actually a very, very satisfying operation for a skin level stricture. It takes about 20 minutes. Um, those kids can usually go home and it's just sort of cutting that stricture and, you know, making your 10 into a 13, and the babies really tolerate it very well.↗
▶Ep 3 · 6:29
clinicalStrictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty.↗
▶Ep 3 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 3 · 7:02
opinionBabies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway.↗
▶Ep 3 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 3 · 9:33
clinicalGroski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed.↗
▶Ep 3 · 12:10
host_summaryKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 3 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 3 · 12:10
quoteKeith Jorgeson used to tell us if you don't dilate him at 2 weeks in the office, you're going to be hosed for a stricture. You got to do it at 2 weeks. So that's all I know.↗
▶Ep 3 · 12:10
clinicalKeith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture.↗
▶Ep 3 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 3 · 15:14
clinicalFor Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen.↗
▶Ep 3 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 3 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 3 · 15:27
clinicalEvery baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.↗
▶Ep 3 · 15:27
quoteEvery baby with with Hirschsprung disease has by nature of the disease.↗
▶Ep 3 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 3 · 16:42
clinicalGroski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract.↗
▶Ep 3 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 3 · 19:18
clinicalTo maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter.↗
▶Ep 3 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 3 · 19:27
opinionBabies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected.↗
▶Ep 3 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 3 · 21:09
clinicalTotal colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization.↗
▶Ep 3 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 3 · 21:26
clinicalChildren with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation.↗
▶Ep 3 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 3 · 21:53
opinionEnterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur.↗
▶Ep 3 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 3 · 22:55
clinicalThere is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through.↗
▶Ep 3 · 23:35
host_summaryMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 3 · 23:35
clinicalMost studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity.↗
▶Ep 3 · 24:14
clinicalData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 3 · 24:14
host_summaryData suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis.↗
▶Ep 3 · 24:25
host_summaryBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 3 · 24:25
clinicalBotox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis.↗
▶Ep 3 · 24:41
opinionNot all patients need prophylactic 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 3 · 24:41
opinionNot all patients need prophylactic 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 3 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
▶Ep 3 · 27:12
clinicalFor patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this.↗
