Rebecca Rentea

I think there's still a question about children that are just sent home with dilations through their fistula and That is something that really is difficult to get away from completely because even not doing a dilation for a day at the neonates bedside for a child that could potentially be sent home and have a delayed posterior sagittal anal ectoplasty, that fistula can close up.

I would say though that the HM anoplasty, there's, um, a really big stress in that paper that long strictures that go through the sphincter complex are likely not to be done well through an HM anoplasty, which should really take place at the skin level.

I think that there is a role with all the techniques that we have now in terms of using water-soluble fiber to thicken stool, Imodium to slow stool down, to be able to titrate the ileostomy effluent before the child has a pull-through.

Basically, a delayed pull-through with irrigation, sending the family home if there is a support system, and that is my editorialization, if there's a support system, is a safe alternative to an operation in the neonatal period.

I think if you wait way too long to do a pull through a special of total colonic, they will have horrible anal sphincter spasm and potentially horrible pelvic disease that makes keeping a pull through really challenging.

Dr. Rentia performs pull-through when the child is toilet trained for urine, typically at age 4, because waiting too long can result in horrible anal sphincter spasm and pelvic disease that makes keeping a pull-through challenging.