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 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 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 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 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 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.
quoteAnd so our first hot topic is anal dilations following posterior sagittal anorectoplasty or the PSA.↗
▶Ep 44 · 1:10
host_summaryA single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.↗
▶Ep 44 · 1:37
host_summaryIn the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.↗
▶Ep 44 · 1:50
host_summaryThe average PSARP was performed at 5 months in the study.↗
▶Ep 44 · 1:52
host_summaryA stricture was defined as a Hagar dilator size of less than 10.↗
▶Ep 44 · 2:26
host_summaryStrictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.↗
▶Ep 44 · 3:09
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 44 · 3:19
opinionDr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.↗
▶Ep 44 · 3:38
opinionDr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.↗
▶Ep 44 · 4:04
epidemiologicalAbout 5 to 8% of patients require a strictureplasty at the two-month period.↗
▶Ep 44 · 5:03
opinionDr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.↗
▶Ep 44 · 7:27
host_summaryLong segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.↗
▶Ep 44 · 7:42
host_summaryA contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.↗
▶Ep 44 · 7:51
host_summaryThere was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.↗
▶Ep 44 · 8:13
host_summaryThere are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.↗
▶Ep 44 · 8:31
host_summaryA hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.↗
▶Ep 44 · 8:49
host_summaryIf a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.↗
▶Ep 44 · 9:25
opinionDr. 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.↗
▶Ep 44 · 11:38
host_summaryA study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days.↗
▶Ep 44 · 11:46
host_summaryPreoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation.↗
▶Ep 44 · 13:26
host_summaryUrethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction.↗
▶Ep 44 · 13:44
host_summaryIf a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence.↗
▶Ep 44 · 13:55
host_summaryA short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement.↗
▶Ep 44 · 14:03
host_summaryRotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy.↗
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 45 · 3:35
host_summaryA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 45 · 4:00
host_summaryLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 45 · 4:36
host_summaryStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 45 · 5:29
host_summaryIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 45 · 6:12
host_summaryThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 45 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 45 · 8:30
quoteI 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.↗
▶Ep 45 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 45 · 9:37
quoteI 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.↗
▶Ep 45 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 45 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 45 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 45 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 45 · 22:57
host_summaryLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 45 · 23:38
host_summaryContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 45 · 23:55
host_summaryFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 45 · 24:23
host_summaryA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 45 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 45 · 25:32
quoteI 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.↗
▶Ep 45 · 26:23
quoteI 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.↗
▶Ep 45 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 45 · 30:06
host_summaryA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 45 · 30:37
host_summaryPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 45 · 30:46
host_summaryConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 45 · 30:55
host_summaryTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 45 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 45 · 31:12
quoteBasically, 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.↗
▶Ep 45 · 35:19
host_summaryThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 45 · 35:57
host_summaryA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 45 · 36:05
host_summaryRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
▶Ep 100 · 1:48
quoteDoctor Levitt, you've always talked about how about 5% of what we do is surgical and the rest is bowel management.↗
▶Ep 100 · 1:48
host_summaryAbout 5% of colorectal work is surgical and the rest is bowel management.↗
▶Ep 100 · 1:48
opinionAbout 5% of colorectal work is surgical and the rest is bowel management.↗
▶Ep 100 · 1:48
quoteDoctor Levitt, you've always talked about how about 5% of what we do is surgical and the rest is bowel management.↗
▶Ep 100 · 9:39
clinicalA Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.↗
▶Ep 100 · 9:39
clinicalA Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.↗
▶Ep 100 · 9:49
clinicalChildren with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.↗
▶Ep 100 · 9:49
quotechildren with spinal differences may need an access to the bladder later in life, and that the beau a beautiful channel with that would actually be from the appendix.↗
▶Ep 100 · 9:49
clinicalChildren with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.↗
▶Ep 100 · 9:49
quotechildren with spinal differences may need an access to the bladder later in life, and that the beau a beautiful channel with that would actually be from the appendix.↗
▶Ep 100 · 11:53
clinicalA cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.↗
▶Ep 100 · 11:53
clinicalA cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.↗
▶Ep 100 · 12:00
quoteI call it the G tube of the colon or G tube of the cecum.↗
▶Ep 100 · 12:00
quoteI call it the G tube of the colon or G tube of the cecum.↗
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
▶Ep 105 · 8:25
clinicalIn a very ill child, a contrast study would not be the best initial option; resuscitation and stabilization should come first.↗
▶Ep 105 · 8:25
clinicalIn a very ill child, a contrast study would not be the best initial option; resuscitation and stabilization should come first.↗
▶Ep 105 · 15:50
quoteIrrigation is CPR of the colon is how I compare it to family.↗
▶Ep 105 · 15:50
quoteIrrigation is CPR of the colon is how I compare it to family.↗
▶Ep 105 · 20:48
clinicalOn contrast enema, if the catheter is inserted too high or the balloon is under too much pressure, distal pathology cannot be easily ascertained.↗
▶Ep 105 · 20:48
clinicalOn contrast enema, if the catheter is inserted too high or the balloon is under too much pressure, distal pathology cannot be easily ascertained.↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 107 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 107 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 107 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 107 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 107 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
▶Ep 107 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
quoteAnd so our first hot topic is anal dilations following posterior sagittal anorectoplasty or the PSA.↗
▶Ep 122 · 0:58
quoteAnd so our first hot topic is anal dilations following posterior sagittal anorectoplasty or the PSA.↗
▶Ep 122 · 1:10
clinicalA single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.↗
▶Ep 122 · 1:10
host_summaryA single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.↗
▶Ep 122 · 1:37
host_summaryIn the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.↗
▶Ep 122 · 1:37
clinicalIn the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.↗
▶Ep 122 · 1:50
clinicalThe average PSARP was performed at 5 months in the study.↗
▶Ep 122 · 1:50
host_summaryThe average PSARP was performed at 5 months in the study.↗
▶Ep 122 · 1:52
host_summaryA stricture was defined as a Hagar dilator size of less than 10.↗
▶Ep 122 · 1:52
clinicalA stricture was defined as a Hagar dilator size of less than 10.↗
▶Ep 122 · 2:26
clinicalStrictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.↗
▶Ep 122 · 2:26
host_summaryStrictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.↗
▶Ep 122 · 3:09
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 122 · 3:09
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 122 · 3:19
opinionDr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.↗
▶Ep 122 · 3:19
opinionDr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.↗
▶Ep 122 · 3:38
opinionDr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.↗
▶Ep 122 · 3:38
opinionDr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.↗
▶Ep 122 · 4:04
epidemiologicalAbout 5 to 8% of patients require a strictureplasty at the two-month period.↗
▶Ep 122 · 4:04
epidemiologicalAbout 5 to 8% of patients require a strictureplasty at the two-month period.↗
▶Ep 122 · 5:03
opinionDr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.↗
▶Ep 122 · 5:03
opinionDr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.↗
▶Ep 122 · 7:27
host_summaryLong segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.↗
▶Ep 122 · 7:27
clinicalLong segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.↗
▶Ep 122 · 7:42
clinicalA contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.↗
▶Ep 122 · 7:42
host_summaryA contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.↗
▶Ep 122 · 7:51
host_summaryThere was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.↗
▶Ep 122 · 7:51
clinicalThere was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.↗
▶Ep 122 · 8:13
clinicalThere are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.↗
▶Ep 122 · 8:13
host_summaryThere are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.↗
▶Ep 122 · 8:31
host_summaryA hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.↗
▶Ep 122 · 8:31
clinicalA hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.↗
▶Ep 122 · 8:49
clinicalIf a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.↗
▶Ep 122 · 8:49
host_summaryIf a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.↗
▶Ep 122 · 9:25
opinionDr. 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.↗
▶Ep 122 · 9:25
opinionDr. 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.↗
▶Ep 122 · 11:38
host_summaryA study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days.↗
▶Ep 122 · 11:38
clinicalA study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days.↗
▶Ep 122 · 11:46
host_summaryPreoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation.↗
▶Ep 122 · 11:46
clinicalPreoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation.↗
▶Ep 122 · 13:26
host_summaryUrethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction.↗
▶Ep 122 · 13:26
clinicalUrethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction.↗
▶Ep 122 · 13:44
host_summaryIf a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence.↗
▶Ep 122 · 13:44
clinicalIf a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence.↗
▶Ep 122 · 13:55
clinicalA short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement.↗
▶Ep 122 · 13:55
host_summaryA short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement.↗
▶Ep 122 · 14:03
clinicalRotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy.↗
▶Ep 122 · 14:03
host_summaryRotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy.↗
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 123 · 3:30
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 123 · 3:35
clinicalA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 123 · 3:35
host_summaryA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 123 · 4:00
clinicalLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 123 · 4:00
host_summaryLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 123 · 4:36
clinicalStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 123 · 4:36
host_summaryStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 123 · 5:29
host_summaryIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 123 · 5:29
clinicalIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 123 · 6:12
host_summaryThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 123 · 6:12
clinicalThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 123 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 123 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 123 · 8:30
quoteI 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.↗
▶Ep 123 · 8:30
quoteI 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.↗
▶Ep 123 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 123 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 123 · 9:37
quoteI 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.↗
▶Ep 123 · 9:37
quoteI 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.↗
▶Ep 123 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 123 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 123 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 123 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 123 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 123 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 123 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 123 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 123 · 22:57
host_summaryLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 123 · 22:57
clinicalLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 123 · 23:38
clinicalContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 123 · 23:38
host_summaryContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 123 · 23:55
host_summaryFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 123 · 23:55
clinicalFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 123 · 24:23
clinicalA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 123 · 24:23
host_summaryA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 123 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 123 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 123 · 25:32
quoteI 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.↗
▶Ep 123 · 25:32
quoteI 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.↗
▶Ep 123 · 26:23
quoteI 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.↗
▶Ep 123 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 123 · 26:23
quoteI 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.↗
▶Ep 123 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 123 · 30:06
host_summaryA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 123 · 30:06
clinicalA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 123 · 30:37
clinicalPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 123 · 30:37
host_summaryPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 123 · 30:46
host_summaryConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 123 · 30:46
clinicalConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 123 · 30:55
clinicalTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 123 · 30:55
host_summaryTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 123 · 31:12
quoteBasically, 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.↗
▶Ep 123 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 123 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 123 · 31:12
quoteBasically, 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.↗
▶Ep 123 · 35:19
clinicalThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 123 · 35:19
host_summaryThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 123 · 35:57
host_summaryA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 123 · 35:57
clinicalA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 123 · 36:05
host_summaryRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
▶Ep 123 · 36:05
clinicalRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
▶Ep 2 · 8:25
clinicalIn a very ill child, a contrast study would not be the best initial option; resuscitation and stabilization should come first.↗
▶Ep 2 · 15:50
quoteIrrigation is CPR of the colon is how I compare it to family.↗
▶Ep 2 · 20:48
clinicalOn contrast enema, if the catheter is inserted too high or the balloon is under too much pressure, distal pathology cannot be easily ascertained.↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 3 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 3 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 3 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 3 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 3 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
▶Ep 3 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 44 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 44 · 4:57
clinicalLone Star retractor should be used to obtain a circumferential view of the anastomotic area during exam under anesthesia↗
▶Ep 44 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 44 · 5:06
quoteYou really wanna make Make sure that you get a circumferential view of the area. It's, it, a lot of these things sound like you could just kind of do it or get a little bit of a look or take a speculum or something, but you really wanna set up so that you can look at all these things carefully.↗
▶Ep 44 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
▶Ep 44 · 15:08
quoteSo the big reveal here, uh, Doctor Levitt described it perfectly earlier. This was a transition zone from where we did a really, uh, nice generous full thickness rectal biopsy. So, no ganglion cells and nerves up to 80 microns on average.↗
quoteAnd so our first hot topic is anal dilations following posterior sagittal anorectoplasty or the PSA.↗
▶Ep 51 · 1:10
clinicalA single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.↗
▶Ep 51 · 1:37
clinicalIn the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.↗
▶Ep 51 · 1:50
clinicalThe average PSARP was performed at 5 months in the study.↗
▶Ep 51 · 1:52
clinicalA stricture was defined as a Hagar dilator size of less than 10.↗
▶Ep 51 · 2:26
clinicalStrictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.↗
▶Ep 51 · 3:09
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 51 · 3:19
opinionDr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.↗
▶Ep 51 · 3:38
opinionDr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.↗
▶Ep 51 · 4:04
epidemiologicalAbout 5 to 8% of patients require a strictureplasty at the two-month period.↗
▶Ep 51 · 5:03
opinionDr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.↗
▶Ep 51 · 7:27
clinicalLong segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.↗
▶Ep 51 · 7:42
clinicalA contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.↗
▶Ep 51 · 7:51
clinicalThere was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.↗
▶Ep 51 · 8:13
clinicalThere are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.↗
▶Ep 51 · 8:31
clinicalA hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.↗
▶Ep 51 · 8:49
clinicalIf a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.↗
▶Ep 51 · 9:25
opinionDr. 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.↗
▶Ep 51 · 11:38
clinicalA study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days.↗
▶Ep 51 · 11:46
clinicalPreoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation.↗
▶Ep 51 · 13:26
clinicalUrethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction.↗
▶Ep 51 · 13:44
clinicalIf a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence.↗
▶Ep 51 · 13:55
clinicalA short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement.↗
▶Ep 51 · 14:03
clinicalRotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy.↗
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 52 · 3:30
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 52 · 3:35
host_summaryA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 52 · 3:35
clinicalA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 52 · 4:00
clinicalLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 52 · 4:00
host_summaryLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 52 · 4:36
host_summaryStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 52 · 4:36
clinicalStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 52 · 5:29
clinicalIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 52 · 5:29
host_summaryIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 52 · 6:12
host_summaryThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 52 · 6:12
clinicalThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 52 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 52 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 52 · 8:30
quoteI 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.↗
▶Ep 52 · 8:30
quoteI 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.↗
▶Ep 52 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 52 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 52 · 9:37
quoteI 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.↗
▶Ep 52 · 9:37
quoteI 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.↗
▶Ep 52 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 52 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 52 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 52 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 52 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 52 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 52 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 52 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 52 · 22:57
clinicalLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 52 · 22:57
host_summaryLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 52 · 23:38
host_summaryContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 52 · 23:38
clinicalContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 52 · 23:55
host_summaryFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 52 · 23:55
clinicalFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 52 · 24:23
host_summaryA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 52 · 24:23
clinicalA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 52 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 52 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 52 · 25:32
quoteI 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.↗
▶Ep 52 · 25:32
quoteI 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.↗
▶Ep 52 · 26:23
quoteI 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.↗
▶Ep 52 · 26:23
quoteI 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.↗
▶Ep 52 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 52 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 52 · 30:06
clinicalA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 52 · 30:06
host_summaryA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 52 · 30:37
host_summaryPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 52 · 30:37
clinicalPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 52 · 30:46
clinicalConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 52 · 30:46
host_summaryConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 52 · 30:55
clinicalTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 52 · 30:55
host_summaryTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 52 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 52 · 31:12
quoteBasically, 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.↗
▶Ep 52 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 52 · 31:12
quoteBasically, 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.↗
▶Ep 52 · 35:19
host_summaryThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 52 · 35:19
clinicalThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 52 · 35:57
clinicalA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 52 · 35:57
host_summaryA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 52 · 36:05
host_summaryRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
▶Ep 52 · 36:05
clinicalRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
▶Ep 2 · 1:48
opinionAbout 5% of colorectal work is surgical and the rest is bowel management.↗
▶Ep 2 · 1:48
quoteDoctor Levitt, you've always talked about how about 5% of what we do is surgical and the rest is bowel management.↗
▶Ep 2 · 1:48
quoteDoctor Levitt, you've always talked about how about 5% of what we do is surgical and the rest is bowel management.↗
▶Ep 2 · 1:48
host_summaryAbout 5% of colorectal work is surgical and the rest is bowel management.↗
▶Ep 2 · 9:39
clinicalA Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.↗
▶Ep 2 · 9:39
clinicalA Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.↗
▶Ep 2 · 9:49
quotechildren with spinal differences may need an access to the bladder later in life, and that the beau a beautiful channel with that would actually be from the appendix.↗
▶Ep 2 · 9:49
clinicalChildren with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.↗
▶Ep 2 · 9:49
quotechildren with spinal differences may need an access to the bladder later in life, and that the beau a beautiful channel with that would actually be from the appendix.↗
▶Ep 2 · 9:49
clinicalChildren with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.↗
▶Ep 2 · 11:53
clinicalA cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.↗
▶Ep 2 · 11:53
clinicalA cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.↗
▶Ep 2 · 12:00
quoteI call it the G tube of the colon or G tube of the cecum.↗
▶Ep 2 · 12:00
quoteI call it the G tube of the colon or G tube of the cecum.↗
quoteAnd so our first hot topic is anal dilations following posterior sagittal anorectoplasty or the PSA.↗
▶Ep 1 · 1:10
clinicalA single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.↗
▶Ep 1 · 1:37
clinicalIn the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.↗
▶Ep 1 · 1:50
clinicalThe average PSARP was performed at 5 months in the study.↗
▶Ep 1 · 1:52
clinicalA stricture was defined as a Hagar dilator size of less than 10.↗
▶Ep 1 · 2:26
clinicalStrictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.↗
▶Ep 1 · 3:09
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 1 · 3:19
opinionDr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.↗
▶Ep 1 · 3:38
opinionDr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.↗
▶Ep 1 · 4:04
epidemiologicalAbout 5 to 8% of patients require a strictureplasty at the two-month period.↗
▶Ep 1 · 5:03
opinionDr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.↗
▶Ep 1 · 7:27
clinicalLong segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.↗
▶Ep 1 · 7:42
clinicalA contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.↗
▶Ep 1 · 7:51
clinicalThere was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.↗
▶Ep 1 · 8:13
clinicalThere are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.↗
▶Ep 1 · 8:31
clinicalA hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.↗
▶Ep 1 · 8:49
clinicalIf a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.↗
▶Ep 1 · 9:25
opinionDr. 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.↗
▶Ep 1 · 11:38
clinicalA study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days.↗
▶Ep 1 · 11:46
clinicalPreoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation.↗
▶Ep 1 · 13:26
clinicalUrethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction.↗
▶Ep 1 · 13:44
clinicalIf a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence.↗
▶Ep 1 · 13:55
clinicalA short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement.↗
▶Ep 1 · 14:03
clinicalRotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy.↗
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 2 · 3:30
quoteAre routine anal dilations needed following a PSARP? And what this study found in a single institution prospective randomized controlled trial. Is that They may not be needed.↗
▶Ep 2 · 3:35
clinicalA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 2 · 3:35
host_summaryA single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up.↗
▶Ep 2 · 4:00
clinicalLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 2 · 4:00
host_summaryLiterature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing.↗
▶Ep 2 · 4:36
clinicalStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 2 · 4:36
host_summaryStricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12.↗
▶Ep 2 · 5:29
clinicalIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 2 · 5:29
host_summaryIn the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups.↗
▶Ep 2 · 6:12
clinicalThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 2 · 6:12
host_summaryThe number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group).↗
▶Ep 2 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 2 · 6:23
quoteSo there is a really good case here to abandon doing dilations postoperatively for children with anorectal malformations.↗
▶Ep 2 · 8:30
quoteI 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.↗
▶Ep 2 · 8:30
quoteI 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.↗
▶Ep 2 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 2 · 9:35
clinicalThe Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique.↗
▶Ep 2 · 9:37
quoteI 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.↗
▶Ep 2 · 9:37
quoteI 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.↗
▶Ep 2 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 2 · 10:25
clinicalCurrent practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed.↗
▶Ep 2 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 2 · 11:07
clinicalThe Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals.↗
▶Ep 2 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 2 · 18:17
opinionThe optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft.↗
▶Ep 2 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 2 · 18:31
quote2 to 3 months is nice because you're just keeping the fistula open. You're not trying to increase the size. You're not trying to quote-unquote, go anywhere to like get to a 12. You're just wanting the stool to be able to come out.↗
▶Ep 2 · 22:57
host_summaryLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 2 · 22:57
clinicalLong-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles.↗
▶Ep 2 · 23:38
clinicalContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 2 · 23:38
host_summaryContrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed.↗
▶Ep 2 · 23:55
host_summaryFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 2 · 23:55
clinicalFor long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures.↗
▶Ep 2 · 24:23
clinicalA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 2 · 24:23
host_summaryA European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown.↗
▶Ep 2 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 2 · 25:32
quoteI 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.↗
▶Ep 2 · 25:32
quoteI 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.↗
▶Ep 2 · 25:32
clinicalWater-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients.↗
▶Ep 2 · 26:23
quoteI 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.↗
▶Ep 2 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 2 · 26:23
clinicalDelaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging.↗
▶Ep 2 · 26:23
quoteI 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.↗
▶Ep 2 · 30:06
host_summaryA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 2 · 30:06
clinicalA PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group).↗
▶Ep 2 · 30:37
clinicalPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 2 · 30:37
host_summaryPost-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups).↗
▶Ep 2 · 30:46
host_summaryConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 2 · 30:46
clinicalConstipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease.↗
▶Ep 2 · 30:55
host_summaryTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 2 · 30:55
clinicalTransition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation.↗
▶Ep 2 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 2 · 31:12
clinicalDelayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support.↗
▶Ep 2 · 31:12
quoteBasically, 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.↗
▶Ep 2 · 31:12
quoteBasically, 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.↗
▶Ep 2 · 35:19
host_summaryThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 2 · 35:19
clinicalThe urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence.↗
▶Ep 2 · 35:57
host_summaryA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 2 · 35:57
clinicalA short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation.↗
▶Ep 2 · 36:05
clinicalRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
▶Ep 2 · 36:05
host_summaryRotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning.↗
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
▶Ep 2 · 1:48
quoteDoctor Levitt, you've always talked about how about 5% of what we do is surgical and the rest is bowel management.↗
▶Ep 2 · 1:48
host_summaryAbout 5% of colorectal work is surgical and the rest is bowel management.↗
▶Ep 2 · 9:39
clinicalA Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel.↗
▶Ep 2 · 9:49
quotechildren with spinal differences may need an access to the bladder later in life, and that the beau a beautiful channel with that would actually be from the appendix.↗
▶Ep 2 · 9:49
clinicalChildren with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel.↗
▶Ep 2 · 11:53
clinicalA cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction.↗
▶Ep 2 · 12:00
quoteI call it the G tube of the colon or G tube of the cecum.↗
