Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
With Dr. Lindsay Clark & Dr. Megan Misa & Dr. Dr. Felipe Gli · hosted by Dr. Dr. Mark Levitt · Colorectal Channel
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Many centers are starting irrigation competency even with an ostomy in place, particularly for total colonic Hirschsprung patients who may have delayed takedown
Enterocolitis remains a risk for Hirschsprung patients even after pull-through at about a rate of 20% of all patients
Regular irrigations minimize enterocolitis risk
Total colonic Hirschsprung patients represent the highest risk group for enterocolitis
Most centers still do some kind of crusting, putting stool on the bottom first while patients have a stoma for small periods of time to help get their bottom used to it
Betel leaf was used for peristomal skin protection in Bangladesh with pristine skin results
Diet and nutrition management is not one size fits all; families must identify individual food triggers through pattern recognition
There have been advances in robotic-assisted repair for Hirschsprung disease and use of ICG to check blood supply of pull-throughs
ICG fluorescence imaging can reduce the risk of leaks and ischemia during pull-throughs
High frequency ultrasound measurement of muscle internal thickness can help determine the segment of aganglionic bowel
More surgeons are able to perform robotic surgery on children less than 10 kg because equipment is improving
Robotic surgery expenses have become almost equivalent to other techniques
Goblet cells increase from proximal to distal bowel, producing more mucus distally which has a protective role
The more proximal bowel that needs to be resected, the more at risk the patient is for future enterocolitis because proximal segments don't make as much protective mucus
Mechanical stress and distension on the bowel wall leads to increased gut microbial dysbiosis and breakdown in mucosal lining and barrier function
Bowel wall stress shows upregulation of pro-inflammatory factors affecting immune response, contributing to enterocolitis
Most pull-through decompensation occurs despite originally good pathology, due to inadequate post-operative management
Aggressive management with laxatives when needed and Botox when needed prevents pull-through decompensation
The perineal-preserving PSARP avoids perineal body dissection altogether and avoids dehiscence possibility
Perineal-preserving PSARP could potentially avoid colostomies and colostomy closures in many patients
PRAA (posterectal advancement anoplasty) involves mobilization of posterior rectal wall only in males with perineal fistula and some females with perineal fistula when the fistula is in the anteriormost extent of the sphincteric ellipse
In vestibular fistula repair, surgeons do not need to dissect all the way to the areolar plane separating anterior rectum from posterior vagina; they only need to ensure no tension on the rectum during anoplasty
Delaying vaginal reconstruction in cloaca may allow for other surgical options with less conflict and avoid bowel vaginoplasty
A vaginal replacement can hold the spot in the perineum and be resected later when the patient is older
Cloaca patients need long-term follow-up especially during puberty to avoid menstrual obstruction, incapacity for egress, and risk of endometriosis and damage to uterus and fallopian tubes
Structures that look atretic may actually grow into real useful structures, supporting a strategy of waiting on Mullerian structures
A bowel neovagina can bridge the gap when native vagina does not reach, and may be removable in the future when native vagina can be pulled through after puberty
Removal of the skin tag in chronic anal fissure can lead to better long-term healing
Injection of 20 to 50 units of Botox can improve healing in chronic anal fissure
There is a higher incidence of perianal disease in children with Crohn's disease, and sometimes perianal disease can be the first hint that the patient will develop Crohn's disease
Enteral nutrition is as effective as steroids in treating transmural inflammation or stenosis of small bowel in Crohn's disease