Collection
Anorectal Malformations and Colorectal Surgery
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
For neonates, one panelist dilates; for older kids, redo cases, or ambulatory patients where dilation would be traumatic, they hold off Routine Anal Dilations After PSARP: Questioning a Decades-Old Practice · 1:46
Surgical Technique and Timing4 items
Routine Anal Dilations After PSARP: Questioning a Decades-Old Practice
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In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery , Drs. Jamie Harris, Elizabeth Speck, Aaron Garrison, and Annie Le-Nguyen revisit a long-standing postoperative practice in colorectal surgery: are routi
podcast2:32 · Nov 2026
Perineal body-preserving PSARP versus classic approach: expert panel discussion
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In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery , Drs. Nelson Rosen, Elizabeth Speck, Aaron Garrison, and Jamie Harris explore a key surgical debate: classic PSARP vs. the perineal body–preserving appr
podcast2:13 · Nov 2026
Timing of PSARP for rectal vestibular fistulas: early versus delayed repair
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In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery , Dr. Jamie Harris—joined by Drs. Nelson Rosen, Annie Le-Nguyen, Aaron Garrison, and Elizabeth Speck—explores one of the most debated questions in colorec
podcast3:45 · Nov 2026
Pediatric Imperforate Anus (Anorectal Malformation) Treatment & Management: Approach Considerations, Surgical Care, Medical Care
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Treatment: Anorectal malformations include a wide spectrum of defects in the development of the lowest portion of the intestinal and urogenital tracts. Many children with these malformations are said to have an imperforate anus because they
article · Nov 2026
Diagnosis and Complications1 item
Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations.
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Rectovaginal fistula is a term that continues to be used frequently to describe girls with anorectal malformations. This study attempts to evaluate the true frequency of this anomaly and the consequences of its misdiagnosis. A retrospective
article · Nov 2026
In older children with low-risk history for Hirschsprung disease (fine for first couple years then constipation worsened), biopsy should usually be done after routine management measures are tried. — Nelson Rosen, Diagnostic workup for Hirschsprung disease in newborns and children · 5:32
Diagnosis and Workup1 item
Diagnostic workup for Hirschsprung disease in newborns and children
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The workup for Hirschsprung disease is bread-and-butter pediatric surgery but it can certainly get confusing. Dr. Nelson Rosen is the Associate Director of the Colorectal Center at the Cincinnati Children's Hospital Medical Center and here
video10:48 · Nov 2026
Surgical Management2 items
Botox injection during Hirschsprung pull-through: evidence and technique considerations
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This video from GlobalCast MD, featuring Cincinnati Children's, recaps key insights from the 13th Annual Pediatric Surgery Update Course on the use of Botox in Hirschsprung's Disease. It discusses current practices, poll results among pedia
podcast1:55 · Nov 2026
Hirschsprung pull-through timing and the critical role of family irrigation training
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In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery , Drs. Annie Le-Nguyen, Jamie Harris, and Elizabeth Speck discuss one of the most debated questions in Hirschsprung disease management: when is the best
podcast2:04 · Nov 2026
Complications and Outcomes4 items
Hirschsprung disease and anorectal malformations: recognizing rare coexistence in trisomy 21
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This video, part of the GlobalCastMD series featuring Cincinnati Children's, recaps key highlights from the 13th Annual Pediatric Surgery Update Course. Dr. Jill Knepprath and Dr. Aaron Garrison discuss important updates in colorectal surge
podcast1:52 · Nov 2026
Impact of Trisomy 21 on post pull-through enterocolitis and bowel function in children with Hirschsprung disease: A PCPLC analysis.
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We evaluated whether Trisomy 21 (T21) affected bowel management use, ability to toilet train for stool, and rates of Hirschsprung-Associated Enterocolitis (HAEC) in children with Hirschsprung disease (HD). We hypothesized that T21 would be
article · Nov 2026
Hirschsprung-Associated Enterocolitis at a Referral Institution: A Retrospective Review
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Background: Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality amongst patients with Hirschsprung disease (HD); rectal Botulinum toxin (Botox) has been reported a possible prevention strategy. W
article · Nov 2026
Hirschsprung-Associated Enterocolitis: Recognition and Treatment
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https://www.cincinnatichildrens.org/service/c/colorectal
Hi, my name is Nelson Rosen, and I’m a Pediatric Colorectal Surgeon here at Cincinnati Children’s. Today we are going to talk about Hirschsprung Associated Enterocolitis.
Hirschspr
video2:10 · Nov 2026
In a sacral nerve stimulator trial, the rate of wearing a diaper during the day decreased from 19% to 2%. — Ben Hamm, Sacral nerve stimulation for refractory pediatric fecal incontinence · 1:03
Antegrade Continence Enema2 items
One-year outcomes for patients undergoing antegrade continence enema procedures without prior rectal enema therapy: A pediatric colorectal and pelvic learning consortium study
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Purpose: Antegrade continence enemas (ACE) delivered through surgically placed channels help achieve social continence in children with colorectal disorders. Historically, a successful rectal enema program was required before ACE creation,
article · Nov 2026
What Happens Post-Malone? An Investigation of Long-Term Postoperative Management of Antegrade Continence Enemas
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Background: An option for medically refractory fecal incontinence and/or constipation is the antegrade continence enema (ACE). We investigated ACE usage and its perceptions, including whether patients were able to discontinue use of the app
article · Nov 2026
Sacral Nerve Stimulation2 items
Sacral nerve stimulation for refractory pediatric fecal incontinence
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This video, featuring Dr. P. Ben Ham III, discusses sacral nerve stimulation (SNS) as a treatment option for children with severe fecal incontinence and constipation refractory to conventional medical therapies. It presents a clinical scena
podcast2:37 · Nov 2026
Sacral Nerve Stimulation in Children with Medically Refractory Fecal Incontinence or Severe Constipation
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Introduction: The goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation. Methods: We performed a retrospective cohort study of
article · Nov 2026
Beyond the pull-through: A multi-institutional study of long-term surgical and functional outcomes in total colonic Hirschsprung disease - A Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) study
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Purpose: Total colonic Hirschsprung disease (TCHD), a severe Hirschsprung disease variant (∼5-10% of cases), is defined by aganglionosis of the entire colon. This study evaluates short-term surgical outcomes and long-term functional results
article · Nov 2026
Differences in child opportunity index for pediatric patients who travel for subspecialty colorectal care: a pediatric colorectal and pelvic learning consortium (PCPLC) study
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Purpose: The Child Opportunity Index (COI) measures neighborhood-level resources for children. Children with congenital colorectal conditions are managed at few specialty centers. We compared neighborhood opportunity and urbanicity between
article · Nov 2026
For college students living alone without caregivers, depilatory agents (Nair) are recommended as an alternative to clipping — Nelson Rosen, Update Course Rewind: Patient Education and Non-Surgical Management of Pilonidal Disease 2024 · 5:11
Update Course Rewind: Surgical Management of Pilonidal Disease 2024
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In this episode of the Pediatric Surgery Update Course Rewind, Dr. Nelson Rosen and Dr. Whit Holcomb discuss advancements in the surgical management of pilonidal disease, emphasizing minimally invasive techniques like the GIPS procedure. Le
video · Jan 2025
Update Course Rewind: Patient Education and Non-Surgical Management of Pilonidal Disease 2024
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In this episode from the 12th Annual Update Course in Pediatric Surgery, Dr. Nelson Rosen discusses non-surgical approaches to managing pilonidal disease, emphasizing the importance of patient education and hygiene. Learn how techniques lik
video · Dec 2024
Evaluation and management of pilonidal disease in adolescents
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Pediatrician Dr. Paul Bunch consults Dr. Nelson Rosen from the Division of Pediatric Surgery on pilonidal cysts. Episode recorded on July 30, 2025.
Resources discussed in this episode:
Community Practice Support Tool (https://cincin
video43:49 · Nov 2026
Dr. Rosen is a big fan of not packing abscess cavities; he places just the corner of a 4x4 for initial hemostasis, tells patients to soak in the tub so it falls off, then use a top dressing. — Nelson Rosen, Anal pathology in pediatric surgery with Dr. Nelson Rosen · 12:56
Colorectal Quiz Episode 50: Key Takeaways from the 16th European Pediatric Colorectal Conference
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In this special 50th episode of the Colorectal Quiz Podcast , Dr. Marc Levitt and an international panel review key takeaways from the 16th European Pediatric Colorectal Reconstruction Meeting in Stockholm , highlighting emerging ideas, e
podcast24:17 · Nov 2026
Anal pathology in pediatric surgery with Dr. Nelson Rosen
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Anal fissures, hemorrhoids, and abscesses are not a very comfortable topic, but they are fairly common in the pediatric population. Join Dr. Nelson Rosen for the latest treatment algorithms and recommendations regarding pediatric anal patho
podcast17:18 · Feb 2022
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Pilonidal disease management has evolved toward a staged, minimally invasive paradigm. Non-surgical management—weekly hair removal (clipping or depilatory agents) and meticulous hygiene with direct water irrigation—achieves healing in 60–70% of cases [e9514-c2, e9514-c5]. Historical military data demonstrated dramatic improvement with weekly shaving and close monitoring, reducing surgical need . For surgical candidates, minimally invasive approaches (Gibbs procedure: pit excision, cavity curettage, open healing) now represent first-line intervention, with 70–75% achieving durable healing after one operation [e9676-c7, e9676-c14]. The Gibbs technique, essentially a modern iteration of Lord and Millard's 1965 method, offers 20-minute sedation procedures with no activity restriction [e9676-c5, e9676-c10]. Adjunctive cystoscopy ensures complete hair extraction . Laser hair removal post-operatively significantly reduces recurrence in prospective data and should be standard [e9676-c16, e9676-c17]. Patients failing 1–2 minimally invasive attempts with persistent symptoms require off-midline closure, preferably Bascom cleft lift . Wide excision with packing remains globally common but represents outdated practice .
- 60–70% of pilonidal cases heal with non-surgical management: weekly hair removal and direct water irrigation to the natal cleft.
- Minimally invasive surgery (pit excision, cavity curettage) achieves 70–75% durable healing as first-line intervention, with no activity restriction.
- Laser hair removal after surgery significantly reduces recurrence in prospective trials and should be routine.
- Patients failing 1–2 minimally invasive attempts with ongoing symptoms require off-midline closure, preferably Bascom cleft lift.
- Wide excision with packing remains globally common but is outdated; staged minimally invasive approaches are superior.
For patients & families
Pilonidal disease — a condition where hair and debris collect in a small opening near the tailbone — affects many teenagers and young adults. Physicians report that 60 to 70% of cases can heal without surgery when families focus on careful hygiene and regular hair removal. Weekly clipping of the area and thorough washing with water are essential steps that many families aren't told about. When surgery is needed, doctors now favor minimally invasive procedures first — small incisions done under sedation that allow patients to return to normal activities immediately, with success rates around 70-75%. These procedures involve removing the small pits where hair enters and cleaning out the internal cavity. After healing, laser hair removal significantly reduces the chance the problem will come back. For the small number of patients where minimally invasive approaches don't work, surgeons can perform a more extensive operation that moves the skin closure away from the midline crease. The key message physicians emphasize: many cases can be managed without surgery if families understand the importance of hair removal and proper cleaning from the start.
Pilonidal disease — a condition where hair and debris collect in a small opening near the tailbone — affects many teenagers and young adults. Physicians report that 60 to 70% of cases can heal without surgery when families focus on careful hygiene and regular hair removal. Weekly clipping of the area and thorough washing with water are essential steps that many families aren't told about. When surgery is needed, doctors now favor minimally invasive procedures first — small incisions done under sedation that allow patients to return to normal activities immediately, with success rates around 70-75%. These procedures involve removing the small pits where hair enters and cleaning out the internal cavity. After healing, laser hair removal significantly reduces the chance the problem will come back. For the small number of patients where minimally invasive approaches don't work, surgeons can perform a more extensive operation that moves the skin closure away from the midline crease. The key message physicians emphasize: many cases can be managed without surgery if families understand the importance of hair removal and proper cleaning from the start.
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Hirschsprung-Associated Enterocolitis: Recognition and Treatment
In Hirschsprung's disease, the bottom part of the large intestine (colon) lacks half of the nerves needed to work normally.
clinicalNelson Rosen0:13 ↗
In Hirschsprung's disease, the affected intestinal segment squeezes continuously while upstream intestine attempts to push contents through, resulting in functional obstruction.
clinicalNelson Rosen0:25 ↗
Enterocolitis is a complication of Hirschsprung's disease that can occur before or after surgery.
clinicalNelson Rosen0:35 ↗
Enterocolitis presents with bloating, pain, vomiting, diarrhea, and fever.
clinicalNelson Rosen0:44 ↗
Enterocolitis is treated with oral antibiotics.
clinicalNelson Rosen0:56 ↗
Metronidazole (trade name Flagyl) is the most commonly used antibiotic for enterocolitis, targeting bacteria in the large intestine.
clinicalNelson Rosen1:01 ↗
Rectal irrigations are a primary treatment for enterocolitis, involving washing out the distal intestine to remove stool, gas, and bacteria from the intestinal lining.
clinicalNelson Rosen1:11 ↗
Parents are taught to perform rectal irrigations at home.
clinicalNelson Rosen1:11 ↗
Rectal irrigations reduce bloating and allow the child to resume drinking, eating, and normal activities.
clinicalNelson Rosen1:11 ↗
Diagnostic workup for Hirschsprung disease in newborns and children
Hirschsprung disease is a congenital condition that children are born with.
clinicalNelson Rosen1:05 ↗
Hirschsprung disease usually affects the lowermost aspect of the intestine (the rectum or sigmoid).
clinicalNelson Rosen1:11 ↗
In Hirschsprung disease, the system of nerves that allows the intestine to relax is missing in the rectum and lowest part of the colon.
clinicalNelson Rosen1:46 ↗
The missing nerves in Hirschsprung disease are the ganglion cells in the submucosal and myenteric plexus.
Host summaryRod Gerardo summarizing the discussion — not the host's own clinical position1:41 ↗
In Hirschsprung disease, the rectum is always affected, and the question is how much proximal intestine is involved.
clinicalNelson Rosen1:58 ↗
About 85% of Hirschsprung cases begin in the very end part of the sigmoid colon or beginning of the rectum.
epidemiologicalNelson Rosen2:17 ↗
In about 10% of Hirschsprung cases, the entire colon is affected.
epidemiologicalNelson Rosen2:25 ↗
90 to 95% of Hirschsprung cases are recognized in the newborn period.
epidemiologicalPatty Kern2:53 ↗
The first sign of Hirschsprung disease in newborns is usually failure to pass stool within the first 24 to 48 hours.
clinicalPatty Kern3:01 ↗
After failure to pass meconium, newborns with Hirschsprung disease will develop bloating, failure to pass stool, and vomiting.
clinicalPatty Kern3:17 ↗
In the newborn period with concern for Hirschsprung disease, a contrast enema exam is performed in radiology.
clinicalNelson Rosen3:40 ↗
On contrast enema, a sign of Hirschsprung disease is when the rectum (lowest segment) is narrower and then dilates above that level.
clinicalNelson Rosen3:53 ↗
If there is real concern for Hirschsprung disease, a biopsy is done where a tiny piece of the back wall of the rectum is examined for nerves.
clinicalNelson Rosen4:05 ↗
In older children, Hirschsprung disease can be missed.
clinicalNelson Rosen4:46 ↗
Children with Hirschsprung disease very rarely thrive and develop normally.
clinicalNelson Rosen4:53 ↗
In older children with low-risk history for Hirschsprung disease (fine for first couple years then constipation worsened), biopsy should usually be done after routine management measures are tried.
guidelineNelson Rosen5:32 ↗
At some centers with experienced gastroenterologists, anorectal manometry can be performed to evaluate for Hirschsprung disease.
clinicalNelson Rosen6:25 ↗
In anorectal manometry, the gastroenterologist uses a balloon catheter to measure pressures in the anus and rectum, looking for the recto-anal inhibitory reflex.
clinicalNelson Rosen6:44 ↗
The normal recto-anal inhibitory reflex is when you blow a balloon up in the rectum and stretch it, the sphincter should relax.
clinicalNelson Rosen7:06 ↗
Anorectal manometry is not very sensitive for Hirschsprung disease; a normal manometry does not completely rule out Hirschsprung disease.
clinicalNelson Rosen7:26 ↗
Nobody would operate on manometry findings alone; if there is suggestive manometry, a biopsy will still be done.
guidelineNelson Rosen7:59 ↗
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