3 views 0 likes

StayCurrentMD

GCMD Space · View profile →

Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?

Video Published 2026-05-01 Updated 2026-06-10

Timestops (3)

Questioning Traditional Dilation Protocols

Heineke-Mikulicz Anoplasty Technique Overview

Access Challenges in Canadian Practice

Topic Overview

Expert panel discusses evolving practice around routine anal dilations following posterior sagittal anorectoplasty (PSARP), examining evidence that questions this traditional paradigm. Alternative approaches including selective dilation based on patient age and the Heineke-Mikulicz anoplasty for skin-level strictures are presented as options to reduce family stress while maintaining outcomes.

Key Takeaways

Routine anal dilations after PSARP lack strong evidence and cause significant parental anxiety and PTSD for patients and caregivers.
Single-institution data show similar re-operation rates (2 patients each) whether dilations are performed or not in children under 2 years.
Heineke-Mikulicz anoplasty is a safe, minimally invasive outpatient alternative to long-term dilations for skin-level strictures.
Age and healthcare access should guide dilation decisions: neonates often dilated, older ambulatory children may avoid trauma by skipping.
15% of PSARP patients required Heineke-Mikulicz anoplasty regardless of dilation protocol, suggesting stricture risk is multifactorial.

Keywords

Psarp Anal Dilation Anorectal Malformation Heineke-mikulicz Anoplasty Pediatric Colorectal Surgery Postoperative Stricture

Hashtags

#PediatricSurgery #ColorectalSurgery #AnorectalMalformation #PSARP

Transcript

Globalcast MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. I'm Jill Knerath with Stay Current MD. In this video series, we will be recapping some of the key highlights from our 13th annual update course in pediatric surgery. Still need routine anal dilations after PSARP. For decades, every child received anal dilations after PSARP, but are these actually necessary? We have to start to question this paradigm. There are data that support parental anxiety. PTSD for both the patients and the caregivers. Families are worried that they're going to hurt their babies and they're going to hurt this repair. This study from Spain followed the historical dilation protocol two weeks after PSA. They did them twice a day, and the Hagar size was increased by 1 millimeter each week until they reached the optimal size. Another single institution review in kids under 2 years of age that shows. Half and half dilations versus no dilations. Two kids in each group had to have a re-operation for that neoanal stricture, and about 15% of the kids required a Heineke-Mikowitz broplasty. The Heineke-Mulix anoplasty is a procedure for skin-level strictures in PISA patients. It is done by making incisions at the 12, 36, and 9 o'clock positions, making a rhorhomboid shape that Opens up the strictured area. It does not require flaps or any mobilization of the rectum. HMA is safe, effective, and minimally invasive. It can be done outpatient as an alternative to long-term dilations after PSA. What does the rest of our panel say? Personally, I think with neonate, we dilate. If it happens to be an older kid, a redo and they're ambulatory or old enough where I think that's traumatic for everybody, then I hold off. I also usually dilate for neonatal cases. One of our concerns in Canada is that we don't have easy access to schedule elective cases. So this is why we prefer to dilate all of these cases up front. To sum it up, there isn't strong evidence to support mandatory anal dilation after PSA, and it can cause stress for the families. Age of the patient and access to returning for an outpatient procedure are things to consider when making these decisions. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.

Comments

Loading comments…