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Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?
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Topic Overview
In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Jamie Harris, Elizabeth Speck, Aaron Garrison, Nelson Rosen, and Annie Le-Nguyen revisit a long-standing postoperative practice in colorectal surgery: are routine anal dilations after PSARP truly necessary?
Key Highlights:
Questioning a Surgical Tradition:
For decades, postoperative anal dilations have been considered standard after PSARP—but emerging studies and clinician experience are challenging whether they should be universally required.
Emotional Impact on Families:
Panelists discussed the significant anxiety and stress dilations can create for caregivers, including concerns about harming the repair and reports of PTSD-like experiences for both families and patients.
What the Data Shows:
Recent institutional reviews comparing dilation protocols versus no dilations found similar rates of neoanal stricture and reoperation, suggesting mandatory dilations may not always improve outcomes.
Alternative Approaches:
Heineke-Mikulicz anoplasty (HMA) was highlighted as a safe, minimally invasive outpatient option for managing strictures instead of prolonged dilation regimens.
Why Some Surgeons Still Dilate:
Many surgeons continue postoperative dilations in neonates, particularly in healthcare systems where rapid access to elective revision procedures may be limited.
Individualized Decision-Making:
Patient age, anatomy, caregiver comfort, access to follow-up care, and institutional resources all play a role in deciding whether postoperative dilations are appropriate.
This session emphasizes that postoperative care after PSARP may not need a one-size-fits-all approach—and that family-centered decision-making is becoming increasingly important in colorectal surgery.
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