From
Dr. Nelson G. Rosen
Routine Anal Dilations After PSARP: Questioning a Decades-Old Practice
hosted by Dr. Jill Knepprath
Chapter 1 of 4
Historical context
Introduction and Historical Context
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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
There are data that support parental anxiety and PTSD for both the patients and the caregivers associated with anal dilations
Families are worried that they're going to hurt their babies and they're going to hurt this repair
A single institution review in kids under 2 years of age showed half with dilations versus half without dilations
Two kids in each group (dilations vs no dilations) had to have a re-operation for neoanal stricture
About 15% of the kids required a Heineke-Mikulicz anoplasty
For neonates, one panelist dilates; for older kids, redo cases, or ambulatory patients where dilation would be traumatic, they hold off
One panelist usually dilates for neonatal cases
In Canada, lack of easy access to schedule elective cases is a concern, which is why one panelist prefers to dilate all cases up front
For decades, every child received anal dilations after PSARP
A study from Spain followed the historical dilation protocol starting two weeks after PSARP, doing dilations twice a day, increasing the Hagar size by 1 millimeter each week until reaching optimal size
The Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients
Heineke-Mikulicz anoplasty is done by making incisions at the 12, 3, 6, and 9 o'clock positions, making a rhomboid shape that opens up the strictured area
Heineke-Mikulicz anoplasty does not require flaps or any mobilization of the rectum
Heineke-Mikulicz anoplasty is safe, effective, and minimally invasive
Heineke-Mikulicz anoplasty can be done outpatient as an alternative to long-term dilations after PSARP
There isn't strong evidence to support mandatory anal dilation after PSARP
Anal dilations can cause stress for the families
Age of the patient and access to returning for an outpatient procedure are things to consider when making dilation decisions