# Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP? — GCMD Library 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.
Type: video · 2 min · posted 2026-05-01 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895 ## Chapters - [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=1) Introduction and Question Framing - [0:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=28) Evidence Review - [1:12](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=72) Heineke-Mikulicz Anoplasty - [1:44](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=104) Panel Practice Patterns ## Statements - "For decades, every child received anal dilations after PSARP" — Jill Knepprath (clinical) [0:21](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=21) - "Data support parental anxiety associated with anal dilations" (epidemiological) [0:30](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=30) - "PTSD occurs for both patients and caregivers related to anal dilations" (clinical) [0:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=33) - "Families are worried that they're going to hurt their babies and hurt the repair" (clinical) [0:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=37) - "Spanish study followed historical dilation protocol starting two weeks after PSARP" — Jill Knepprath (clinical) [0:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=40) - "Spanish protocol involved dilations twice daily with Hagar size increased by 1 millimeter each week until optimal size reached" — Jill Knepprath (clinical) [0:45](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=45) - "Single institution review in children under 2 years showed half received dilations and half did not" (clinical) [0:53](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=53) - "Two children in each group (dilations vs no dilations) required reoperation for neoanal stricture" (clinical) [1:02](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=62) - "Approximately 15% of children required Heineke-Mikulicz anoplasty" (epidemiological) [1:02](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=62) - "Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients" — Jill Knepprath (clinical) [1:12](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=72) - "HMA is performed by making incisions at 12, 3, 6, and 9 o'clock positions creating a rhomboid shape that opens the strictured area" — Jill Knepprath (clinical) [1:20](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=80) - "HMA does not require flaps or mobilization of the rectum" — Jill Knepprath (clinical) [1:30](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=90) - "HMA is safe, effective, and minimally invasive" — Jill Knepprath (clinical) [1:34](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=94) - "HMA can be done outpatient as an alternative to long-term dilations after PSARP" — Jill Knepprath (clinical) [1:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=98) - "Neonates typically receive dilations in one surgeon's practice" (opinion) [1:46](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=106) - "Older children, redo cases, and ambulatory patients may not receive dilations due to trauma concerns" (opinion) [1:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=109) - "Neonatal cases usually receive dilations in Canadian practice" (opinion) [1:57](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=117) - "Limited access to schedule elective cases in Canada influences preference to dilate all cases up front" (opinion) [2:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=120) - "There isn't strong evidence to support mandatory anal dilation after PSARP" — Jill Knepprath (clinical) [2:09](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=129) - "Anal dilations can cause stress for families" — Jill Knepprath (clinical) [2:09](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=129) - "Age of patient and access to returning for outpatient procedure are considerations when deciding on dilations" — Jill Knepprath (opinion) [2:17](https://library.globalcastmd.com/watch/update-course-rewind-2025-do-we-still-need-routine-anal-dilations-after-psarp-11895?t=137) ## 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai