# Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives — GCMD Library In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Nelson Rosen, Annie Le-Nguyen, Aaron Garrison, Jamie Harris, and Elizabeth Speck discuss one of the most common questions in Hirschsprung disease management: when is the best time to perform a pull-through procedure?

Key Highlights:

Neonatal vs Delayed Pull-Through:
A recent PCPLC retrospective study compared neonatal pull-throughs to delayed procedures and found no significant difference in enterocolitis rates, postoperative complications, or long-term fecal continence outcomes.

Timing Remains Flexible:
The neonatal group underwent surgery at a median age of 11 days, while delayed repairs occurred closer to 3 months—highlighting the wide variation in current practice.

Importance of Home Irrigations:
Panelists emphasized that family ability to perform effective rectal irrigations is often more important than patient age when determining timing of surgery.

Preventing Enterocolitis:
Families who are well-trained in washouts can help prevent dangerous complications like enterocolitis and perforation by maintaining adequate decompression at home.

Patient- and Family-Centered Decision Making:
Factors such as caregiver comfort, access to follow-up, and successful irrigation education should guide operative timing rather than a strict protocol.

This session highlights that successful Hirschsprung management depends not only on surgical timing, but also on empowering families with the skills needed for safe home care.
Type: video · 2 min · posted 2026-05-07 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009 ## Chapters - [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=1) Introduction and Case Presentation - [0:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=33) Timing Poll Results and Literature Review - [1:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=73) Expert Opinion on Family Training ## Statements - "Suction rectal biopsy is diagnostic for Hirschsprung's disease" (clinical) [0:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=27) - "There is not really evidence in the literature of good timing to perform a pull-through procedure" (clinical) [0:44](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=44) - "A 2021 PCPLC retrospective study compared outcomes of neonatal pull-through versus delayed primary pull-through" (epidemiological) [0:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=50) - "The median age of the neonatal group was 11 days at time of surgery" — Jill Knepprath (epidemiological) [0:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=59) - "The median age of the delayed group was 98 days at time of surgery" — Jill Knepprath (epidemiological) [1:02](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=62) - "The study found no difference in preoperative and postoperative enterocolitis between neonatal and delayed pull-through groups" — Jill Knepprath (epidemiological) [1:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=66) - "The study found no difference in fecal incontinence at follow-up between neonatal and delayed pull-through groups" — Jill Knepprath (epidemiological) [1:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=66) - "Family ability to perform irrigations at home is an important skill" (opinion) [1:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=73) - "A family who is really good at irrigations will save a baby's life" (opinion) [1:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=83) - "Kids whose families cannot perform adequate washouts may not be able to go home" (clinical) [1:29](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=89) - "Inadequate decompression can lead to hospitalization with colitis or perforation" (clinical) [1:29](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=89) - "Studies show no difference in complications between neonatal and delayed pull-through procedures for Hirschsprung patients" — Jill Knepprath (epidemiological) [1:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=102) - "Decisions on timing should factor in the family's ability to perform irrigations" — Jill Knepprath (opinion) [1:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-hirschsprung-s-pull-through-why-family-training-may-save-lives-12009?t=110) ## Transcript Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. I'm Jill Knepprath 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. This is on the Hirschsprung's pull through and why family training may save lives. You have a term newborn patient with delayed passage of meconia. You do a suction rectal biopsy, which is diagnosis for Hirschprung's disease. When would you perform the pull-through procedure? The poll showed that about 30%. Of the audience would perform the pull through before the baby was discharged from the NICU. 39% would perform it after the baby was 3 months old. In the literature, there's not really an evidence of the good timing to perform a pull-through procedure. This was a study from 2021 from PCPLC. It's a retrospective study that compared outcomes of neonatal pull-through versus delayed primary pull-through. The median age of the neonatal group was 11. Days at time of surgery compared to 98 days for the delayed group. They found no difference in preoperative and postoperative enterocolitis or fecal incontinence at follow-up. I delay at least 1 month, sometimes 3 months, depending on when the family can get back because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have. I completely agree with that. The family who's really good at irrigations will save a baby's life. What I've learned in the kids who are not able to go home because family can't ever do really good washouts, so they don't go home and then they're not adequately decompressed and they end up in the hospital with a colitis or a perforation. In summary, studies show no difference in complications between neonatal and delayed pull-through procedures for Hirschprung patients. Decisions on timing should factor in the family's ability to perform irrigations. 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