# Constipation — GCMD Library living collection

Everything in the library about constipation — built automatically from dossiers that name it.

Updated: n/a · 10 episodes · 173 cited statements

## Episodes
### Diagnosis & Workup
- [Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665) — video · 12:53 · [machine version](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665.md)
- [Use of hydrocolonic sonography to monitor the effects of an enema: Pediatric...](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065) — video · 12:46 · [machine version](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065.md)

### Medical Management
- [Bowel Management - Bowel Management In Communities With Limited Resources](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664) — video · 9:14 · [machine version](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664.md)

### Surgical Management
- [Tricks - New Duhamel - Laparoscopic Trans-rectal Rectosigmoidectomy](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630) — video · 10:29 · [machine version](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630.md)
- [Laparoscopic Duhamel: Pediatric Surgery Difficult Cases 2013](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051) — video · 10:29 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051.md)
- [Sacral Nerve Stimulator Placement: A Novel Surgical Navigation Tool for...](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515) — video · 4:59 · [machine version](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515.md)

### Evidence & Research
- [Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263) — video · 1:09 · [machine version](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263.md)

### Case-Based Learning
- [The Colorectal Quiz Episode 8: Motility Disorders Part 1](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824) — podcast · 14:04 · [machine version](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824.md)
- [Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304) — podcast · 14:18 · [machine version](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304.md)
- [Colorectal Quiz: Episode 42 - HD Constipation](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506) — podcast · 14:48 · [machine version](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=0) Presentation of the New Laparoscopic Duhamel Technique (Ep 1)
- [6:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=360) Faculty Discussion and Technical Concerns (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=0) Introduction and institutional context (Ep 2)
- [1:32](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=92) Patient population and inpatient program structure (Ep 2)
- [4:40](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=280) Treatment protocols and discharge planning (Ep 2)
- [6:40](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=400) Outcomes, challenges, and social assistance role (Ep 2)
- [8:53](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=533) Closing remarks (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=0) Introduction to hydrocolonic sonography and its indications (Ep 3)
- [2:30](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=150) Diagnostic workup and patient preparation (Ep 3)
- [5:20](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=320) Equipment and technique for hydrocolonic sonography (Ep 3)
- [8:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=480) Sonographic findings and interpretation (Ep 3)
- [10:50](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=650) Post-procedure management and clinical outcomes (Ep 3)
- [12:09](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=729) Technical interruption and session transition (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0) Presentation of the New Laparoscopic Duhamel Technique (Ep 4)
- [6:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=360) Faculty Discussion: Residual Stump and Sphincter Concerns (Ep 4)
- [8:12](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=492) Expert Commentary on Laparoscopic Duhamel Experience (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=0) Introduction to hydrocolonic sonography and its indications (Ep 5)
- [2:30](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=150) Diagnostic evaluation and treatment protocol (Ep 5)
- [5:50](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=350) Equipment and technique for hydrocolonic sonography (Ep 5)
- [9:10](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=550) Ultrasound findings and clinical outcomes (Ep 5)
- [11:20](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=680) Technical difficulties and conclusion (Ep 5)
- [0:00](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=0) Introduction to Sacral Neuromodulation and Hybrid OR Setup (Ep 6)
- [1:30](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=90) Patient Positioning and Anatomical Landmark Identification (Ep 6)
- [2:30](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=150) Cone Beam CT Acquisition and Virtual Path Planning (Ep 6)
- [3:30](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=210) Needle Insertion, Lead Placement, and Electrical Testing (Ep 6)
- [4:30](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=270) Subcutaneous Pocket Creation and Temporary Generator Connection (Ep 6)
- [0:00](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=0) Introduction and Episode Setup (Ep 7)
- [1:31](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=91) Case Presentation and Expert Introductions (Ep 7)
- [2:51](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171) Defining Failure of Medical Management (Ep 7)
- [4:43](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=283) Initial Evaluation and Diagnostic Approach (Ep 7)
- [6:10](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=370) Contrast Enema Interpretation and Limitations (Ep 7)
- [8:45](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=525) Anorectal Manometry and Absent RAIR Finding (Ep 7)
- [11:20](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=680) Summary and Conclusion (Ep 7)
- [0:04](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=4) Introduction and recap of part one (Ep 8)
- [1:09](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=69) Appendix sharing and channel lengthening techniques (Ep 8)
- [4:38](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=278) Ambulatory status and surgical planning considerations (Ep 8)
- [7:39](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=459) Orifice placement and operative sequencing (Ep 8)
- [11:09](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=669) Enema techniques for poor pelvic floor tone (Ep 8)
- [0:00](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=0) Introduction (Ep 9)
- [0:12](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=12) Study Design (Ep 9)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining the relationship between delayed diagnosis of Hirschsprung disease and postoperative/functional outcomes. — Alex Halpern (clinical) [Ep 9 · 0:12](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=12)
- The study included 679 patients with Hirschsprung disease from 14 different sites. — Alex Halpern (epidemiological) [Ep 9 · 0:23](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=23)
- Increased age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure. — Alex Halpern (clinical) [Ep 9 · 0:29](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=29)
- Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively. — Alex Halpern (clinical) [Ep 9 · 0:39](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=39)
- No association was found between age at diagnosis and 30-day complication rate after initial pull-through. — Alex Halpern (clinical) [Ep 9 · 0:49](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=49)
- No association was found between age at diagnosis and need for pull-through revision. — Alex Halpern (clinical) [Ep 9 · 0:49](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=49)
- Delayed diagnosis of Hirschsprung disease affects certain postoperative and functional outcomes in patients. — Alex Halpern (clinical) [Ep 9 · 0:58](https://origin-library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functio-9263?t=58)
- Failure of medical management is defined as appropriate treatment with no appropriate response — Kahleb Graham (clinical) [Ep 7 · 2:51](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171)
- Patients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management — Kahleb Graham (clinical) [Ep 7 · 3:04](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=184)
- Patients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management — Kahleb Graham (clinical) [Ep 7 · 3:04](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=184)
- Failure of retrograde enemas is considered failure of medical management — Kahleb Graham (clinical) [Ep 7 · 3:21](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=201)
- Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management — Anil Darbari (clinical) [Ep 7 · 3:35](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=215)
- General pediatricians typically prescribe osmotic laxatives (MiraLax, lactulose) and stimulant laxatives (Senna, bisacodyl), but there are other medications GI specialists use that pediatricians are not accustomed to prescribing — Anil Darbari (clinical) [Ep 7 · 3:57](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=237)
- Some children stool every day but don't completely evacuate — Anil Darbari (clinical) [Ep 7 · 4:58](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=298)
- Initial evaluation includes history (triggers, stooling frequency, sensation of complete emptying), physical exam (abdominal distension, palpable stool, rectal exam), and diagnostic imaging (abdominal X-ray, water-soluble contrast enema) — Anil Darbari (clinical) [Ep 7 · 4:46](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=286)
- In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio — Kahleb Graham (clinical) [Ep 7 · 5:27](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=327)
- Water-soluble contrast (not barium) is used for contrast enemas because it helps empty the colon and acts as a cleanout for patients starting new medical therapy — Jason Frischer (clinical) [Ep 7 · 8:06](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=486)
- Contrast studies are not great predictors of how patients will respond to medical or surgical management; normal-looking colons may not respond while abnormal-appearing colons may respond well — Jason Frischer (clinical) [Ep 7 · 7:12](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=432)
- Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum — Anil Darbari (clinical) [Ep 7 · 9:35](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=575)
- High pressures on anorectal manometry may suggest underlying inability to relax, causing a functional obstruction — Anil Darbari (clinical) [Ep 7 · 10:00](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=600)
- Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR) — Anil Darbari (clinical) [Ep 7 · 10:09](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=609)
- Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate, comparing sensation to defecate with internal anal sphincter response — Anil Darbari (clinical) [Ep 7 · 10:19](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=619)
- Doctor Levitt states he doesn't know how he survived without anorectal manometry testing — Marc Levitt (opinion) [Ep 7 · 10:47](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=647)
- In the past, surgeons did not understand the major role the sphincter played in many patients — Jason Frischer (opinion) [Ep 7 · 10:51](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=651)
- Colonic motility assessment is critical because in the past, colons or sigmoid colons were resected based on appearance, but patients had motility disorders and did not need resection — Marc Levitt (clinical) [Ep 7 · 7:36](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=456)
- Many dilated colons will respond to treatment — Marc Levitt (clinical) [Ep 7 · 7:54](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=474)
- When a 7 cm appendix is shared between urology and colorectal surgery, the urologist typically takes 6.25 cm leaving only 0.75 cm for colorectal use — Jason Frischer (clinical) [Ep 8 · 1:17](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=77)
- Urologists typically take a 70/30 split when sharing the appendix — Marc Levitt (opinion) [Ep 8 · 1:38](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=98)
- The colorectal team benefits from using the appendix portion closer to the cecum which has a stronger blood supply — Jason Frischer (clinical) [Ep 8 · 1:55](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=115)
- A short appendiceal stump can be extended by suturing or using a laparoscopic non-cutting linear stapler along the cecal wall to add 2-3 cm of length — Jason Frischer (clinical) [Ep 8 · 2:05](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=125)
- One of the problems with Malone appendicostomy is leakage — Jason Frischer (clinical) [Ep 8 · 2:34](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=154)
- The longer the Malone channel, the less likely it is to leak — Jason Frischer (clinical) [Ep 8 · 2:47](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=167)
- Extending the Malone channel by 2-3 cm using suturing or stapling can be extremely helpful in preventing leakage — Jason Frischer (clinical) [Ep 8 · 2:55](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=175)
- Children in rural locations or with behavioral issues who pull at tubes are good candidates for an unplicated Malone (clinical) [Ep 8 · 3:02](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=182)
- Rectal irrigation using pressurized water systems made for patients with hand difficulties is an alternative to Malone and Mitrofanoff procedures — Jason Frischer (clinical) [Ep 8 · 3:43](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=223)
- Coloplast makes a rectal irrigation device for self-administration of enemas — Jason Frischer (clinical) [Ep 8 · 4:25](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=265)
- Spinal patients with absent coccyx have difficulty retaining rectal enema fluid even for the short time from standing to reaching the toilet — Wendy (clinical) [Ep 8 · 4:57](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=297)
- Cecostomy or Malone routes allow spinal patients with mobility compromise to use a small floor potty rather than transferring to a toilet — Wendy (clinical) [Ep 8 · 5:23](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=323)
- Most spinal patients prefer not to have a stoma bag and prefer transferring to a commode for antegrade flush — Marc Levitt (clinical) [Ep 8 · 5:45](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=345)
- If the colon is very difficult to empty (requiring voluminous or concentrated enemas) and the urologist needs to do bladder augmentation, the sigmoid can be removed from colonic transit to make bowel management easier and used by the urologist for augmentation — Marc Levitt (clinical) [Ep 8 · 6:38](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=398)
- If the patient has an easy to empty colon, the colon can stay in and the urologist can use small bowel for augmentation — Marc Levitt (clinical) [Ep 8 · 7:24](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=444)
- A good bowel management plan can influence the urologic surgical plan — Marc Levitt (clinical) [Ep 8 · 7:52](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=472)
- Once patients are emptying regularly for stool without impactions, their bladder may work better and reflux might resolve — Marc Levitt (clinical) [Ep 8 · 7:58](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=478)
- Successful bowel management might save a patient from needing ureteral reimplantation — Marc Levitt (clinical) [Ep 8 · 8:09](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=489)
- Urologists often request that bowel management work happen first before determining what bladder surgery is needed — Marc Levitt (clinical) [Ep 8 · 8:15](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=495)
- In Kansas City, the Mitrofanoff goes at the umbilicus and the MACE or appendicostomy goes in the right lower quadrant (clinical) [Ep 8 · 9:19](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=559)
- Anatomically, the bladder is a midline structure and access through the umbilicus makes sense, while the cecum is in the right lower quadrant — Marc Levitt (clinical) [Ep 8 · 9:29](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=569)
- At Cincinnati Children's, 99% of Malones are placed in the umbilicus and almost all Mitrofanoffs are in the right lower quadrant with a tunnel channel through the rectus to prevent leakage — Jason Frischer (clinical) [Ep 8 · 9:43](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=583)
- The primary determinant of orifice location is where the appendix reaches and its blood supply — Jason Frischer (clinical) [Ep 8 · 10:21](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=621)
- Orifices should be properly separated and not matured until all teams have completed their work to avoid pulling on each other's mesentery — Marc Levitt (clinical) [Ep 8 · 10:39](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=639)
- Laxity of the pelvic floor and anal canal is a huge issue in spinal patients, especially when doing retrograde enemas — Jason Frischer (clinical) [Ep 8 · 11:09](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=669)
- Adding bisacodyl to the flush has shown good success in spinal patients — Wendy (clinical) [Ep 8 · 11:31](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=691)
- Spinal patients sometimes do better with smaller flush volumes because their colons empty at different rates — Wendy (clinical) [Ep 8 · 11:35](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=695)
- Putting additional water volume into the enema balloon helps hold it in place so fluid doesn't leak around it in patients who cannot hold the enema like other children (clinical) [Ep 8 · 12:16](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=736)
- Felipe Glu is a colorectal research fellow at Children's National Hospital — Felipe Glu (clinical) [Ep 10 · 0:11](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=11)
- Chris Geyer runs a colorectal program at Children's Hospital Los Angeles (clinical) [Ep 10 · 0:41](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=41)
- Hirschsprung's disease is a very anatomically fixable problem and with a good operation you should get a good result (clinical) [Ep 10 · 1:38](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=98)
- About one-third of Hirschsprung patients are constipated and need to be proactively and aggressively managed to avoid trouble (epidemiological) [Ep 10 · 1:47](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=107)
- Surgeons might leave behind the dilated segment right above the aganglionic segment as an anatomic reason for decompensation (clinical) [Ep 10 · 2:11](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=131)
- The most relevant reason for decompensation is that the patient never figured out how to successfully empty their sphincters and the pull-through decompensates (clinical) [Ep 10 · 2:22](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=142)
- Normal calretinin staining is expected because calretinin hangs out with ganglion cells (clinical) [Ep 10 · 3:14](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=194)
- In younger children age less than 3 or so, hypertrophic nerves are defined as greater than 40 microns in diameter (clinical) [Ep 10 · 3:47](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=227)
- The definition of hypertrophic nerve is more gray in older patients and in patients who have chronic constipation issues (clinical) [Ep 10 · 4:01](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=241)
- If there are no ganglion cells and no calretinin staining, that is a retained Hirschsprung's and that patient needs a redo to a higher level (clinical) [Ep 10 · 4:27](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=267)
- If there are good ganglion cells with abundant ganglion cells and normal calretinin, the nerve hypertrophy could represent transition zone or could represent that the bowel has decompensated over time because it hasn't emptied and gotten dilated (clinical) [Ep 10 · 4:38](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=278)
- The anorectal manometry is expected to be abnormal in Hirschsprung patients and many patients are going to have an abnormal amen but they're OK (clinical) [Ep 10 · 6:46](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=406)
- One of the things done with Botox is to try to get patients to learn to overcome non-relaxing sphincters by other maneuvers like pushing on their abdominal wall (clinical) [Ep 10 · 6:56](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=416)
- There are many patients that are completely asymptomatic doing great with Hirschsprung's that have residual absent RAIR (clinical) [Ep 10 · 7:11](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=431)
- In Hirschsprung patients with sphincter problems, the colon is not the problem; the problem usually is the sphincters or the pelvic floor (clinical) [Ep 10 · 7:39](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=459)
- If you get an awake anorectal manometry in a cooperative patient and you get a normal RAIR and can detect the resting pressure, the kid goes home with no anesthesia and no procedure (clinical) [Ep 10 · 8:14](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=494)
- If the RAIR is absent, you're obligated to do a biopsy and give Botox (clinical) [Ep 10 · 8:29](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=509)
- Botox is given if the resting pressure of the external sphincter is also high (clinical) [Ep 10 · 8:36](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=516)
- Pelvic floor dysynergia can be detected on anorectal manometry and is a good indication that pelvic floor physical therapy is going to help that patient (clinical) [Ep 10 · 8:41](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=521)
- Colonic manometry should not be done in Hirschsprung patients who have obstructive symptoms because it's not the colon but the distal pull-through that's the problem (clinical) [Ep 10 · 9:55](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=595)
- You must rule out anatomic and pathologic causes before any colonic manometry is considered (clinical) [Ep 10 · 10:11](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=611)
- You must get rid of the distal obstruction, which is why colonic manometry in a patient with distal obstruction is the wrong test (clinical) [Ep 10 · 10:18](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=618)
- Once distal obstruction is ruled out or fixed and the colon is still not working, then you have a problem and that would be a case for colonic manometry (clinical) [Ep 10 · 10:31](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=631)
- The rule of thumb is if there's a segment less than 30 centimeters of inadequate HAPCs, they are not super aggressive about it; over 30 centimeters is definitely more of a red flag (clinical) [Ep 10 · 11:01](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=661)
- In a PCPLC Consortium study of close to 100 patients with functional constipation and segmental dysmotility of the sigmoid, 97% successfully responded to Malone only and never needed a resection (epidemiological) [Ep 10 · 11:54](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=714)
- Five years ago, surgeons were taking sigmoids out of patients with segmental dysmotility, but the new data shows this is not necessary (clinical) [Ep 10 · 12:28](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=748)
- A Malone procedure is a route for medical treatment that gives antegrade access to the colon for the gastroenterologist to give better medical treatment (clinical) [Ep 10 · 13:24](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=804)
- Doing everything extraperitoneally is a nice feature of the technique. — Cathy (opinion) [Ep 1 · 6:28](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=388)
- All of these techniques are good adjuncts to the armamentarium for Hirschsprung's disease, and knowing more techniques allows tailoring to appropriate patients. — Cathy (opinion) [Ep 1 · 6:28](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=388)
- Stretching the sphincters aggressively is one of the mistakes people make when doing a transanal pull-through. (clinical) [Ep 1 · 7:34](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=454)
- A transanal pull-through should be done by pulling everything out and doing it on the outside without stretching the sphincters. (clinical) [Ep 1 · 7:34](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=454)
- In early experience with laparoscopic Duhamel, the colon was brought outside and transected outside, then put back again when there were difficulties closing the stump. (clinical) [Ep 1 · 8:23](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=503)
- With increased experience, the colon is no longer brought outside and a pretty short stump is left. (clinical) [Ep 1 · 8:23](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=503)
- Even if more stump is left, it can be trimmed later before closing the stump down. (clinical) [Ep 1 · 8:23](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=503)
- Using the end of a GIA stapler for making the side-to-side anastomosis allows the technique to be used even in neonates at a very early age. (clinical) [Ep 1 · 8:23](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=503)
- The speaker's team visited the Cincinnati Colorectal Center for Children 3 years ago for a 1-week bowel management training. (clinical) [Ep 2 · 0:44](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=44)
- The hospital is a public children's and maternity hospital in Brasília, Brazil's capital, serving as a reference center for neonatal surgery. (clinical) [Ep 2 · 1:32](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=92)
- Patients are referred for fecal incontinence or constipation, including anorectal malformation patients previously operated on at the hospital. (clinical) [Ep 2 · 2:23](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=143)
- Initial evaluation includes office appointment with doctor and nurse (last Friday of the month, average 8 patients), complete history and physical exam, contrast enema with hydrosoluble contrast to assess colon dilation, and sacral ratio calculation. (clinical) [Ep 2 · 2:23](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=143)
- The program uses an inpatient model (one patient at a time for one-week admission) because patients have poor economic conditions and live far from the hospital, making daily outpatient visits impractical. (clinical) [Ep 2 · 3:50](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=230)
- On admission, an abdominal x-ray is obtained to check for fecal impaction; if impacted, enemas are given until disimpaction is confirmed by x-ray before starting bowel management. (clinical) [Ep 2 · 4:40](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=280)
- Senna laxatives are used for patients with constipation and overflow pseudo-incontinence. (clinical) [Ep 2 · 5:10](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=310)
- Enemas are used for patients with true fecal incontinence. (clinical) [Ep 2 · 5:10](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=310)
- Nurses teach parents hands-on how to administer enemas until parents feel confident. (clinical) [Ep 2 · 5:30](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=330)
- The program preferentially uses ready-made glycerin enemas, with saline as an alternative and phosphates added if a more irritating solution is needed. (clinical) [Ep 2 · 5:50](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=350)
- Patients are discharged when the correct enema regimen is found that cleans the colon, and they receive all materials needed for the first month of management. (clinical) [Ep 2 · 6:10](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=370)
- Patients are seen in clinic every 6 months for follow-up. (clinical) [Ep 2 · 6:30](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=390)
- The medical team must provide social assistance, including writing medical reports for patients to obtain materials and laxatives from government and health entities or local hospitals. (clinical) [Ep 2 · 6:40](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=400)
- Laxatives are very expensive in Brazil, requiring patients to seek government assistance to afford them. (clinical) [Ep 2 · 7:10](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=430)
- Failures and recurrences occur mainly due to noncompliance related to social and economic reasons, including patients stopping laxatives, leading to constipation recurrence and requiring readmission for disimpaction. (clinical) [Ep 2 · 7:30](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=450)
- Parents sometimes switch to less expensive laxatives without medical guidance, causing management problems. (clinical) [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=480)
- The program has treated 50 children for fecal incontinence: 12 with true fecal incontinence (11 anorectal malformations, 1 Hirschsprung disease) achieving 90% success with enemas. (epidemiological) [Ep 2 · 8:15](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=495)
- The program has treated 38 patients with overflow pseudo-incontinence (21 idiopathic constipation, 9 anorectal malformations, 8 Hirschsprung disease) achieving 95% success rate. (epidemiological) [Ep 2 · 8:35](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=515)
- The overflow pseudo-incontinence group has many recurrences due to the high cost of laxatives. (clinical) [Ep 2 · 8:35](https://origin-library.globalcastmd.com/watch/bowel-management-bowel-management-in-communities-with-limited-resources-664?t=515)
- Hydrocolonic sonography is used to avoid guessing the enema volume and to avoid radiography in bowel management. — Stephanie (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=0)
- Hydrocolonic sonography is indicated for fecal incontinence to evaluate colonic motility and measure the volume of enema needed. — Stephanie (clinical) [Ep 3 · 0:28](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=28)
- Hydrocolonic sonography is indicated for constipation to visualize fecal impaction, evaluate colonic motility, and identify stool infection. — Stephanie (clinical) [Ep 3 · 1:20](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=80)
- The diagnostic process includes pediatric surgical evaluation with detailed clinical history, physical examination, exact classification of the anorectal malformation, and evaluation for associated defects. — Stephanie (clinical) [Ep 3 · 2:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=120)
- Patients are requested to fulfill a two-week defecation protocol prior to therapy to distinguish pseudo-incontinence (overflow with intact continence organ) from true fecal incontinence. — Stephanie (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=180)
- Treatment always starts with intestinal purgation using polyethylene glycol (macrogol or movicol) to achieve a clean colon for evaluation. — Stephanie (clinical) [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=240)
- The bowel management program includes individually tailored enema, anal hygiene (showering after every enema), physiotherapy, and a defecation protocol to monitor success. — Stephanie (clinical) [Ep 3 · 4:40](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=280)
- Two pump systems can be used for hydrocolonic sonography: an electric pump system (originally for stoma irrigation) or a hand pump (made for people with spina bifida). — Stephanie (clinical) [Ep 3 · 5:20](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=320)
- The speaker's center uses a Foley catheter 24 French with a 30 mL balloon blockage, the same catheter system used in Cincinnati. — Stephanie (clinical) [Ep 3 · 6:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=360)
- For successful sonography, there should be no air in the colon, as air makes abdominal ultrasound monitoring very difficult. — Stephanie (clinical) [Ep 3 · 6:40](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=400)
- The catheter should be cleared of any air before insertion to prevent air introduction into the colon during the procedure. — Stephanie (clinical) [Ep 3 · 7:20](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=440)
- Explanation and cooperation of the children is very important; the procedure is demonstrated using the child's fist to represent the anal opening and showing that the inflated balloon does not hurt. — Stephanie (clinical) [Ep 3 · 7:40](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=460)
- Hydrocolonic sonography is performed in a special room in the presence of parents, with children watching the water progress on the ultrasound screen. — Stephanie (clinical) [Ep 3 · 8:20](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=500)
- In a successfully cleaned colon, ultrasound shows colonic movement and allows contact with every colonic cell; the time between filling and first movement (adaptation period) can be measured. — Stephanie (clinical) [Ep 3 · 9:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=540)
- White spots on ultrasound represent air bubbles and indicate the colon is not totally clean. — Stephanie (clinical) [Ep 3 · 9:40](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=580)
- The goal is to monitor whether the enema reaches the cecum and measure the volume needed to reach that point. — Stephanie (clinical) [Ep 3 · 10:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=600)
- If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema. — Stephanie (opinion) [Ep 3 · 10:30](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=630)
- Hydrocolonic sonography can visualize fecal impaction (fecal stones in the rectum) in children with chronic constipation. — Stephanie (clinical) [Ep 3 · 11:00](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=660)
- The ideal toilet position for post-enema defecation is sitting low with feet firmly fixed on the ground. — Stephanie (clinical) [Ep 3 · 11:30](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=690)
- In a series of 20 patients aged 14 years and older with fecal incontinence after anorectal malformation surgery, all had constant social problems and soiling before treatment. — Stephanie (epidemiological) [Ep 3 · 11:50](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=710)
- After tailored enema therapy guided by hydrocolonic sonography, 18 of 20 patients achieved continence at 6 and 12 months follow-up. — Stephanie (epidemiological) [Ep 3 · 11:50](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=710)
- The two patients who continued to have incontinence and soiling were those who did not follow the regime and decided not to do rectal irrigation. — Stephanie (epidemiological) [Ep 3 · 11:50](https://origin-library.globalcastmd.com/watch/bowel-management-use-of-ultrasound-to-monitor-effects-of-enema-665?t=710)
- Doing everything extraperitoneally is a nice feature of the technique. — Cathy (opinion) [Ep 4 · 6:28](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=388)
- All of these techniques are good adjuncts to the armamentarium for Hirschsprung's disease, and knowing more techniques allows tailoring to appropriate patients. — Cathy (opinion) [Ep 4 · 6:28](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=388)
- One of the mistakes people make when doing a transanal pull-through is to stretch the sphincters and do the operation on the inside; it should be done by pulling everything out and doing it on the outside without stretching the sphincters. (clinical) [Ep 4 · 7:34](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=454)
- Aggressive sphincter stretching during the transanal approach may damage the sphincters. (clinical) [Ep 4 · 7:34](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=454)
- In early experience with laparoscopic Duhamel, the colon was brought outside to transect it and then put back, but with increased experience this is no longer done and a pretty short stump is left. (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=503)
- Even if more stump is left, it can be trimmed later before closing the stump down. (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=503)
- By doing all dissection from the inside, overstretching of the anus can be avoided. (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=503)
- The end of a GIA stapler can be used for making the side-to-side anastomosis, allowing the procedure to be performed even in neonates at a very early age. (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=503)
- A real pouch does not have to be left behind with this technique. (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=503)
- Hydrocolonic sonography is used to avoid making a guess about enema amount and to avoid radiography (clinical) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=0)
- Hydrocolonic sonography allows evaluation of colonic motility and measurement of enema volume needed in fecal incontinence (clinical) [Ep 5 · 0:25](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=25)
- In constipation, hydrocolonic sonography can visualize fecal impaction and evaluate colonic motility (clinical) [Ep 5 · 1:10](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=70)
- A two-week defecation protocol is required prior to therapy to distinguish pseudo-incontinence with overflow from true fecal incontinence (clinical) [Ep 5 · 2:30](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=150)
- Treatment always starts with intestinal purgation with polyethylene glycol (macrogol or movicol) to achieve a clean colon for evaluation (clinical) [Ep 5 · 3:40](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=220)
- The bowel management program includes individually tailored enema, anal hygiene with showering after every enema, physiotherapy, defecation protocol monitoring, and psychiatric workup in many cases (clinical) [Ep 5 · 4:20](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=260)
- Two pump systems can be used: an electric pump originally for stoma irrigation, or a hand pump made for people with spina bifida (clinical) [Ep 5 · 5:10](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=310)
- A Foley catheter 24 French with 30 mL blockage is used, the same catheter system as used in Cincinnati (clinical) [Ep 5 · 6:20](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=380)
- No air should be present in the colon during sonography because air makes it very difficult to monitor the abdomen with ultrasound (clinical) [Ep 5 · 7:30](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=450)
- The catheter should be cleared of any air before insertion to ensure successful sonography (clinical) [Ep 5 · 8:00](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=480)
- Hydrocolonic sonography is done in a special room in the presence of parents (clinical) [Ep 5 · 8:40](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=520)
- With a successfully cleaned colon, ultrasound shows lovely movement allowing contact with every colonic cell (clinical) [Ep 5 · 9:10](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=550)
- The adaptation period (time between filling the colon and first movement) can be measured (clinical) [Ep 5 · 9:40](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=580)
- White spots on ultrasound represent air bubbles indicating the patient is not totally clean (clinical) [Ep 5 · 10:00](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=600)
- The goal is to monitor whether the enema reaches the cecum and measure the volume needed to reach that point (clinical) [Ep 5 · 10:20](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=620)
- If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema (opinion) [Ep 5 · 10:50](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=650)
- In 20 adult patients (age 14+ years) with fecal incontinence after anorectal malformation surgery, all had constant social problems and soiling before treatment (epidemiological) [Ep 5 · 11:20](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=680)
- After receiving tailored enemas guided by hydrocolonic sonography, only 2 of 20 patients still had problems with incontinence and soiling at 6 and 12 month follow-up (epidemiological) [Ep 5 · 11:40](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=700)
- The two treatment failures were patients who did not follow the regime and decided not to do any more rectal irrigation (epidemiological) [Ep 5 · 12:00](https://origin-library.globalcastmd.com/watch/use-of-hydrocolonic-sonography-to-monitor-the-effects-of-an-enema-pediatric-1065?t=720)
- Placement in our institution happens in a hybrid operating room equipped with a C-ARM cone beam CT and a surgical navigation system. (clinical) [Ep 6 · 0:28](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=28)
- Using this technique enables us to offer this therapy to patients with dysplastic or malformed sacra whose anatomy would be otherwise prohibitive for traditional or purely fluoroscopic interventions. (clinical) [Ep 6 · 0:40](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=40)
- The patient is placed under general anesthesia and position prone with a pelvic roll for elevation and stabilization. (clinical) [Ep 6 · 0:58](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=58)
- The horizontal axis is marked at the posterior inferior iliac spine in the cranial aspect of the sciatic notch. (clinical) [Ep 6 · 1:40](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=100)
- The vertical axis are traced overlying the medial aspect of the S3 neural foramina bilaterally, roughly 2 centimeters from the midline. (clinical) [Ep 6 · 1:52](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=112)
- Conventional skin entry points are marked 2 centimeters cranially to these intersections. (clinical) [Ep 6 · 2:08](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=128)
- A cone beam CT run is acquired intraoperatively and a three dimensional model constructed for procedural guidance. (clinical) [Ep 6 · 2:30](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=150)
- The planned needle entry site was identified around 1 centimeter caudal to the traditional markings in this case. (clinical) [Ep 6 · 3:05](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=185)
- A bellows contraction identifies proper placement at the S3 foramen with confirmation by plantar flexion of the great toe. (clinical) [Ep 6 · 3:35](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=215)
- The marker should be visible halfway through the foramen. (clinical) [Ep 6 · 4:05](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=245)
- A tined lead is then inserted under live visualization until the 3rd and 4th marks straddle the interior edge of the sacrum. (clinical) [Ep 6 · 4:12](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=252)
- This lead consists of 4 distal electrodes, tines or barbs for stabilization, distance markers, and 4 proximal connectors. (clinical) [Ep 6 · 4:25](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=265)
- Over the next 2 to 4 weeks, the patient's bowel function is carefully recorded and compared to previous records. (clinical) [Ep 6 · 4:45](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=285)
- If a positive effect is demonstrated with neuromodulation, a permanent generator is implanted in a second stage. (clinical) [Ep 6 · 4:55](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=295)
- If unsuccessful, the lead can be removed without permanent damage to the nerve. (clinical) [Ep 6 · 5:05](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=305)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The rectoanal inhibitory reflex (RAIR) is the response where the internal anal sphincter relaxes when the rectum becomes distended with stool — Rod summarizing the discussion [Ep 7 · 9:11](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=551)
- Anorectal manometry is critical for determining whether a patient needs surgery or resection, as patients with motility disorders do not need surgery — Rod summarizing the discussion [Ep 7 · 12:03](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=723)
- Careful assessment of existing bowel management including sit time, ingredients, and flush volume is necessary before the next surgical intervention — The host summarizing the discussion [Ep 8 · 7:39](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=459)
- Fecal impaction can push on the bladder and change the angle of the ureter entering the bladder, causing reflux — Jason Frischer summarizing the discussion [Ep 8 · 8:39](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=519)
- The last steps of combined procedures should be maturing the Mitrofanoff, maturing the Malone, then closing the abdomen — Jason Frischer summarizing the discussion [Ep 8 · 10:51](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=651)
- Having families or patients stand up at the end of their flush, move around, then sit back down helps evacuate more stool because things move through their colon differently — Wendy summarizing the discussion [Ep 8 · 11:54](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=714)
- In spinal patients with poor pelvic floor muscles, using additional water in the balloon, larger balloon size, or different shapes like a cone helps with enema administration — Amanda Jensen summarizing the discussion [Ep 8 · 12:48](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urolog-4304?t=768)
- An absent rectal anal inhibitory reflex means that the internal anal sphincter doesn't relax when the rectum is distended, which can contribute to constipation — Felipe Glu summarizing the discussion [Ep 10 · 6:35](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=395)
- HAPCs (high amplitude propagating contractions) aid in the transfer of colonic contents over long distance and often precede emptying — Felipe Glu summarizing the discussion [Ep 10 · 11:17](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=677)
- While surgery can correct the underlying anatomical problem in Hirschsprung disease, many other factors can contribute to constipation including motility disorders, pelvic floor dysfunction, and behavioral issues — Felipe Glu summarizing the discussion [Ep 10 · 14:15](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=855)
- The new Duhamel pull-through was designed to eliminate the septic intraabdominal step, avoid intraabdominal sutures, determine the length of the residual stump, and assure a more secure colorectal anastomosis. — The host summarizing the discussion [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=0)
- The posterior rectal wall incision is made 1.5 centimeters from the dentate line. — The host summarizing the discussion [Ep 1 · 1:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=60)
- The retrorectal tissue is easily dissected digitally, allowing access to the retrorectal space to the sacral promontory. — The host summarizing the discussion [Ep 1 · 2:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=120)
- Dissection is performed along the lateral walls of the rectum approximately 50% of the circumference of the posterior rectal wall. — The host summarizing the discussion [Ep 1 · 2:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=120)
- The laparoscopic endopelvic dissection and entry into the retrorectal space is described as basically a bloodless process. — The host summarizing the discussion [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=180)
- The sigmoid is stapled transversely with a GIA stapler 75 millimeters, which can be reinforced with PDS or Vicryl invaginating sutures. — The host summarizing the discussion [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=240)
- The level at which to cut is defined by pathologic markers intraoperatively by frozen section or by mapping a transition zone with previous suction biopsies. — The host summarizing the discussion [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=240)
- The anastomosis is completed with the Martin technique and modification, leaving a very ample window with minimal chance of stenosis. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=300)
- At 6 months postoperatively, colonoscopy showed a residual pouch of approximately 3 centimeters in an asymptomatic patient. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=300)
- Problems that can occur include accumulation of feces, constipation, and fecal impaction when the stump is left too long. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=300)
- The residual stump can be divided if necessary, as demonstrated via video. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=300)
- The technique is recommended for all pediatric patients, including patients with very dilated colons, and is described as reproducible, easy, and fast with minimal incidence of constipation and stenosis. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/tricks-new-duhamel-laparoscopic-trans-rectal-rectosigmoidectomy-630?t=300)
- The new Duhamel pull-through was designed to eliminate the septic intraabdominal step, avoid intraabdominal sutures, determine the length of the residual stump, and assure a more secure colorectal anastomosis. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The first incision is made with electrocautery on the posterior wall of the rectum 1.5 centimeters from the dentate line. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The retrorectal tissue is easily dissected digitally, allowing access to the retrorectal space to the sacral promontory. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- Dissection is performed along the lateral walls of the rectum approximately 50% of the circumference of the posterior rectal wall. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The sigmoid colon is mobilized laparoscopically and pulled through the retrorectal space using a clamp placed transanally. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The distal rectal segment is stapled transversely with a GIA stapler 75 millimeters, which can be reinforced with PDS or Vicryl invaginating sutures. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The level at which to cut is defined by pathologic markers intraoperatively by frozen section or by mapping a transition zone with previous suction biopsies. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The anastomosis is completed using the Martin technique and modification, leaving a very ample window with minimal chance of stenosis. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- At 6 months postoperatively, colonoscopy showed a residual pouch of approximately 3 centimeters in an asymptomatic patient. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- Problems that can occur include accumulation of feces, constipation, and fecal impaction when the stump is left too long. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The residual stump can be divided if necessary using endoscopic techniques. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- The technique is recommended for all pediatric patients, including patients with very dilated colons, and is reproducible, easy, and fast with minimal incidence of constipation and stenosis. — The host summarizing the discussion [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-duhamel-pediatric-surgery-difficult-cases-2013-1051?t=0)
- Sacral neuromodulation is a therapy aimed at improving the quality of life of patients with constipation and fecal incontinence by delivering electrical impulses through a probe placed near the sacral nerve. — The host summarizing a resource [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=0)
- This technology acts like a pacemaker to promote bowel and sphincter function. — The host summarizing a resource [Ep 6 · 0:20](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=20)
- These would provide access to the S3 foramina at a 60 degree angle in the traditional approach without navigation. — The host summarizing a resource [Ep 6 · 2:18](https://origin-library.globalcastmd.com/watch/sacral-nerve-stimulator-placement-a-novel-surgical-navigation-tool-for-1515?t=138)

## Changelog
- Sep 16: 3 items added automatically
- Sep 15: 3 items added automatically
- Sep 11: 1 item added automatically
- Sep 7: 3 items added automatically

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