# Rectal Bladder Neck Fistula — GCMD Library living collection

Everything in the library about rectal bladder neck fistula — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 61 cited statements

## Episodes
### Surgical Management
- [Recto-Bladderneck Fistula: Laparoscopic-Assisted Anorectoplasty](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097) — video · 3:30 · [machine version](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097.md)

### Evidence & Research
- [Update Course Rewind: Pediatric Colorectal Consortium 2021](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357) — podcast · 14:55 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357.md)
- [Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413) — video · 36:32 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413.md)

### Emerging & Future Directions
- [Update Course 2023 - Updates in Colorectal Pathology](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268) — video · 27:42 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=0) Anal Dilations After PSARP: Evidence for Abandonment (Ep 1)
- [4:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=254) Timing of Repair for Low Anorectal Malformations (Ep 1)
- [6:57](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=417) Hirschsprung Disease: Long Segment Management and Timing (Ep 1)
- [9:48](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=588) Bowel Management in Anorectal Malformations (Ep 1)
- [11:35](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=695) Timing of Pull-Through for Hirschsprung Disease and Health Disparities (Ep 1)
- [12:58](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=778) Cloacal Reconstruction: Anatomic Considerations (Ep 1)
- [0:05](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=5) Anal Dilations Following PSARP: Evidence for Abandoning Routine Protocol (Ep 2)
- [7:16](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=436) Introduction to the Pediatric Colorectal and Pelvic Learning Consortium (Ep 2)
- [12:11](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=731) Timing of Repair for Low Anorectal Malformations: Early Versus Delayed (Ep 2)
- [21:01](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1261) Total Colonic Hirschsprung Disease: Earlier Pull-Through with Ileostomy Management (Ep 2)
- [26:42](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1602) Bowel Management in Anorectal Malformation Patients (Ep 2)
- [29:55](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1795) Timing of Pull-Through for Rectosigmoid Hirschsprung Disease (Ep 2)
- [31:48](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1908) Disparities in Continence Outcomes for Anorectal Malformation Patients (Ep 2)
- [33:33](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2013) Cloacal Reconstruction: Moving Beyond the 3-Centimeter Rule (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=0) Laparoscopic-Assisted Anorectoplasty for Recto-Bladder Neck Fistula (Ep 3)
- [0:03](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=3) Introduction and Dilation Practice Survey (Ep 4)
- [3:27](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=207) Nationwide Dilation Trial and Strictureplasty (Ep 4)
- [7:28](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=448) International Perspectives and Practice Variation (Ep 4)
- [13:55](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=835) Hirschsprung Enterocolitis Case and Management Options (Ep 4)
- [16:42](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1002) Botox Technique and Dosing (Ep 4)
- [18:49](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1129) Enterocolitis Pathophysiology Discussion (Ep 4)
- [23:35](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1415) Botox Evidence Review (Ep 4)
- [25:13](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1513) Perineal Body-Sparing PSARP Techniques (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Dr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty. — Rebecca Rentea (opinion) [Ep 1 · 3:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=199)
- Dr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option. — Rebecca Rentea (opinion) [Ep 1 · 3:38](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=218)
- About 5 to 8% of patients require a strictureplasty at the two-month period. — Rebecca Rentea (epidemiological) [Ep 1 · 4:04](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=244)
- Dr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home. — Rebecca Rentea (opinion) [Ep 1 · 5:03](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=303)
- Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. — Caitlin Smith (opinion) [Ep 1 · 6:22](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=382)
- Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. — Caitlin Smith (clinical) [Ep 1 · 6:32](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=392)
- Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. — Caitlin Smith (clinical) [Ep 1 · 6:47](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=407)
- Dr. Rentia performs pull-through when the child is toilet trained for urine, typically at age 4, because waiting too long can result in horrible anal sphincter spasm and pelvic disease that makes keeping a pull-through challenging. — Rebecca Rentea (opinion) [Ep 1 · 9:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=565)
- Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. — Caitlin Smith (opinion) [Ep 1 · 12:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=760)
- The Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique. — Rebecca Rentea (clinical) [Ep 2 · 9:35](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=575)
- Current practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed. — Rebecca Rentea (clinical) [Ep 2 · 10:25](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=625)
- The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals. — Rebecca Rentea (clinical) [Ep 2 · 11:07](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=667)
- Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. — Caitlin Smith (opinion) [Ep 2 · 17:39](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1059)
- The optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft. — Rebecca Rentea (opinion) [Ep 2 · 18:17](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1097)
- Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. — Caitlin Smith (clinical) [Ep 2 · 18:54](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1134)
- Water-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients. — Rebecca Rentea (clinical) [Ep 2 · 25:32](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1532)
- Delaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging. — Rebecca Rentea (clinical) [Ep 2 · 26:23](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1583)
- Delayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support. — Rebecca Rentea (clinical) [Ep 2 · 31:12](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1872)
- Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through. — Caitlin Smith (clinical) [Ep 4 · 5:31](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=331)
- Strictureplasty for skin-level stricture takes approximately 20 minutes, patients usually go home same day, and converts a Hagar 10 to Hagar 13; no dilations are performed after strictureplasty. — Julia Groski (clinical) [Ep 4 · 6:29](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=389)
- Babies generally tolerate dilations well, but for patients over 6 months (especially approaching 12 months), dilations are often not successful and stricture may develop anyway. — Julia Groski (opinion) [Ep 4 · 7:02](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=422)
- A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort. — Caitlin Smith (clinical) [Ep 4 · 8:23](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=503)
- Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped. — Caitlin Smith (clinical) [Ep 4 · 9:09](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=549)
- Groski does not routinely discuss dilations preoperatively if patient has a colostomy, knowing they will return to operating room for colostomy closure, which is an appropriate time for strictureplasty if needed. — Julia Groski (clinical) [Ep 4 · 9:33](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=573)
- Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa. — Caitlin Smith (clinical) [Ep 4 · 10:44](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=644)
- In resource-limited settings where patients cannot afford to return for a second surgery, routine dilations may be preferable to prevent strictures requiring additional procedures. (opinion) [Ep 4 · 12:34](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=754)
- For Hirschsprung disease patients with recurrent enterocolitis after pull-through, first rule out mechanical obstruction by ensuring no stricture on rectal exam, normal contrast enema, and pathology review showing no transition zone on pull-through specimen. — Julia Groski (clinical) [Ep 4 · 15:14](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=914)
- Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease. — Julia Groski (clinical) [Ep 4 · 15:27](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=927)
- Groski uses 100 units of Botox in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection near the genitourinary tract. — Julia Groski (clinical) [Ep 4 · 16:42](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1002)
- Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each. — Caitlin Smith (clinical) [Ep 4 · 17:18](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1038)
- Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced. — Caitlin Smith (clinical) [Ep 4 · 17:31](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1051)
- To maintain continence, the dentate line must be preserved, which requires leaving a small amount of aganglionic internal sphincter. — Julia Groski (clinical) [Ep 4 · 19:18](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1158)
- Babies with Hirschsprung disease outgrow enterocolitis as their external sphincter matures and is able to overcome the internal sphincter, and as they are potty trained, assuming no surgical problem and all aganglionic bowel has been resected. — Julia Groski (opinion) [Ep 4 · 19:27](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1167)
- The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared. — Caitlin Smith (clinical) [Ep 4 · 20:11](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1211)
- Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool. — Caitlin Smith (clinical) [Ep 4 · 20:42](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1242)
- Total colonic Hirschsprung disease has a significantly higher rate of enterocolitis after pull-through compared to shorter segment disease, which is counterintuitive given less colon for bacterial colonization. — Julia Groski (clinical) [Ep 4 · 21:09](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1269)
- Children with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through, without a well-understood explanation. — Julia Groski (clinical) [Ep 4 · 21:26](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1286)
- Enterocolitis in a diverted colon is theoretically possible with a tight stoma that is not emptying well, but speakers have not personally seen this occur. — Julia Groski (opinion) [Ep 4 · 21:53](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1313)
- There is discussion of whether colectomy should be performed at the time of total colonic Hirschsprung diagnosis due to enterocolitis risk, but speakers have historically left the colon in place and removed it at pull-through. — Julia Groski (clinical) [Ep 4 · 22:55](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1375)
- A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic. — Caitlin Smith (clinical) [Ep 4 · 23:12](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1392)
- Not all patients need prophylactic Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy. — Julia Groski (opinion) [Ep 4 · 24:41](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1481)
- The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients. — Caitlin Smith (clinical) [Ep 4 · 26:22](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1582)
- For patients undergoing dilations without diversion, the perineal body seeing stool immediately postoperatively creates high risk for postoperative infection; perineal body-sparing technique helps avoid this. — Julia Groski (clinical) [Ep 4 · 27:12](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1632)
- In this case, the rectum is high, connected to the bladder, and is not reachable safely from a posterior sagittal approach alone, as shown on distal colostogram. (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=0)
- Port placement uses umbilical access, a 4mm trocar in the right upper quadrant for the camera, a right lower quadrant port for the surgeon's right hand, and the umbilicus for the surgeon's left hand. (clinical) [Ep 3 · 1:00](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=60)
- A left upper quadrant port can be placed if needed to help retract the sigmoid. (clinical) [Ep 3 · 1:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=90)
- The bladder is fixed to the anterior abdominal wall with a transcutaneous stay suture to provide better exposure of the pelvis. (clinical) [Ep 3 · 1:40](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=100)
- The distal rectum is mobilized circumferentially using hook electrocautery, starting anteriorly and working laterally until posterior attachments can be visualized and released. (clinical) [Ep 3 · 2:00](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=120)
- During rectal mobilization, both ureters and vas deferens must be identified and avoided. (clinical) [Ep 3 · 2:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=150)
- A 3mm endosealer is used for attachments near the bladder to avoid thermal spread. (clinical) [Ep 3 · 2:45](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=165)
- Great care is taken to preserve the inferior mesenteric artery and its branches, which provide intramural blood supply to the distal rectum. (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=180)
- The fistula is divided at the point of maximal tapering of the distal rectum near the bladder using a 3mm instrument. (clinical) [Ep 3 · 3:20](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=200)
- The bladder side of the divided fistula is closed with a grasper and a preloaded endo loop. (clinical) [Ep 3 · 3:50](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=230)
- After fistula ligation, rectal length must be gained to perform anoplasty without tension. (clinical) [Ep 3 · 4:05](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=245)
- There is no need for prone positioning; the patient's legs are placed up for the posterior sagittal portion. (clinical) [Ep 3 · 4:20](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=260)
- The muscle complex is identified with a nerve stimulator, and a limited posterior sagittal incision is made. (clinical) [Ep 3 · 4:35](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=275)
- The limited posterior sagittal incision allows for safer passage into the pelvis and permits tacking of the rectum to the posterior edge of the sphincter complex. (clinical) [Ep 3 · 4:50](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=290)
- Blunt dissection is used to create a space between the sacrum and the pubis. (clinical) [Ep 3 · 3:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=210)
- Once the peritoneum is entered, the abdomen is insufflated and the rectum is passed into the tract. (clinical) [Ep 3 · 3:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=210)
- The rectum is placed within the center of the sphincter and anchored to the posterior aspect of the sphincter complex. (clinical) [Ep 3 · 3:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=210)
- An anoplasty with 16 sutures is performed, and the posterior sagittal incision is closed. (clinical) [Ep 3 · 3:30](https://origin-library.globalcastmd.com/watch/recto-bladderneck-fistula-laparoscopic-assisted-anorectoplasty-6097?t=210)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=70)
- There is literature suggesting a component of psychosocial, psychological dissociation in children on later testing related to anal dilations. — Ellen Encisco summarizing the discussion [Ep 1 · 1:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=91)
- In the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 1:37](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=97)
- The average PSARP was performed at 5 months in the study. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 1:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=110)
- A stricture was defined as a Hagar dilator size of less than 10. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 1:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=112)
- The standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less. — Todd Ponsky summarizing the discussion [Ep 1 · 1:57](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=117)
- In the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal. — Todd Ponsky summarizing the discussion [Ep 1 · 2:16](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=136)
- Strictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 2:26](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=146)
- The number of strictures, number needing anoplasties, and number of redo operations were the same between dilation and no-dilation groups. — Ellen Encisco summarizing the discussion [Ep 1 · 2:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=175)
- The number of patients who had rectal prolapse is consistent with the literature. — Ellen Encisco summarizing the discussion [Ep 1 · 3:04](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=184)
- A study of 30-day outcomes for ARM with perineal or rectovaginal fistulas divided patients into early repair (before 6 days old) and late repair (6-8 weeks), with 66 early and 231 late repairs among 291 patients. — Ellen Encisco summarizing the discussion [Ep 1 · 5:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=320)
- 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 5:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=340)
- A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 5:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=345)
- Long segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 7:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=447)
- A contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 7:42](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=462)
- There was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 7:51](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=471)
- There are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 8:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=493)
- A hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 8:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=511)
- If a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 8:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=529)
- A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 10:36](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=636)
- Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 10:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=645)
- The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 11:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=674)
- A study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 11:38](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=698)
- Preoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 11:46](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=706)
- A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 1 · 12:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=735)
- Urethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 13:26](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=806)
- If a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 13:44](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=824)
- A short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 13:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=835)
- Rotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 1 · 14:03](https://origin-library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=843)
- A single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 3:35](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=215)
- Stricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 4:36](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=276)
- In the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 5:29](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=329)
- The number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 6:12](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=372)
- Literature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=240)
- An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 14:55](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=895)
- A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 15:53](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=953)
- Long-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 22:57](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1377)
- Contrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 23:38](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1418)
- For long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 23:55](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1435)
- A European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 24:23](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1463)
- A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 28:58](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1738)
- In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 29:18](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1758)
- Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 28:16](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1696)
- A PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 30:06](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1806)
- Post-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 30:37](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1837)
- Constipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 30:46](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1846)
- Transition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 30:55](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1855)
- In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 32:12](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1932)
- A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 2 · 32:32](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1952)
- The urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 35:19](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2119)
- A short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 35:57](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2157)
- Rotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 2 · 36:05](https://origin-library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2165)
- A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age. — Caitlin Smith summarizing the discussion [Ep 4 · 3:27](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=207)
- In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group. — Caitlin Smith summarizing the discussion [Ep 4 · 4:13](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=253)
- In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic. — Caitlin Smith summarizing the discussion [Ep 4 · 4:24](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=264)
- Keith Jorgeson taught that if you don't dilate at 2 weeks in the office, you will develop a stricture. — Julia Groski summarizing the discussion [Ep 4 · 12:10](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=730)
- Most studies on Botox for Hirschsprung disease are single-institution and retrospective, with limitations due to high phenotypic variance in disease presentation and severity. — Julia Groski summarizing the discussion [Ep 4 · 23:35](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1415)
- Data suggests prophylactic Botox has not been shown to decrease the risk of enterocolitis. — Julia Groski summarizing the discussion [Ep 4 · 24:14](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1454)
- Botox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis. — Julia Groski summarizing the discussion [Ep 4 · 24:25](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1465)
- Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques. — Caitlin Smith summarizing the discussion [Ep 4 · 25:48](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1548)
- The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter. — Caitlin Smith summarizing the discussion [Ep 4 · 26:01](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1561)
- The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin. — Caitlin Smith summarizing the discussion [Ep 4 · 26:54](https://origin-library.globalcastmd.com/watch/update-course-2023-updates-in-colorectal-pathology-7268?t=1614)

## Changelog
- Sep 19: 1 item added automatically
- Sep 7: 3 items added automatically

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai