# Ulcerative Colitis — GCMD Library living collection

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

Updated: n/a · 10 episodes · 175 cited statements

## Episodes
### Fundamentals
- [The Colorectal Quiz Episode 21: The History of Hirschsprung Disease](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818) — video · 15:20 · [machine version](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818.md)

### Acute Management
- [Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346) — video · 5:57 · [machine version](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346.md)

### Surgical Management
- [Ulcerative Colitis and Familial Adenomatous Polyposis: Update Course 2016](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422) — video · 46:16 · [machine version](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422.md)
- [Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913) — video · 44:22 · [machine version](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913.md)
- [Inflammatory Bowel Disease: Update Course 2015](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987) — video · 13:49 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987.md)

### Evidence & Research
- [The Role of Diversion During Ileal Pouch Anal Anastomosis (IPAA) Creation in Pediatric Ulcerative Colitis - JPS](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998) — video · [machine version](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998.md)
- [El papel de la ostomía durante la creación del Pouch ileal coon anastomosis anal (IPAA) en la colitis ulcerosa pediátrica - JPS](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999) — video · [machine version](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999.md)
- [The Colorectal Quiz Episode 21: The History of Hirschsprung Disease](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861) — podcast · 15:56 · [machine version](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861.md)

### Case-Based Learning
- [Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655) — video · 28:36 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655.md)
- [Inflammatory Bowel Disease: Update Course 2014](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042) — video · 28:36 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=0) Clinical vignette and historical context of IV fluid selection (Ep 1)
- [1:16](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=76) Evidence for isotonic maintenance fluids and the hyponatremia problem (Ep 1)
- [3:19](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=199) Dissemination of new practice and audience response (Ep 1)
- [4:44](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=284) Special populations and future directions (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=0) Case presentation and preoperative considerations in acute ulcerative colitis (Ep 2)
- [5:34](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=334) Anastomotic technique and height: stapled vs. hand-sewn approaches (Ep 2)
- [11:31](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=691) Surgical technique: laparoscopic approach and pouch construction (Ep 2)
- [17:02](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1022) Mesenteric management and operative efficiency (Ep 2)
- [23:01](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381) Fertility, pregnancy, and sexual function outcomes (Ep 2)
- [30:31](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1831) Functional outcomes and conversion to Crohn disease (Ep 2)
- [36:58](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2218) Venous thromboembolism prophylaxis and risk factors (Ep 2)
- [40:35](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2435) Contrast studies before ileostomy closure and FAP timing (Ep 2)
- [45:02](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2702) Patient education tools and multimedia resources (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0) Case 1: Imaging modalities for fibrostenotic and fistulizing Crohn's disease (Ep 3)
- [7:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=420) Case 1: Surgical management of perianal abscess with ileal stricture (Ep 3)
- [15:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900) Seton techniques and perianal fistula outcomes (Ep 3)
- [20:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200) Isolated terminal ileal Crohn's as distinct entity (Ep 3)
- [23:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380) Case 2: Surgical approach to refractory ulcerative colitis (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0) Introduction to ERAS Concept and Historical Context (Ep 4)
- [7:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=420) ERAS Components and Physiologic Rationale (Ep 4)
- [15:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900) Evidence Base: Adult and Pediatric Outcomes (Ep 4)
- [22:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320) Implementation Strategy and Team Building (Ep 4)
- [30:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800) Interactive Discussion: Practical Implementation Questions (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=0) Crohn's Disease Case: Timing of Surgery and TNF Inhibitor Management (Ep 5)
- [3:05](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=185) Ulcerative Colitis: J-Pouch Reconstruction and Infertility Considerations (Ep 5)
- [8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507) Surveillance Colonoscopy as Alternative to Prophylactic Colectomy (Ep 5)
- [9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578) Indeterminate Colitis: Surgical Approach and J-Pouch Controversy (Ep 5)
- [11:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691) Technical Considerations and Volume-Outcome Relationship for J-Pouch (Ep 5)
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=0) Case 1 Introduction: Crohn's with Perianal Abscess - Imaging Modalities (Ep 6)
- [3:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=227) Surgical Management of Fistulizing and Fibrostenotic Crohn's Disease (Ep 6)
- [12:45](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765) Perianal Disease Management and Strictureplasty Indications (Ep 6)
- [18:24](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1104) Duodenal Crohn's and Isolated Terminal Ileal Disease (Ep 6)
- [20:46](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1246) Case 2: Severe Ulcerative Colitis - Surgical Approach (Ep 6)
- [0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0) Study Overview: Diversion During IPAA in Pediatric Ulcerative Colitis (Ep 7)
- [0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0) Ostomy necessity in pediatric IPAA for ulcerative colitis (Ep 8)
- [0:00](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=0) Introduction and Overview (Ep 9)
- [1:00](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=60) Hirschsprung, Swenson, and the Development of Early Techniques (Ep 9)
- [4:06](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=246) Duhamel, Rabine, and Boley (Ep 9)
- [5:05](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=305) Personal Connections to Dr. Boley (Ep 9)
- [8:34](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=514) Henrys and Martin: Primary Pull-Through and Ulcerative Colitis (Ep 9)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Harold Hirschsprung identified that a baby could be sick due to this problem but did not understand the pathology. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- The disease is named Hirschsprung disease, not apostrophe S. — Marc Levitt (guideline) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Orvar Swenson figured out the pathology by going to the pathology lab and defined the fact that there were no ganglion cells. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Prior to Swenson's work, removal of the dilated colon was the treatment, which was a mistake; it was the distal narrow colon that was the problem. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Swenson developed the first operation for Hirschsprung disease, a full-thickness rectal dissection. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Some surgeons still do Suave procedures, but they are becoming more Swenson-like with maybe a one-centimeter cuff; Dan von Allman calls those 'Suavesons with a one-centimeter cuff.' — Marc Levitt (opinion) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Dr. Yancey was the first surgeon to describe a submucosal dissection for Hirschsprung disease, but published in a journal not widely read; Dr. Suave published later in a more widely read journal, so the technique is called Suave rather than Yancey. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- The Suave technique was developed because people said the Swenson caused fecal and urinary incontinence or voiding dysfunction; Swenson himself wrote that the operation was good but surgeons were doing it wrong by dissecting too wide. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Doing a proper Swenson right on the bowel wall, like a PSARP right on the bowel wall, avoids nerve injury; if you see fat you can get closer, as the nerves are in the fatty layer. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Swenson was 105 when he died and used to write letters to Levitt and Alberto Pena asking them to promote the Swenson operation. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Duhamel had the idea to leave the original rectum behind and do a pull-through next to it, then mate the two lumens. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- The Duhamel is now really only appropriate for an ilio-Duhamel, although Levitt would still do an ilioanal. — Marc Levitt (opinion) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Rabine did a low anterior resection for Hirschsprung disease, leaving about six centimeters behind; some patients did fine as ganglionated bowel pooped through the six centimeters of aganglionated bowel, but that operation has gone to the wayside. — Marc Levitt (clinical) [Ep 10 · 0:26](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=26)
- Dr. Boley was the first to do the primary coloanal anastomosis of a Suave, eliminating the need to leave the bowel hanging out and come back at day seven; the proper description is the Suave technique with the Boley modification, i.e., a Suave-Boley. — Marc Levitt (clinical) [Ep 10 · 5:57](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=357)
- Henry So was a pediatric surgeon in the Philippines and the first to do a primary pull-through (transabdominal) with no preceding stoma, because patients with stomas at home in the Philippines faced such social stigma that babies were basically left to die by their families. — Marc Levitt (clinical) [Ep 10 · 5:57](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=357)
- Dr. Martin was the first surgeon-in-chief and pediatric surgeon at Cincinnati Children's Hospital. — Jason Frischer (clinical) [Ep 10 · 9:40](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=580)
- Dr. Martin developed the Martin procedure, an expansion of the Duhamel for long-segment Hirschsprung disease, leaving a longer aganglionated segment of rectum and pulling through ganglionated bowel. — Jason Frischer (clinical) [Ep 10 · 9:40](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=580)
- Dr. Martin's biggest contribution was in ulcerative colitis; in 1977, before the J-pouch, he took the endorectal pull-through technique used in Hirschsprung disease and applied it to ulcerative colitis, doing a total proctocolectomy with ilioanal anastomosis. — Marc Levitt (clinical) [Ep 10 · 10:34](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=634)
- The transanal dissection and Suave plane dissection is the same concept as the mucosectomy in ulcerative colitis. — Marc Levitt (clinical) [Ep 10 · 10:34](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=634)
- Helen Noblet figured out the suction rectal biopsy; she is from Melbourne, Australia. — Marc Levitt (clinical) [Ep 10 · 11:41](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- Keith Jorgensen did the laparoscopic version of the Suave; in his original description (with Tom Inge on the paper), they talked about leaving a five-centimeter cuff, which nowadays would be way too much. — Marc Levitt (clinical) [Ep 10 · 11:41](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- Jack Langer approached Hirschsprung disease transanally, doing a transanal resection of the rectosigmoid with or without laparoscopy or laparotomy. — Marc Levitt (clinical) [Ep 10 · 11:41](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- Luis de la Torre also did transanal resection around the same time as Jack Langer; some places around the world are doing transanal only, and Levitt does that in certain circumstances. — Marc Levitt (clinical) [Ep 10 · 11:41](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- Dan Teitelbaum did an incredible amount of work in Hirschsprung disease, particularly significant research in enterocolitis; he passed away from a brain tumor. — Marc Levitt (clinical) [Ep 10 · 11:41](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13861?t=701)
- Iatrogenic hyponatremia is one of the biggest problems in hospitals, related to ADH physiology and the use of hypotonic fluids rather than normal saline. (clinical) [Ep 1 · 1:23](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- Children become hyponatremic because they are given half normal saline, and the data on this are clear. (clinical) [Ep 1 · 1:23](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=83)
- The correct maintenance fluid for a 15-year-old post-colectomy patient is D5 normal saline with 20 milliequivalents of potassium. (guideline) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=125)
- The American Academy of Pediatrics is coming out with a consensus statement on isotonic maintenance fluids (anticipated as of March). (guideline) [Ep 1 · 2:31](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- Hospitalized children develop hyponatremia because they receive less than isotonic (hypotonic) solutions, leading to cerebral edema and other complications. (clinical) [Ep 1 · 2:31](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=151)
- The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia. (guideline) [Ep 1 · 2:58](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=178)
- At ABSA, 48% of respondents correctly identified isotonic fluid as the answer, which the speakers considered a high number given the radical change from traditional teaching. (epidemiological) [Ep 1 · 3:30](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=210)
- Hypotonic fluids were originally developed based on theoretical calculations of sodium and chloride losses by a scientist approximately 100 years ago, not on evidence from real patients. (clinical) [Ep 1 · 4:24](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=264)
- Newborn babies are different because their kidney function is immature when first born, so the amount of electrolytes given changes over the first couple of days of life. (clinical) [Ep 1 · 4:47](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- Term newborns on the first day of life should receive D10W (dextrose 10% in water) with no saline. (guideline) [Ep 1 · 4:47](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=287)
- In adult critical care literature, practice is shifting from normal saline to lactated Ringer's as the normal isotonic solution, and the same shift is expected to occur in pediatrics. (opinion) [Ep 1 · 5:14](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=314)
- Lactated Ringer's is a more physiologic isotonic solution than normal saline. (clinical) [Ep 1 · 5:40](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- There is not yet literature in children supporting the use of D5 lactated Ringer's, but it is anticipated. (opinion) [Ep 1 · 5:40](https://origin-library.globalcastmd.com/watch/isotonic-maintenance-fluid-practice-gap-discussion-at-update-course-2018-346?t=340)
- In the last 50 J-pouch patients at Cincinnati Children's, none had an albumin level greater than 3.5 g/dL at the time of surgery. — Jason Frischer (clinical) [Ep 2 · 3:18](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=198)
- Pediatric UC patients differ from adult populations because adults often undergo reconstructive surgery for dysplasia, which is extremely rare in pediatric patients. — Jason Frischer (clinical) [Ep 2 · 3:38](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=218)
- The speaker's rule of thumb for pouch sizing is age of patient plus 1 cm (e.g., 6 cm pouch for a 5-year-old, 11 cm for a 10-year-old), with a maximum of 15 cm for post-pubertal patients. — Jason Frischer (clinical) [Ep 2 · 15:12](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=912)
- The speaker limits maximum pouch size to 12 cm after having several 15 cm pouches become so dilated they required revision. — Todd Ponsky (clinical) [Ep 2 · 15:45](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=945)
- Taking the mesentery extracorporeally (after laparoscopic mobilization) took a solid hour off the procedure time, reducing cases from all-day to 2-2.5 hours. — Todd Ponsky (clinical) [Ep 2 · 17:02](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1022)
- The speaker converted from open stapling device to endoscopic stapling device for pouch creation because the limbs are smaller, making the common enterotomy smaller and the operation cleaner. — Jason Frischer (clinical) [Ep 2 · 19:40](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1180)
- Leak rate after J-pouch is quoted as somewhere between 5 and 15%, which correlates with pelvic infections. — Jason Frischer (clinical) [Ep 2 · 23:01](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381)
- Cincinnati Children's data showed daytime soiling rate of about 5% in younger patients and nighttime soiling in about one-third of patients (18% in older patients), with no statistically significant difference between younger (mean age 7) and older (mean age 14) groups. — Jason Frischer (epidemiological) [Ep 2 · 29:00](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1740)
- The rate of conversion from UC to Crohn disease was approximately 10-12% in both younger and older patient populations, with no difference between age groups. — Jason Frischer (epidemiological) [Ep 2 · 29:20](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1760)
- A 12-year-old UC patient developed a golf ball-sized thrombus in the right atrium 3 hours after subtotal colectomy, despite compression boots for thromboprophylaxis. — Jason Frischer (clinical) [Ep 2 · 30:31](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1831)
- The compartment syndrome rate in patients with elevated legs for extended periods is surprisingly high, leading one surgeon to keep legs down in stirrups until anal work is required. — Todd Ponsky (clinical) [Ep 2 · 26:50](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1610)
- In a study of contrast enemas before ileostomy closure, none demonstrated problems that weren't already known clinically; symptomatic patients had pouch problems, asymptomatic patients did not. — Jason Frischer (clinical) [Ep 2 · 40:35](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2435)
- Indications for FAP surgery include: symptomatic presentation (bleeding, pain), colonoscopy showing >100 polyps with increasing burden, or dysplasia (extremely rare in pediatric population). — Todd Ponsky (clinical) [Ep 2 · 43:50](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2630)
- For FAP patients with family history, colonoscopy screening typically begins at least 10 years prior to the age when the affected parent was diagnosed with heavy polyp burden. — Todd Ponsky (clinical) [Ep 2 · 44:25](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2665)
- Pediatric gastroenterologists are so committed to medical management that they sometimes keep UC patients longer on therapy, resulting in sicker children (bleeding, on TPN, steroids, and Remicade) when surgery is finally consulted. — Todd Ponsky (opinion) [Ep 2 · 23:01](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1381)
- Three-stage operations (simple colectomy first) can dramatically change the course for very sick UC patients, allowing them to become immunocompetent before subsequent reconstructive procedures. — Todd Ponsky (opinion) [Ep 2 · 23:40](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1420)
- Cincinnati Children's averages 10-18 J-pouches per year in recent years. — Jason Frischer (epidemiological) [Ep 2 · 25:50](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1550)
- One surgeon made an agreement with a partner to specialize: taking thyroids and IBD patients while giving up lung lesions, allowing the team to develop expertise through repetition (10,000 hours concept) and reduce case times significantly. — Todd Ponsky (clinical) [Ep 2 · 25:00](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1500)
- Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease. — Samir Pandya (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=180)
- Perianal abscesses in Crohn's disease are unlikely to heal without fecal diversion because bowel continuity slows healing. — Samir Pandya (opinion) [Ep 3 · 10:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=600)
- Modern TNF inhibitor drugs are effective at healing perianal disease in Crohn's, potentially allowing avoidance of fecal diversion in selected patients. — Samir Pandya (clinical) [Ep 3 · 11:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=660)
- Patients and parents would rather deal with a chronic perianal problem than manage a stoma. — Samir Pandya (opinion) [Ep 3 · 12:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=720)
- Most Crohn's perianal abscesses are not single; when draining a perianal abscess in Crohn's disease, there are usually several fistulas present. — Samir Pandya (clinical) [Ep 3 · 13:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=780)
- Setons are very effective for perianal fistulas and should be used more often in pediatric surgery than they currently are. — Samir Pandya (opinion) [Ep 3 · 14:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=840)
- It is less morbid to perform laparoscopic diversion in 15% of patients whose perianal disease fails to heal than to give 100% of patients an ostomy upfront. — Samir Pandya (opinion) [Ep 3 · 15:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900)
- Crohn's patients can develop peristomal fistulas as a complication of stoma creation. — Samir Pandya (clinical) [Ep 3 · 16:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=960)
- Crohn's disease affects the entire GI tract as a chronic disorder, even when only one segment shows active stricturing disease. — Samir Pandya (clinical) [Ep 3 · 17:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1020)
- A cutting seton requires 360-degree tension on tissue to actively divide it, whereas a non-cutting seton is placed loosely to allow drainage and gradual fibrosis without active cutting. — Samir Pandya (clinical) [Ep 3 · 19:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1140)
- For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can be effective, making the stricture more pliable and allowing weight gain. — Samir Pandya (clinical) [Ep 3 · 21:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1260)
- Isolated terminal ileal Crohn's disease may be a separate disease entity from perianal or diffuse Crohn's disease because it behaves very differently, with prolonged remission after resection. — Samir Pandya (opinion) [Ep 3 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Patients with isolated terminal ileal Crohn's disease should be considered for earlier resection before starting Remicade because of the favorable long-term outcomes after resection. — Samir Pandya (opinion) [Ep 3 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Pediatric IBD patients referred for surgery are often in horrible nutritional shape because GI physicians view surgery as failure and carry patients on medical therapy for too long. — Samir Pandya (opinion) [Ep 3 · 23:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380)
- Patients with severe ulcerative colitis who are emaciated, hypoalbuminemic, on steroids, and in poor nutritional status often require three-stage surgery: subtotal colectomy with end ileostomy, then subsequent J-pouch creation. — Samir Pandya (clinical) [Ep 3 · 24:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1440)
- Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after the subsequent J-pouch operation. — Samir Pandya (clinical) [Ep 3 · 25:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1500)
- The best ulcerative colitis patients ever look is when they have their end ileostomy after subtotal colectomy, before J-pouch creation. — Samir Pandya (opinion) [Ep 3 · 26:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1560)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis is rare but can be managed with local therapy. — Samir Pandya (clinical) [Ep 3 · 27:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1620)
- Endorectal dissection technique (similar to Hirschsprung surgery) can be performed safely for ulcerative colitis J-pouch even in relatively sick patients, as long as a diverting ileostomy is created. — Samir Pandya (clinical) [Ep 3 · 28:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1680)
- Continued bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can force earlier-than-anticipated completion of the J-pouch procedure. — Samir Pandya (clinical) [Ep 3 · 29:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1740)
- Between stage 1 and stage 2 of ulcerative colitis surgery, patients often gain 20 to 30 pounds, which can make the subsequent operation technically harder. — Samir Pandya (clinical) [Ep 3 · 30:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1800)
- Henrik Kehlet published results 20 years ago showing open sigmoidectomy patients discharged within a couple of days with multimodal care, achieving rapid return to work without high readmission rates and with very low complication rates. — Matt Kurt (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0)
- National anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding. — Matt Kurt (guideline) [Ep 4 · 4:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- The sooner an IV is removed and the patient leaves the hospital, the safer the patient becomes, because as long as humans are administering care in hospitals, patients remain at risk for medication errors involving the five rights (right patient, dose, medicine, mode, timing). — Matt Kurt (opinion) [Ep 4 · 5:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=300)
- Adult ERAS programs implement 17-20 protocol steps, whereas pediatric studies have only implemented about 5 steps, representing a significant implementation gap. — Matt Kurt (clinical) [Ep 4 · 11:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=690)
- Preoperative pain medication cocktail includes gabapentin and acetaminophen in large quantities; adult programs add celecoxib to this regimen. — Matt Kurt (clinical) [Ep 4 · 15:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900)
- Patients receive high-sugar electrolyte solutions until 2 hours before surgery after stopping solids at midnight, avoiding bringing a dehydrated patient to the operating room. — Matt Kurt (clinical) [Ep 4 · 4:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- Foley catheters are removed immediately after surgery for ileocecectomy; for J-pouch procedures they are left overnight and removed in the morning, with no urinary retention issues reported. — Matt Kurt (clinical) [Ep 4 · 17:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1050)
- Patients are fed and given fluids on postoperative day 0; if they drink successfully once, they are advanced to solid food, with the rationale that dexamethasone increases hunger, ondansetron prevents nausea, and avoiding overhydration and narcotics allows the gut to function. — Matt Kurt (clinical) [Ep 4 · 18:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1110)
- A 17-year-old patient with ulcerative colitis had colectomy and was ready for discharge the night of surgery, actually discharged postoperative day 2; same pattern occurred for J-pouch creation and ileostomy closure. — Matt Kurt (clinical) [Ep 4 · 20:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1200)
- IBD patients on TPN, steroids, and other medications do not go home in 2 days but will go home in 3-4 days with ERAS protocol, compared to longer traditional stays. — Matt Kurt (clinical) [Ep 4 · 21:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1260)
- Individual ERAS components may not have significant evidence bases by themselves, but when bundled together like other care bundles, they create a second-order change in outcomes. — Matt Kurt (opinion) [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320)
- Creating a formal multidisciplinary team (anesthesia, perioperative nursing, floor nursing, nurse clinician) dramatically improved protocol compliance; before team formalization, 5-8 components were achieved, afterward compliance increased substantially. — Matt Kurt (clinical) [Ep 4 · 24:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1440)
- Monthly team meetings review compliance for each individual patient, identify upcoming cases, discuss needed improvements, and provide ongoing education; this audit process is critical to program success. — Matt Kurt (clinical) [Ep 4 · 25:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1500)
- Anesthesiologists view ERAS as part of their future through the 'surgical home' concept, making them natural partners in implementation. — Matt Kurt (opinion) [Ep 4 · 26:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1560)
- Engaging partners through data demonstration rather than just advocacy is more effective; showing improved outcomes leads to adoption, whereas simply talking about the protocol has different results. — Matt Kurt (opinion) [Ep 4 · 27:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1620)
- Gabapentin is an anti-seizure medication that influences neurologic pain and works well as part of multimodal analgesia; pediatric dosing is 10 mg/kg. — Matt Kurt (clinical) [Ep 4 · 30:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800)
- IV lidocaine given intraoperatively attenuates the inflammatory response to surgical wounding, helping patients recover more quickly; this is used in some adult programs. — Matt Kurt (clinical) [Ep 4 · 31:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1860)
- Chewing gum given to school-aged patients generates saliva that goes down the GI tract, stimulating bowel function and gas passage; this is a cheap addition to the protocol. — Matt Kurt (clinical) [Ep 4 · 37:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2220)
- When patients develop complications such as bowel obstruction or anastomotic leak, they come off the ERAS protocol and are treated as traditional patients; this occurred in approximately 10% of cases in the speaker's series. — Matt Kurt (clinical) [Ep 4 · 39:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2340)
- NG tubes prolong ileus because they suction out material that would otherwise go downstream and stimulate bowel function. — Matt Kurt (clinical) [Ep 4 · 43:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2580)
- Patient and family education with goal sheets may be on equal footing with physiologic interventions in terms of impact, as empowering patients and giving them control over their care drives compliance and outcomes. — Matt Kurt (opinion) [Ep 4 · 22:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1350)
- For Crohn's disease with terminal ileum stricture and phlegmonous changes encasing the ureter, laparoscopic ileocystectomy with a lighted ureteral stent for ureter identification is the appropriate surgical approach. (clinical) [Ep 5 · 1:05](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=65)
- If the patient is stable, giving a couple weeks of antibiotics to cool down inflammation before surgery is advisable in Crohn's disease. (clinical) [Ep 5 · 1:26](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=86)
- There is no data to support the exact timing of preoperative antibiotics in Crohn's disease. (clinical) [Ep 5 · 1:35](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=95)
- Based on small literature, surgery should be delayed 2-4 weeks from the last TNF inhibitor infusion preoperatively if possible. (clinical) [Ep 5 · 1:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- Postoperatively, TNF inhibitor can be restarted after about 2 weeks if active disease is seen in other parts of the bowel, or after 4 weeks if disease is less aggressive. (clinical) [Ep 5 · 1:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- The literature on anastomotic complications with TNF inhibitors is mixed; wound complications are the biggest concern in the literature. (clinical) [Ep 5 · 2:34](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=154)
- The decision to perform single-stage versus diverted J-pouch reconstruction depends on intraoperative findings including ease of pouch creation, tissue health, and presence of tension. (clinical) [Ep 5 · 3:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- Patients on steroids and infliximab have risk factors for anastomotic complications. (clinical) [Ep 5 · 3:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- Surgery for ulcerative colitis may be indicated when complications of medical therapy (long-term side effects of anti-TNF drugs, steroids, growth failure) become intolerable, even if the disease is controlled. (clinical) [Ep 5 · 4:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=278)
- Only about 20% of patients with ulcerative colitis develop colon cancer by 20 years from the time of original diagnosis. (epidemiological) [Ep 5 · 8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- Patients with ulcerative colitis can live their entire life with their colons if they undergo yearly surveillance colonoscopy; there is no reason to have a colectomy without other indications beyond cancer risk alone. (clinical) [Ep 5 · 8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- For indeterminate colitis with patchy disease throughout the colon, the conservative approach is to divert with ileostomy and observe what happens to the colon. (clinical) [Ep 5 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- For indeterminate colitis with extensively diseased colon, one would consider subtotal colectomy with ileostomy to obtain a large specimen for pathologic determination of disease type. (clinical) [Ep 5 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- There is literature on doing total proctocolectomy and J-pouch for indeterminate colitis, but it carries more risk. (clinical) [Ep 5 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- Performing a J-pouch in a patient who turns out to have Crohn's disease creates significant challenges. (clinical) [Ep 5 · 10:35](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=635)
- Thin asthenic females with indeterminate colitis do not do well with J-pouch. (clinical) [Ep 5 · 10:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=657)
- A stepwise approach to J-pouch in indeterminate colitis allows time to obtain more diagnostic information between stages. (clinical) [Ep 5 · 11:09](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=669)
- J-pouch is a procedure with a definite learning curve in terms of technical aspects. (opinion) [Ep 5 · 11:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691)
- In pediatric patients, the rectum can be divided laparoscopically, everted or stapled across at the columns, then the J-pouch created externally with anvil placement for EEA anastomosis, as an alternative to the adult technique. (clinical) [Ep 5 · 11:58](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=718)
- J-pouch provides the best operation for control of bowel issues in ulcerative colitis patients, and patients can still carry pregnancies even if natural conception is impaired. (opinion) [Ep 5 · 12:58](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=778)
- Children presenting with Crohn's disease and perianal/perirectal abscess often have non-colonic small intestinal disease. (clinical) [Ep 6 · 1:23](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=83)
- MR enterography provides information about both stricture anatomy and chronicity of disease, helping determine whether a stricture is chronic/fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. (clinical) [Ep 6 · 3:51](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=231)
- For a patient with 18-pound weight loss over 4 months and dilated bowel proximal to an 8 cm terminal ileal stricture, these are indications for ileal resection. (clinical) [Ep 6 · 6:42](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=402)
- Perianal abscesses in Crohn's disease may not heal without temporary diversion, even after resection of gross bowel disease. (opinion) [Ep 6 · 7:50](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=470)
- For first-time perianal abscess in Crohn's disease, temporary diversion should be considered via laparoscopic ileal resection with end ileostomy and mucous fistula, with stoma closure planned at 3-6 months. (opinion) [Ep 6 · 8:42](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=522)
- Diversion is typically reserved for patients with distal colon disease as part of perianal disease, not for isolated small bowel Crohn's with perianal abscess. (opinion) [Ep 6 · 9:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=551)
- Bowel continuity slows healing of perianal abscesses in Crohn's disease. (clinical) [Ep 6 · 9:24](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=564)
- Patients and parents would rather deal with a chronic perianal problem than a stoma, unless there is extensive distal colonic disease. (opinion) [Ep 6 · 9:52](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=592)
- Setons are very effective for perianal Crohn's disease and are used frequently by colorectal surgeons but rarely by pediatric surgeons, who should use them more often. (opinion) [Ep 6 · 10:40](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=640)
- When draining a perianal abscess in Crohn's disease, there are usually several fistulas present, not just a single one. (clinical) [Ep 6 · 11:07](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=667)
- If resection with primary anastomosis and seton placement fails to heal perianal disease, a subsequent laparoscopic diversion can be performed with low morbidity. — Dan (clinical) [Ep 6 · 12:02](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=722)
- Rectal advancement flap is an option for fistula closure after seton drainage, but only in the setting of no active proctitis. (clinical) [Ep 6 · 12:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=756)
- A non-cutting seton can be progressively tightened by adding silk sutures to make the loop smaller as it erodes through tissue, without causing pain to the patient. (clinical) [Ep 6 · 15:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=957)
- A cutting seton requires 360-degree tension on tissue to actually cut through; progressive tightening without tension is a non-cutting seton technique. (clinical) [Ep 6 · 16:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1007)
- For duodenal Crohn's stricture, management with Remicade combined with endoscopic and fluoroscopic dilation can be effective, with stricture becoming more pliable after 3 cycles of Remicade. (clinical) [Ep 6 · 18:30](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1110)
- Isolated ileocecal Crohn's disease in teenagers may have recurrence-free intervals as long as 10-15 years after resection, allowing symptom-free passage through puberty into adulthood. (clinical) [Ep 6 · 19:20](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1160)
- Isolated terminal ileal disease may be a separate disease entity from perianal or diffuse Crohn's disease, as it behaves very differently. (opinion) [Ep 6 · 20:04](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1204)
- For isolated terminal ileal Crohn's disease, early resection before starting Remicade may be a reasonable approach, as these patients do well and can go through teenage years and growth phase successfully. (opinion) [Ep 6 · 20:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1229)
- In Europe, ultrasound is generally advocated for basically everything, and it is increasingly used in sophisticated pediatric radiology departments for chronic inflammatory bowel disease, though MRI remains the standard diagnostic tool. — Philip (clinical) [Ep 6 · 21:01](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1261)
- For a patient with ulcerative colitis in reasonably good nutrition, subtotal colectomy with pull-through and either J-pouch or straight anastomosis with loop ileostomy (closed at 6 weeks to 2 months) is appropriate. (clinical) [Ep 6 · 23:01](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1381)
- Patients with ulcerative colitis referred for surgery are often in horrible shape because GI doctors view surgery as failure and carry patients on medical therapy for too long, resulting in emaciation, low albumin, poor nutritional status, and prolonged steroid exposure. (opinion) [Ep 6 · 23:37](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1417)
- For sick ulcerative colitis patients, a three-stage approach is used: subtotal colectomy with end ileostomy, followed by subsequent J-pouch creation. (clinical) [Ep 6 · 24:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after subsequent J-pouch creation, and often look their best when they have their stoma. (clinical) [Ep 6 · 24:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy can occur but is rare and can be managed with local therapy. (clinical) [Ep 6 · 24:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1487)
- Even in relatively sick ulcerative colitis patients, endorectal pull-through can be performed safely using an endorectal technique similar to Hirschsprung surgery, as long as it is backed up with an ileostomy. (clinical) [Ep 6 · 25:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1500)
- A 3-year-old with severe ulcerative colitis (one of the youngest cases seen) had rectum that felt like tissue paper but was successfully treated with endorectal pull-through and J-pouch, with the child blossoming afterward. (clinical) [Ep 6 · 25:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- Continued bleeding from the rectal stump after subtotal colectomy can force earlier-than-anticipated completion of pull-through, occurring more frequently than realized. (clinical) [Ep 6 · 25:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- One problem with three-stage ulcerative colitis surgery is that patients often gain 20-30 pounds between stage 1 and 2, making the subsequent operation harder. (clinical) [Ep 6 · 26:17](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1577)
- Double-staple technique for ileal pouch-anal anastomosis can be performed by everting the rectum and stapling at the top of the columns, requiring a 21mm stapler. (clinical) [Ep 6 · 26:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1598)
- If a patient has received infliximab within the last 6 weeks, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk. (guideline) [Ep 6 · 28:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1691)
- Harold Hirschsprung figured out that a baby could be sick due to this problem but did not understand the pathology. — Marc Levitt (clinical) [Ep 9 · 1:03](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=63)
- The correct name is Hirschsprung disease, not apostrophe S. — Marc Levitt (opinion) [Ep 9 · 1:16](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=76)
- Orvar Swenson figured out the pathology by going to the pathology lab and defined the fact that there were no ganglion cells. — Marc Levitt (clinical) [Ep 9 · 1:24](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=84)
- Prior to Swenson's work, removal of the dilated colon was the treatment, which was a mistake—it was the distal narrow colon that was the problem. — Marc Levitt (clinical) [Ep 9 · 1:35](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=95)
- Swenson developed the first operation for Hirschsprung's disease, which is a full thickness rectal dissection. — Marc Levitt (clinical) [Ep 9 · 1:46](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=106)
- Modern Suave operations are becoming more Swenson-like, making maybe a 1 centimeter cuff, which Dan von Almen describes as basically Swensons with a 1 centimeter cuff. — Marc Levitt (clinical) [Ep 9 · 2:00](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=120)
- The operation ought not to be called the Suave because Doctor Yancey was the first surgeon who described a submucosal dissection for Hirschsprung's disease, but he published in a journal that not many people read, while Suave published years later in a more widely-read journal. — Marc Levitt (clinical) [Ep 9 · 2:13](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=133)
- The Yancey/Suave technique was developed because people said the Swenson caused fecal and urinary incontinence or voiding dysfunction after the operation. — Marc Levitt (clinical) [Ep 9 · 2:42](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=162)
- Doctor Swenson wrote a paper saying the critics were wrong, it's a good operation, and they were doing it wrong by dissecting too wide. — Marc Levitt (clinical) [Ep 9 · 2:56](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=176)
- Yancey, Suave, and Duhamel did everything in their power to avoid the full thickness rectal dissection and stay out of that rectal plane to avoid injury to the nerve erigentes. — Marc Levitt (clinical) [Ep 9 · 3:10](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=190)
- Doing a proper Swenson right on the bowel wall—if you see fat, you can get closer—keeps you away from the nerves which are in the fatty layer; dissecting too wide will injure them. — Marc Levitt (clinical) [Ep 9 · 3:30](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=210)
- Swenson used to write letters to Mark Levitt and Alberto Pena thanking them for promoting the Swenson and asking them to tell everybody it's a good operation; he was 105 when he died. — Marc Levitt (clinical) [Ep 9 · 3:48](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=228)
- Duhamel had the idea to leave the original rectum behind and do a pull-through next to it, then mate the two lumens. — Marc Levitt (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=246)
- At this point, the Duhamel is really only appropriate for an ileoduhamel, although Levitt would still do an ileoanal. — Marc Levitt (opinion) [Ep 9 · 4:22](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=262)
- Rabine did a low anterior resection for Hirschsprung's, leaving about 6 centimeters behind; amazingly, some of those patients did perfectly fine with ganglionated bowel pooping through the 6 centimeters of aganglionic bowel. — Marc Levitt (clinical) [Ep 9 · 4:35](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=275)
- Doctor Boley was the first one to do the primary coloanal anastomosis of a Suave, eliminating the need to leave the bowel hanging out and come back at day 7. — Marc Levitt (clinical) [Ep 9 · 6:15](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=375)
- The proper description is the Suave technique with the Boley modification, i.e., a Suave-Boley. — Marc Levitt (clinical) [Ep 9 · 6:36](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=396)
- Hung Bae Kim is the person that figured out the STEP procedure. — Marc Levitt (clinical) [Ep 9 · 8:23](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=503)
- Henrys was a pediatric surgeon in the Philippines and was the first surgeon to do a primary pull-through—a transabdominal operation with no preceding stoma. — Marc Levitt (clinical) [Ep 9 · 8:39](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=519)
- Henrys did the primary pull-through because patients who were at home with stomas in the Philippines were not cared for due to social stigma, and the babies were basically left to die by their families. — Marc Levitt (clinical) [Ep 9 · 8:58](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=538)
- Doctor Martin developed the Martin procedure, which is an expansion of the Duhamel procedure—leaving a longer aganglionic segment of rectum and pulling through ganglionated bowel for long segment Hirschsprung's disease. — Jason Frischer (clinical) [Ep 9 · 10:09](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=609)
- Martin's biggest contribution was to ulcerative colitis; in 1977, before the J pouch, he took the endorectal pull-through technique from Hirschsprung's disease and transferred it to the surgical treatment of ulcerative colitis, doing a total proctocolectomy with ileoanal anastomosis. — Jason Frischer (clinical) [Ep 9 · 10:40](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=640)
- The transanal dissection, the Suave plane dissection, is the same concept as the mucosectomy in ulcerative colitis. — Marc Levitt (clinical) [Ep 9 · 11:34](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=694)
- Helen Noblet is the one who figured out the suction rectal biopsy; she's from Melbourne, Australia. — Marc Levitt (clinical) [Ep 9 · 12:32](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=752)
- Keith Jorgeson is the one that did the laparoscopic version of the Suave; in his original description with Tom Hinge, they talked about leaving a 5 centimeter cuff, which nowadays would be way too much. — Marc Levitt (clinical) [Ep 9 · 12:40](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=760)
- Jack Langer approached transanally to do a transanal resection of the rectosigmoid with or without laparoscopy or laparotomy; Luis de la Torre did the same around the same time. — Marc Levitt (clinical) [Ep 9 · 13:17](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=797)
- Some places around the world are doing transanal only; Levitt does that in certain circumstances. — Marc Levitt (clinical) [Ep 9 · 13:43](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=823)
- Dan Teitelbaum did an incredible amount of work in Hirschsprung's disease and particularly a significant amount of research in enterocolitis. — Marc Levitt (clinical) [Ep 9 · 13:51](https://origin-library.globalcastmd.com/watch/the-colorectal-quiz-episode-21-the-history-of-hirschsprung-disease-13818?t=831)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Cleveland Clinic data showed anastomotic leak rates were significantly different in hypoalbuminemic patients (albumin <3.5) compared to those with normal albumin levels after pouch surgery. — Jason Frischer summarizing a resource [Ep 2 · 2:31](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=151)
- A consensus statement recommends that delay in surgical intervention to enhance nutrition is not recommended in acute UC flares. — Jason Frischer summarizing a resource [Ep 2 · 4:22](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=262)
- Pre-operative steroid administration is associated with increased risk of anastomotic leak and infectious complications. — Jason Frischer summarizing a resource [Ep 2 · 4:35](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=275)
- Low serum albumin is a marker associated with increased risk of post-operative infections. — Jason Frischer summarizing a resource [Ep 2 · 4:45](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=285)
- The cumulative risk of cancer approximately 25 years after restorative proctocolectomy is about 3.5%. — Jason Frischer summarizing a resource [Ep 2 · 10:40](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=640)
- Average-risk J-pouch patients should undergo pouchoscopy and biopsy every 3 years, starting 10 years following their diagnosis of ulcerative colitis. — Jason Frischer summarizing a resource [Ep 2 · 10:55](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=655)
- Infertility rates after J-pouch are between 43% and 63% at two years, compared to North American baseline infertility rate of approximately 8%. — Jason Frischer summarizing a resource [Ep 2 · 24:10](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1450)
- Infertility rates following open J-pouch operations went as high as 90+%, but more recent papers following laparoscopic approach show rates in the 20-30% range. — Jason Frischer summarizing a resource [Ep 2 · 24:40](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1480)
- C-section rate in J-pouch patients is between 38 and 78% versus 22% in the general population. — Jason Frischer summarizing a resource [Ep 2 · 26:10](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1570)
- There is no literature to support whether C-section versus vaginal delivery is safer in J-pouch patients, but when asked, colorectal surgeons unanimously suggest C-section. — Jason Frischer summarizing a resource [Ep 2 · 26:25](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1585)
- Helsinki Group data showed daytime stooling frequency of about 5-6 bowel movements per day in J-pouch patients, with daytime incontinence in 22% and nighttime soiling in 56%. — Jason Frischer summarizing a resource [Ep 2 · 28:20](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=1700)
- Adult literature strongly supports using heparin or low molecular weight heparin in combination with compression boots for VTE prophylaxis, showing no increased bleeding risk or adverse outcomes. — Jason Frischer summarizing a resource [Ep 2 · 37:53](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2273)
- All IBD patients are at higher risk for thromboembolism, which puts the surgical patient population at elevated baseline risk. — Jason Frischer summarizing a resource [Ep 2 · 36:58](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2218)
- PICC lines in IBD patients are a huge risk factor for thromboembolism, with much greater odds ratio for developing thromboembolic events. — Jason Frischer summarizing a resource [Ep 2 · 38:32](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2312)
- Thromboprophylaxis efficacy is much better if administered before induction of anesthesia rather than during or after. — Todd Ponsky summarizes what Dr. Jason Frischer said [Ep 2 · 37:39](https://origin-library.globalcastmd.com/watch/ulcerative-colitis-and-familial-adenomatous-polyposis-update-course-2016-422?t=2259)
- In a review study published recently, CT enterography is more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise determines which modality performs better in practice. — Samir Pandya summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0)
- Contrast-enhanced ultrasound has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in patients with known diagnosis, according to the Peloda study published in Pediatrics 2013. — Samir Pandya summarizing a resource [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- Contrast-enhanced ultrasound is only available for clinical use in Europe at present and has not been approved by the FDA. — Samir Pandya summarizing a resource [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line. — Samir Pandya summarizing a resource [Ep 3 · 5:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=300)
- MR enterography provides information about the chronicity of Crohn's disease strictures, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. — Samir Pandya summarizing a resource [Ep 3 · 6:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=360)
- Rectal advancement flap for Crohn's perianal fistula is only appropriate in the setting of no active proctitis, and results diminish with time. — Samir Pandya summarizing a resource [Ep 3 · 18:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1080)
- Even with permanent fecal diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood. — Samir Pandya summarizing a resource [Ep 3 · 20:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200)
- Isolated ileocecal Crohn's disease in teenagers can have recurrence-free intervals as long as 10 to 15 years after resection, allowing symptom-free passage through puberty into adulthood. — Samir Pandya summarizing a resource [Ep 3 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- If a patient has received infliximab within the last 6 weeks before surgery for ulcerative colitis, there is evidence (both adult and pediatric) that a three-stage approach should probably be used due to increased complication risk. — Samir Pandya summarizing a resource [Ep 3 · 28:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- At 2 years follow-up, there is hardly any difference in bowel frequency between straight ileoanal anastomosis and J-pouch (10 cm J-pouches) for ulcerative colitis, based on a series of 120-130 straight and 110-115 J-pouch patients. — Samir Pandya summarizing a resource [Ep 3 · 28:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- Traditional intraoperative fluid administration delivers 3 times the IV volume compared to enhanced recovery protocols, as demonstrated by studies monitoring fluid administration. — Matt Kurt summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=180)
- Adult colorectal surgery has a large number of randomized controlled trials demonstrating ERAS reduces complications and length of stay without causing increased readmissions. — Matt Kurt summarizing a resource [Ep 4 · 6:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=360)
- Meta-analysis from adult colorectal surgery demonstrates significant decrease in length of stay, significant decrease in non-surgical complications (VTEs, urinary tract infections, surgical site infections), without increase in readmissions when ERAS protocols are used. — Matt Kurt summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=540)
- Pediatric ERAS literature consists of only 5-6 articles, most written by Ben-Oni Mathai, showing decreased length of stay with similar complication rates and no increase in readmissions, but each study implemented only about 5 of 20 protocol components (approximately 25% compliance). — Matt Kurt summarizing a resource [Ep 4 · 10:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=630)
- Goal-directed fluid therapy using pressors and albumin helps limit fluid administration; the most important inflection point in MD Anderson's program was preventing residents from bolusing patients postoperatively. — Matt Kurt summarizing a resource [Ep 4 · 16:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=960)
- The most recent literature on mechanical bowel preparation suggests that combining both mechanical prep and oral antibiotics provides the best outcomes, though this recommendation has changed yearly. — Matt Kurt summarizing a resource [Ep 4 · 35:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2100)
- Sleeve gastrectomy patients implementing ERAS components, particularly gabapentin, have gone home on postoperative day 1 in all but one case, compared to previous average of closer to 2 days. — Matt Kurt summarizing a resource [Ep 4 · 41:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2460)
- A Journal of Pediatric Surgery study showed that 70% of patients are NPO longer than necessary when coming to the operating room, arriving dehydrated despite standard NPO guidelines. — Matt Kurt summarizing a resource [Ep 4 · 34:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2040)
- Gawande's checklist manifesto demonstrated that a 30% compliance rate with a protocol dropped mortality in half, suggesting that partial ERAS compliance still provides benefit. — Matt Kurt summarizing a resource [Ep 4 · 40:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2400)
- In Sweden, 50% of facilities are doing ileorectal anastomosis instead of ileal pouch-anal anastomosis due to concerns about infertility in females. — The host summarizing the discussion [Ep 5 · 5:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Infertility rates after J-pouch are as high as 60% in some series. — The host summarizing the discussion [Ep 5 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- The infertility rate in the United States general population is around 10-11%. — The host summarizing the discussion [Ep 5 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- Infertility rate after laparoscopic J-pouch procedures is about 20-30%, compared to 50-60% with open procedures. — The host summarizing the discussion [Ep 5 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- Fecundity rate (ability to carry a pregnancy) is the same after J-pouch; patients may need assistance with conception but can carry pregnancies. — The host summarizing the discussion [Ep 5 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- In some European practices, performing a pull-through operation on a patient before the end of their childbearing years is considered unacceptable. — The host summarizing the discussion [Ep 5 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- It is no longer necessarily true that the colon must be removed in all ulcerative colitis patients; surveillance colonoscopy is an acceptable alternative. — The host summarizing the discussion [Ep 5 · 8:02](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=482)
- Some surgeons perform total proctocolectomy with J-pouch reconstruction in selected Crohn's patients with good results, as presented in adult literature. — The host summarizing the discussion [Ep 5 · 10:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=648)
- CT enterography may be more accurate than MR enterography according to a recent review study, though institutional radiologist expertise determines which modality performs better locally. — The host summarizing the discussion [Ep 6 · 0:54](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=54)
- Contrast-enhanced ultrasound in Europe has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in those with known diagnosis, according to a 2013 Peloda study in Pediatrics. — The host summarizing the discussion [Ep 6 · 2:19](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=139)
- Peristomal complications are unique to Crohn's patients, including fistulas around the stoma. — The host summarizing the discussion [Ep 6 · 12:45](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765)
- Crohn's disease affects the entire GI tract, though one particular segment may be strictured at a given time. — The host summarizing the discussion [Ep 6 · 13:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=791)
- Current adult literature recommendations for perianal Crohn's include non-cutting setons, with Remicade exposure ranging from 25-100% of patients. — The host summarizing the discussion [Ep 6 · 14:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=871)
- Endorectal advancement flap results for perianal fistulas diminish with time. — The host summarizing the discussion [Ep 6 · 15:16](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=916)
- Even with permanent diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood. — The host summarizing the discussion [Ep 6 · 17:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1047)
- A study of approximately 120-130 straight ileal-anal anastomoses and 110-115 J-pouches (10 cm pouches) showed hardly any difference in bowel frequency at 2 years. — The host summarizing the discussion [Ep 6 · 27:28](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1648)
- The study was a retrospective cohort analysis examining the impact of ostomy in patients undergoing ileal pouch-anal anastomosis — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- The study included 317 patients total: 238 in the ostomy group and 79 in the no-ostomy group — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- There were no significant differences in surgical site infection rates between patients who received ostomy versus those who did not during IPAA — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- There were no significant differences in postoperative abdominal drain rates between the ostomy and no-ostomy groups — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- There were no significant differences in 30-day readmission rates between patients with and without ostomy during IPAA — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- Ostomy may not always be necessary when performing ileal pouch-anal anastomosis — Cecilia Gigena summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/el-papel-de-la-ostom-a-durante-la-creaci-n-del-pouch-ileal-coon-anastomosis-anal-7999?t=0)
- The study was a retrospective cohort study aimed at analyzing the true impact of performing an ostomy while doing an ileal pouch anastomosis. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- The study included 317 patients total. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- 238 patients received a diverting ileostomy with the IPAA. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- 79 patients only received the IPAA without diversion. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- There were no significant differences in surgical site infections between the diverted and non-diverted groups. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- There were no significant differences in intra-abdominal post-operative drainage between the diverted and non-diverted groups. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- There were no significant differences in 30-day readmission rates between the diverted and non-diverted groups. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)
- The findings suggest that diverting ileostomy is not as mandatory as previously thought during IPAA. — Cecilia Higginah summarizing a resource [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/the-role-of-diversion-during-ileal-pouch-anal-anastomosis-creation-in-pediatric-7998?t=0)

## Changelog
- Sep 24: 3 items added automatically
- Sep 16: 3 items added automatically
- Sep 15: 4 items added automatically

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