Doing dilations alone is probably not the correct management of this for a number of different reasons, but certainly dilations initially will allow for decompression.
Two 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 66 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 66 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 66 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 66 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 66 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 66 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 66 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 66 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
Jamie's statements about Colorectal / ARM & Hirschsprung32 statements
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 180 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 180 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 180 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 180 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 180 · 5:08
clinicalTwo 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 180 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 180 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 180 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 180 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 180 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 180 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 180 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
▶Ep 180 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 180 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 180 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 180 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 180 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
▶Ep 180 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
Update Course Rewind 2025: Timing of PSARP: Early vs. Delayed—Does It Really Matter?
▶Ep 194 · 0:59
quoteDoing dilations alone is probably not the correct management of this for a number of different reasons, but certainly dilations initially will allow for decompression.↗
▶Ep 194 · 0:59
opinionDoing dilations alone is probably not the correct management for rectal vestibular fistula for a number of different reasons.↗
▶Ep 194 · 0:59
clinicalDilations initially will allow for decompression in rectal vestibular fistula.↗
▶Ep 194 · 1:06
clinicalIt is recommended to dilate only to a 7 Hegar to decrease the potential scarring along the track for future PARPs.↗
▶Ep 194 · 1:06
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future Parps.↗
▶Ep 194 · 1:56
clinicalTwo important studies on PSARP timing both came out in 2021.↗
▶Ep 194 · 2:12
clinicalAnother 2021 study looked at 30-day outcomes comparing neonatal versus delayed anoplasty in a multi-institutional retrospective study through the PCPLC.↗
▶Ep 194 · 2:22
clinicalThe PCPLC study defined early repair as within 14 days versus late as after 14 days.↗
▶Ep 194 · 2:38
clinicalThe PCPLC study concluded the same thing as the NSQIP study regarding safety of early versus delayed repair.↗
clinicalThere is discrepancy in the literature regarding the definition of delayed repair, ranging from a couple of months to multiple months of age, with no right timing of delayed repair established.↗
▶Ep 194 · 2:55
clinicalOne drawback to delayed repair is theoretical fibrosis of the fistula tract, making dissection a little bit more difficult on the PSARP.↗
▶Ep 194 · 3:00
clinicalIf the fistula is not completely decompressed, the rectum can get distended and make it technically more difficult to perform the PSARP.↗
▶Ep 194 · 3:14
clinicalWith social determinants of health, it's not always easy for families to make multiple trips for care, as it can be a long distance and expensive.↗
Jamie's statements about Hirschsprung disease18 statements
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 78 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 78 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 78 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 78 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 78 · 5:08
clinicalTwo 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 78 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 78 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 78 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 78 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 78 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 78 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 78 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
▶Ep 78 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 78 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 78 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 78 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 78 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
▶Ep 78 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
Jamie's statements about Recto-vestibular Fistula10 statements
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 3 · 2:33
clinicalWhen dilating a recto-vestibular fistula preoperatively, dilate only to 7 Hegar to decrease potential scarring along the tract for future PSARP.↗
▶Ep 3 · 2:33
quoteI would recommend only dilating to a 7 Hagar to decrease the potential scarring along the track for future PAPs↗
▶Ep 3 · 5:08
clinicalTwo 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 3 · 13:09
quoteyou can try it and you can always extend your incision if for some reason you're not getting the visualization that you, that you think you need↗
▶Ep 3 · 13:23
clinicalIf lost in the anatomy during perineal body-preserving PSARP, it is easy to convert to a standard PSARP by extending the incision.↗
▶Ep 3 · 13:23
quoteif you are lost in the anatomy and you need to make a bigger incision and convert, it's super easy to do that↗
▶Ep 3 · 14:03
clinicalPerineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
▶Ep 3 · 21:03
opinionFamilies who are competent with rectal irrigations before Hirschsprung pull-through will be more comfortable performing irrigations after pull-through, which can save the baby's life by treating enterocolitis early.↗
▶Ep 3 · 21:03
quoteI tend to do it a little bit more delayed, and it's because I like the families to demonstrate that they can do irrigations at home. I think that's such an important skill for them to have.↗
▶Ep 3 · 21:13
quotethe rate of enterocolitis after pull-through is obviously not zero despite our best efforts. And so I think if a family is really competent with irrigations, they're going to be much more comfortable after a pull-through doing those irrigations, and that's what's going to save the baby's life.↗
Summaries Jamie gave as host
· 6 summaries
Recaps of other experts' statements, not Jamie's own clinical position.
Summaries Jamie gave as host · Anorectal Malformation2 summaries
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 66 · 5:08
host summaryJamie Harris summarizing the discussion: Two 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 66 · 14:03
host summaryJamie Harris summarizing the discussion: Perineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
Summaries Jamie gave as host · Colorectal / ARM & Hirschsprung2 summaries
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 180 · 5:08
host summaryJamie Harris summarizing the discussion: Two 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 180 · 14:03
host summaryJamie Harris summarizing the discussion: Perineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
Summaries Jamie gave as host · Hirschsprung disease2 summaries
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
▶Ep 78 · 5:08
host summaryJamie Harris summarizing the discussion: Two 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.↗
▶Ep 78 · 14:03
host summaryJamie Harris summarizing the discussion: Perineal body-preserving PSARP does not add operative time compared to standard PSARP, which is important in neonates to minimize anesthetic time.↗
