Caitlin Smith
148 statements · 5 topics · summaries given as host listed separately
Featured statements
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
quote ·
Anorectal Malformation
Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me.
quote ·
Colorectal / ARM & Hirschsprung
You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease.
quote ·
Colorectal / ARM & Hirschsprung
You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult.
quote ·
Anorectal Malformation
And also much higher rate of enterocolitis in children with trisomy 21.
Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods.
clinical ·
Hirschsprung disease
Nothing matches these filters — clear the search or widen the filters.
Caitlin's statements about Anorectal Malformation 22 statements
Open the Anorectal Malformation collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Statement
Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups.
Open
Statement
Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months.
Open
Statement
Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult.
Open
Statement
Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Statement
Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients.
Open
Quotation
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
Open
Statement
Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods.
Open
Quotation
You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult.
Open
Quotation
I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age.
Open
Update Course 2023 - Updates in Colorectal Pathology
Quotation
Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety.
Open
Statement
Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through.
Open
Statement
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort.
Open
Statement
Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped.
Open
Statement
Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa.
Open
Statement
Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each.
Open
Statement
Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced.
Open
Statement
The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared.
Open
Statement
Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool.
Open
Quotation
I like to think of my Hirschru's patients as having a colon like a river rather than a pond.
Open
Statement
A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic.
Open
Statement
The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients.
Open
Caitlin's statements about Colorectal / ARM & Hirschsprung 58 statements
Open the Colorectal / ARM & Hirschsprung collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Statement
Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups.
Open
Statement
Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months.
Open
Statement
Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult.
Open
Statement
Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Statement
Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients.
Open
Quotation
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
Open
Statement
Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods.
Open
Quotation
You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult.
Open
Quotation
I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age.
Open
Update Course 2023 - Updates in Colorectal Pathology
Quotation
Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety.
Open
Quotation
Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety.
Open
Statement
A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age.
Open
Statement
In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group.
Open
Statement
In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic.
Open
Statement
Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through.
Open
Statement
Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through.
Open
Statement
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort.
Open
Statement
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort.
Open
Statement
Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped.
Open
Statement
Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped.
Open
Statement
Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa.
Open
Statement
Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa.
Open
Statement
Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each.
Open
Statement
Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each.
Open
Statement
Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced.
Open
Statement
Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced.
Open
Statement
The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared.
Open
Statement
The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared.
Open
Statement
Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool.
Open
Quotation
I like to think of my Hirschru's patients as having a colon like a river rather than a pond.
Open
Quotation
I like to think of my Hirschru's patients as having a colon like a river rather than a pond.
Open
Statement
Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool.
Open
Statement
A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic.
Open
Statement
A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic.
Open
Statement
Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques.
Open
Statement
The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter.
Open
Statement
The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients.
Open
Statement
The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients.
Open
Statement
The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin.
Open
Update Course Rewind: Botox in Hirschsprung Disease 2023
Quotation
You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease.
Open
Statement
Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.
Open
Statement
To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left.
Open
Quotation
In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of a ganglion. Internal sphincter, and I think that babies outgrow it because their external sphincter is able to overcome their internal sphincter, and I think that takes time for their body to mature, but I don't know that we have pinpointed the actual pathophysiology.
Open
Statement
Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures.
Open
Statement
The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed.
Open
Quotation
Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me.
Open
Statement
There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease.
Open
Statement
Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease.
Open
Quotation
There is discussion of whether or not when you're, when you make the diagnosis of total colon Hirschprung at that time, should you do the colectomy because of the risk of enterocolitis, and I don't have a strong opinion on that.
Open
Statement
There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk.
Open
Statement
There is significant phenotypic variance in Hirschsprung disease, making study data imperfect.
Open
Quotation
The thing about Hirschhorn disease, I think we all realize is that there's so much phenotypic variance. So in studying the use of Botox in postpo through enterocolitis, the data is not perfect.
Open
Quotation
Maybe not everyone needs it at the time of pull through, but maybe there is a subset of patients who really do have some predisposition to enterocolitis. And using Botox as part of that treatment strategy would be beneficial.
Open
Statement
Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy.
Open
Caitlin's statements about Hirschsprung disease 28 statements
Open the Hirschsprung disease collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Statement
Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups.
Open
Statement
Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months.
Open
Statement
Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult.
Open
Statement
Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Quotation
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
Open
Statement
Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients.
Open
Statement
Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods.
Open
Quotation
You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult.
Open
Quotation
I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age.
Open
Update Course 2023 - Updates in Colorectal Pathology
Quotation
Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety.
Open
Statement
A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age.
Open
Statement
In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group.
Open
Statement
In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic.
Open
Statement
Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through.
Open
Statement
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort.
Open
Statement
Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped.
Open
Statement
Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa.
Open
Statement
Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each.
Open
Statement
Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced.
Open
Statement
The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared.
Open
Quotation
I like to think of my Hirschru's patients as having a colon like a river rather than a pond.
Open
Statement
Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool.
Open
Statement
A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic.
Open
Statement
Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques.
Open
Statement
The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter.
Open
Statement
The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients.
Open
Statement
The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin.
Open
Caitlin's statements about Hirschsprung's-associated Enterocolitis 18 statements
Open the Hirschsprung's-associated Enterocolitis collection →
Update Course Rewind: Botox in Hirschsprung Disease 2023
Quotation
You have to always do your due diligence with a patient who has had their pull through. Why are they getting recurrent enterocolitis? And one of the answers is you did a great operation and they have enterocolitis because they have a poorly functioning sphincter, which every baby with Hirschsprung disease has by nature of the disease.
Open
Statement
Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease.
Open
Statement
To maintain continence, the dentate line must be preserved, requiring a tiny bit of aganglionic internal sphincter to be left.
Open
Quotation
In order to maintain continence, you want to preserve the dentate line, and you have to leave a tiny bit of a ganglion. Internal sphincter, and I think that babies outgrow it because their external sphincter is able to overcome their internal sphincter, and I think that takes time for their body to mature, but I don't know that we have pinpointed the actual pathophysiology.
Open
Statement
The actual pathophysiology of Hirschsprung-associated enterocolitis has not been pinpointed.
Open
Statement
Babies outgrow enterocolitis because their external sphincter becomes able to overcome their internal sphincter as their body matures.
Open
Statement
There is a significantly higher rate of enterocolitis in total colonic Hirschsprung disease after pull-through compared to shorter segment disease.
Open
Quotation
Something that's very interesting is we know that there's a significantly higher rate of enterocolitis in Hirschprung disease after pull-through. So when you take out the entire colon, they have a higher rate of enterocolitis than babies who have shorter segment and have all that colon to have back. Bacteria, so that has always been a little counterintuitive to me.
Open
Statement
Children with trisomy 21 have a much higher rate of enterocolitis in Hirschsprung disease.
Open
Quotation
There is discussion of whether or not when you're, when you make the diagnosis of total colon Hirschprung at that time, should you do the colectomy because of the risk of enterocolitis, and I don't have a strong opinion on that.
Open
Statement
There is discussion about whether colectomy should be performed at the time of total colon Hirschsprung diagnosis because of enterocolitis risk.
Open
Quotation
The thing about Hirschhorn disease, I think we all realize is that there's so much phenotypic variance. So in studying the use of Botox in postpo through enterocolitis, the data is not perfect.
Open
Statement
There is significant phenotypic variance in Hirschsprung disease, making study data imperfect.
Open
Statement
Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy.
Open
Quotation
Maybe not everyone needs it at the time of pull through, but maybe there is a subset of patients who really do have some predisposition to enterocolitis. And using Botox as part of that treatment strategy would be beneficial.
Open
Caitlin's statements about Rectal Bladder Neck Fistula 22 statements
Open the Rectal Bladder Neck Fistula collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Statement
Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups.
Open
Statement
Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months.
Open
Statement
Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult.
Open
Statement
Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Quotation
I think for the neonates, for the infants, the dilations are really well tolerated. Um, for patients who are up to even several months old, I think outside of that for the older, the patients who have older repair, I think, um, At least in my own experience, it, uh, in terms of psychological stressor for the parents, um, and the patient, and I avoid them in those age groups, but I do think that the neonates and those that are under about 3 months' age tolerate them really well.
Open
Statement
Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients.
Open
Statement
Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods.
Open
Quotation
You really wanna get it done before they start solids also because that can make the dilation strategy at home, um, you know, much more difficult.
Open
Quotation
I think this is a really important graph because it shows what percentage of, um, you know, even mild, uh, and moderate anorectal malformation patients in this 5 to 12 year old group really need to rely on enemas and lots of other bowel management strategies to stay clean when they're, um, heading into school age.
Open
Update Course 2023 - Updates in Colorectal Pathology
Quotation
Parents feel like they're hurting their children and, um, you know, they feel, yeah, or doing it wrong. There's a lot of anxiety.
Open
Statement
Strictureplasty is appropriate only for skin-level strictures, not for longer strictures or anything deeper than skin level; patients with longer strictures should undergo redo pull-through.
Open
Statement
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices in a larger cohort.
Open
Statement
Smith sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses dilation options at that visit; if anoplasty looks good, dilations are skipped.
Open
Statement
Strictures can develop in both dilated and non-dilated groups; causes include tension, ischemia, and a band formation at the suture anastomosis between epidermis and mucosa.
Open
Statement
Smith uses 100 units of Botox in 1 cc saline, divided into 4 aliquots of 25 units each.
Open
Statement
Pharmacies often state that 100 units of Botox exceeds weight-based dosing recommendations for pediatric patients, but 100 units has been shown to be safe and is commonly practiced.
Open
Statement
The physiology of Hirschsprung disease creates a colon that acts like a 'pond' with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not diligently cleared.
Open
Statement
Preventing enterocolitis requires increasing and improving clearance of stool from the colon to maintain flow like a 'river' rather than allowing stagnant stool.
Open
Quotation
I like to think of my Hirschru's patients as having a colon like a river rather than a pond.
Open
Statement
A cautionary case occurred where a surgeon performed colectomy for presumed total colonic Hirschsprung at an outside hospital, but final pathology showed the colon was not aganglionic.
Open
Statement
The perineal body is important for sexual function and obstetric outcomes in the future, making preservation important for female ARM patients.
Open
Summaries Caitlin gave as host · 84 summaries
Recaps of other experts' statements, not Caitlin's own clinical position.
Summaries Caitlin gave as host · Anorectal Malformation 19 summaries
Open the Anorectal Malformation collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum.
Open
Update Course 2023 - Updates in Colorectal Pathology
Host summary
Caitlin Smith summarizing the discussion: A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age.
Open
Host summary
Caitlin Smith summarizing the discussion: In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group.
Open
Host summary
Caitlin Smith summarizing the discussion: In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic.
Open
Host summary
Caitlin Smith summarizing the discussion: Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques.
Open
Host summary
Caitlin Smith summarizing the discussion: The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter.
Open
Host summary
Caitlin Smith summarizing the discussion: The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin.
Open
Summaries Caitlin gave as host · Colorectal / ARM & Hirschsprung 26 summaries
Open the Colorectal / ARM & Hirschsprung collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum.
Open
Update Course 2023 - Updates in Colorectal Pathology
Host summary
Caitlin Smith summarizing the discussion: A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age.
Open
Host summary
Caitlin Smith summarizing the discussion: In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group.
Open
Host summary
Caitlin Smith summarizing the discussion: In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic.
Open
Host summary
Caitlin Smith summarizing the discussion: Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques.
Open
Host summary
Caitlin Smith summarizing the discussion: The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter.
Open
Host summary
Caitlin Smith summarizing the discussion: The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin.
Open
Update Course Rewind: Botox in Hirschsprung Disease 2023
Host summary
Caitlin Smith summarizing the discussion: Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations.
Open
Host summary
Caitlin Smith summarizing the discussion: In reading every paper that was ever written on Botox in the anus in the last couple of months, people are doing any amount of Botox in any aloquats in any number of locations.
Open
Host summary
Caitlin Smith summarizing the discussion: Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Some of the data suggest that prophylactic Botox has not been shown to decrease the risk of enterocolitis, but has been shown to decrease the length of stay in patients who have been admitted for enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Botox has been shown to decrease the length of stay in patients admitted for enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Also has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis.
Open
Summaries Caitlin gave as host · Hirschsprung disease 13 summaries
Open the Hirschsprung disease collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum.
Open
Summaries Caitlin gave as host · Hirschsprung's-associated Enterocolitis 7 summaries
Open the Hirschsprung's-associated Enterocolitis collection →
Update Course Rewind: Botox in Hirschsprung Disease 2023
Host summary
Caitlin Smith summarizing the discussion: In reading every paper that was ever written on Botox in the anus in the last couple of months, people are doing any amount of Botox in any aloquats in any number of locations.
Open
Host summary
Caitlin Smith summarizing the discussion: Botox dosing varies widely in the literature: any amount of Botox in any aliquots in any number of locations.
Open
Host summary
Caitlin Smith summarizing the discussion: Some data suggest prophylactic Botox has not been shown to decrease the risk of enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Some of the data suggest that prophylactic Botox has not been shown to decrease the risk of enterocolitis, but has been shown to decrease the length of stay in patients who have been admitted for enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Botox has been shown to decrease the length of stay in patients admitted for enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Also has been shown to potentially decrease hospitalizations in patients who present with recurrent episodes of obstruction or enterocolitis.
Open
Host summary
Caitlin Smith summarizing the discussion: Botox has been shown to potentially decrease hospitalizations in patients with recurrent episodes of obstruction or enterocolitis.
Open
Summaries Caitlin gave as host · Rectal Bladder Neck Fistula 19 summaries
Open the Rectal Bladder Neck Fistula collection →
Update Course Rewind: Pediatric Colorectal Consortium 2021
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence.
Open
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates.
Open
Host summary
Caitlin Smith summarizes what Dr. Rebecca Rentea said: A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum.
Open
Update Course 2023 - Updates in Colorectal Pathology
Host summary
Caitlin Smith summarizing the discussion: A 2021 prospective randomized controlled trial at Nationwide Children's Hospital compared routine dilation versus no dilation after PSARP in 50 patients (25 per arm), all primary repairs under 2 years old, with 12-month follow-up and PSARP performed at average 5 months of age.
Open
Host summary
Caitlin Smith summarizing the discussion: In the Nationwide dilation trial, stricture (defined as Hagar 10 or less) occurred in 3/25 patients in the dilated group and 8/25 in the non-dilated group.
Open
Host summary
Caitlin Smith summarizing the discussion: In the non-dilated group of the Nationwide trial, most strictures were managed with strictureplasty at the time of colostomy closure, so only 3 of 8 patients with strictures required a separate anesthetic.
Open
Host summary
Caitlin Smith summarizing the discussion: Two variations of perineal body-sparing PSARP have been published in 2023, one from Boston and one from DC, with slightly different techniques.
Open
Host summary
Caitlin Smith summarizing the discussion: The Boston perineal body-sparing technique uses a slight posterior sagittal extension of the incision with silks marking the sphincter.
Open
Host summary
Caitlin Smith summarizing the discussion: The DC perineal body-sparing technique uses an incision straight through the sphincter alone, completely preserving the perineal body skin.
Open