Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?
Stay Current in Pediatric SurgeryShow Notes
In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Jamie Harris, Elizabeth Speck, Aaron Garrison, and Annie Le-Nguyen revisit a long-standing postoperative practice in colorectal surgery: are routine anal dilations after PSARP truly necessary? Key Highlights: Questioning a Surgical Tradition: For decades, postoperative anal dilations have been considered standard after PSARP—but emerging studies and clinician experience are challenging whether they should be universally required. Emotional Impact on Families: Panelists discussed the significant anxiety and stress dilations can create for caregivers, including concerns about harming the repair and reports of PTSD-like experiences for both families and patients. What the Data Shows: Recent institutional reviews comparing dilation protocols versus no dilations found similar rates of neoanal stricture and reoperation, suggesting mandatory dilations may not always improve outcomes. Alternative Approaches: Heineke-Mikulicz anoplasty (HMA) was highlighted as a safe, minimally invasive outpatient option for managing strictures instead of prolonged dilation regimens. Why Some Surgeons Still Dilate: Many surgeons continue postoperative dilations in neonates, particularly in healthcare systems where rapid access to elective revision procedures may be limited. Individualized Decision-Making: Patient age, anatomy, caregiver comfort, access to follow-up care, and institutional resources all play a role in deciding whether postoperative dilations are appropriate. This session emphasizes that postoperative care after PSARP may not need a one-size-fits-all approach—and that family-centered decision-making is becoming increasingly important in colorectal surgery.
For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh
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