In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Dr. Jamie Harris—joined by Drs. Nelson Rosen, Annie Le-Nguyen, Aaron Garrison, and Elizabeth Speck—explores one of the most debated questions in colorectal surgery: when is the optimal timing for PSARP in patients with rectovestibular fistula?

Key Highlights:

Early vs. Delayed PSARP: Both early repair (during the newborn admission) and delayed repair (1–3 months of age) are shown to be equally safe, with no significant differences in complications, reoperations, or readmissions.

What the Data Shows: Recent multi-institutional studies (NSQIP and PCPLC) found no difference in 30-day outcomes between early and delayed repairs, reinforcing that timing alone does not determine success.

Role of Dilations: Initial dilations can help decompress the bowel, but should be limited (e.g., up to 7 Hegar) to avoid fibrosis and preserve optimal conditions for future repair.

Clinical Tradeoffs:

• Delayed repair: May increase technical difficulty due to fibrosis or rectal distention if not well managed
• Early repair: Avoids additional hospitalizations and reduces burden on families, especially those facing access or financial barriers

What Really Matters: Decision-making should be individualized—taking into account patient size, comorbidities, surgeon experience, and family logistics, rather than a strict timeline.

This session highlights that while timing remains flexible, thoughtful, patient-centered decision-making is key to achieving the best outcomes.

For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh