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quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji - "Classically, it had been considered that an ileoanal pull-through should not be performed until urinary continence was achieved. The main reason for this recommendation was to avoid severe irritation of the perineal skin due to frequent stooling after proctocolectomy which could be improved if the child could sit on the potty. However, the treatment of perineal skin and in the medical management of hypermotility with loperamide and resins in combination with irrigations have so improved that waiting on the pull-through is no longer recommended. In fact, waiting until a child is older can be problematic as the child then is more aware of passage of stool, and may withhold, and in certain cases this has led to proctalgia fugax, a severe perineal sphincter spasm."

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji - "A colonic resection based solely on a frozen section must be avoided in patients who have an aganglionic zone proximal to the left colon. This is because proximal to the splenic flexure you cannot expect to see hypertrophic nerves (the sacral plexus does not innervate that bowel). Therefore, you are completely dependent upon your pathologist identifying ganglion cells on frozen section which is prone to sampling bias /false negatives. This is due to artifact in the tissue that can occur from the freezing process. Consequently, you risk resection of good bowel that was incorrectly deemed aganglionic by frozen section."