This year the meeting of the Pediatric Colorectal Club was held in Milan. The yearly meeting of pediatric surgeons dedicated to colorectal surgery was founded to bring together surgeons with this special interest. The key focus has always been: Hirschsprung’s disease and (congenital) anorectal malformations. This year more than 200 pediatric surgeons from all over the world came to Milan many of whom gave oral or poster presentations. Anorectal malformations are rare and often associated with urogenital anomalies. One of the keynote speakers emphasized that only a small number of children develop renal failure, particularly those born with urogenital anomalies. The potential risk factors were discussed, and it was emphasized that urinary tract infections in the early years of life need to be prevented. Remarkably, despite a high percentage of urinary reflux, this was not an additional risk factor. It was pointed out that dysplastic or other congenital malformations of the urinary tract have more effect on kidney function. The timing of transplant surgery was discussed, particularly in some of the complex cases. Here was agreement that a thorough preoperative workup is essential before any reconstruction is performed in these cases, e.g., cloacal malformations Research on the genetics of anorectal malformations, which is slowly moving forward, was another topic covered. Multiple genes and multiple environmental factors are involved. A large series of rare variants of genes have been screened but found not to play a major role. It seems that the new focus of research will become the interaction of genes and environmental factors despite the fact that this area is the most difficult to study. Another associated anomaly in patients born with an anorectal malformation is the presence of a tethered cord. It is still a matter of debate what clinical investigations are best for determining the presence of a tethered cord and what management strategy is most effective. The value of ultrasound in the neonate was discussed and seems not to be sensitive enough; some still advocate its use as a screening tool, others prefer MRI but it was not agreed at what age MRI should be performed and whether it was appropriate for asymptomatic patients. There was a lively discussion about whether surgery should be offered to the children with a tethered cord: It was clear that there is no consensus among pediatric surgical units in this regard. There was also disagreement about the timing of surgery: Should it be preventive or only performed when the child becomes symptomatic? Unluckily, there were no pediatric neurosurgeons to contribute to the discussion, and suggestions were made to have them invited to one of the future colorectal meetings. A recently founded European group of pediatric surgeons (ARM-net.eu) is collecting a lot of data on the subject, and this may have impact on the future policy regarding tethered cord. Prof. Alberto Pena, one of the founding fathers of the Colorectal Club and probably the most senior colleague in this field, stated that even at the end of his career, he still finds it difficult to understand the concept of tethered cord. Several papers that were presented related to the transition of children born with an anorectal malformation from pediatric medical services to adult services. The need & I. de Blaauw ivo.deblaauw@radboudumc.nl