Pediatric Colorectal Surgery Tips & Tricks

Based on 30 years of experience as a surgeon working in the field of pediatric colorectal and pelvic reconstructive surgery, author Marc Levitt shares the tips and tricks that he has developed to make operations and patient management easier and reproducible. This book teaches these skills to achieve positive results. Patients with anorectal malformations (ARMs), Hirschsprung disease (HD), fecal incontinence from a variety of conditions, colonic motility disorders, and a myriad of other conditions comprise the field of pediatric colorectal and pelvic reconstruction. Such patients require care throughout their lives from specialists across numerous fields, which may include colorectal surgery, urology, gynecology, and GI motility, as well as specialized nursing, orthopedics, neurosurgery, anesthesia, pathology, radiology, psychology, social work, and nutrition. Sometimes the field can seem chaotic and unpredictable. Reconstruction requires creativity and at times it feels that artwork is being created during the actual operation with no pre-plan in mind. Marc Levitt and his colleagues have worked very hard to counter that feeling, to be fully prepared, and to develop protocols, techniques, and processes that can be adopted by other clinicians, so that optimal results for patients can be achieved. This book reflects both this experience and this approach.

Part I: Anorectal and Cloacal Malformations 1. Newborn Anorectal Malformations 2. Predictors of Continence 3. Operative Decision Making 4. Operative Techniques 5. Anal Stenosis, Rectal Atresia, and Presacral Mass 6. Cloaca 7. Postoperative Care of a PSARP Incision 8. Rare Cases 9. Anorectal Malformation Myths Part II: Hirschsprung Disease 10. Diagnosis 11. Pull-Through 12. Total Colonic Hirschsprung Disease 13. Late Diagnosis Hirschsprung Disease 14. Hirschsprung Disease Myths Part III: Functional Constipation and Fecal Incontinence 15. Bowel Management 16. Evaluation of Constipation and Surgical Adjuncts 17. Malone Appendicostomy (Antegrade) or Enemas (Retrograde) for Colonic Cleaning 18. Malone Complications and Troubleshooting 19. Laxatives 20. Thickening the Stool with Fiber 21. Bacterial Overgrowth 22. Sharing Tissues 23. Functional Constipation and Fecal Incontinence Myths Part IV: Post-PSARP and Post-HD Pull-Through Problems 24. Problems after PSARP 25. Deciding When to Do a Redo Procedure in ARM 26. Problems after an HD Pull-Through 27. Deciding When to Do a Redo Procedure in HD Part V: Miscellaneous Colorectal Topics and Techniques 28. Operating Room Setup and Positioning 29. Stomas 30. Ischiorectal Fat Pad 31. Miscellaneous Colorectal Conditions

Dr Marc Levitt has focused his career on enhancing the care of children with colorectal and pelvic reconstructive needs. He has cared for children from all 50 of the United States and over 75 countries and has performed more than 15,000 pediatric colorectal procedures. He has written three textbooks and this is his fourth, as well as over 300 scientific articles in this subject area. Dr. Levitt received his undergraduate degree from the University of Pennsylvania and his medical degree from the Albert Einstein College of Medicine. He completed his general surgery residency at Mount Sinai Medical Center, a fellowship in Pediatric Colorectal Surgery at Schneider Children’s Hospital and a Pediatric Surgery fellowship at Children’s Hospital of Buffalo. His work extends to educating students, surgeons, other medical colleagues, and nurses, as well as developing integrated centers throughout the world to ensure that all children have access to quality colorectal care. He is actively engaged in helping patients, their doctors, and nurses in resource limited locations through the organization Colorectal Team Overseas, www.ctoverseas.org. He is the Chief of the Division of Colorectal & Pelvic Reconstruction at Children’s National Hospital, in Washington DC, a uniquely integrated team of pediatric colorectal surgeons, urologists, gynecologists, gastroenterologists, and nurses and is a professor of surgery at George Washington University School of Medicine.