Tag Archive for: colorectal

The CTO team in Brazil

Colorectal care across borders: expanding access through global collaboration

Members of the Division of Colorectal & Pelvic Reconstruction at Children’s National Hospital recently traveled to Sao Paulo, Brazil, with the goal of advancing surgical care for children with complex colorectal conditions. Led by Division Chief Marc Levitt, MD, the team collaborated closely with surgeons and nurses at Hospital Municipal Infantil Menino Jesus, performing multiple intricate procedures each day and giving a course to 120+ surgeons from all over Brazil and several surrounding countries. The operations performed and the education that was provided not only gave life-changing care to children in need but also served as critical teaching opportunities, equipping local surgical teams with the skills and knowledge to deliver specialized care in their own communities.  In this way, the team from Children’s National is helping countless children they will never meet, as their new partners in Brazil now have the skills to care for them

This mission was organized through Colorectal Team Overseas, an organization founded and led by Dr. Levitt to advance global pediatric surgical care through education and hands-on training. Colorectal Team Overseas gives Dr. Levitt the opportunity to extend the world-class care delivered at Children’s National to children around the world.

“Every child deserves a chance at a healthy, dignified life, no matter where they are born,” says Dr. Levitt. “On these missions, doctors, nurses and volunteers from the colorectal program at Children’s National and colleagues from around the world work hand-in-hand with medical teams in Brazil — not only to provide surgical care, but to teach, learn and build a foundation for a lasting impact. We are not just performing surgeries; we are restoring futures, together.”

The CTO team in Brazil

Young girl smiling and clapping

Study highlights need for improved screening in anorectal malformation patients

A recent study from the Division of  Colorectal and Pelvic Reconstruction at Children’s National Hospital, led by Chief Marc Levitt, MD, explores the prevalence of additional abnormalities in children born with anorectal malformations (ARM). While many of these abnormalities co-occur, including vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula or esophageal atresia, renal defects and limb defects, known as the VACTERL association, the study reveals that some critical anomalies, particularly spinal cord and gynecologic malformations, are often missed, an oversight that can significantly affect patient outcomes.

What it means

This multi-institutional retrospective study aimed to assess the effectiveness of current diagnostic criteria for VACTERL screening in ARM patients and to identify anomalies that are at risk of being overlooked. The researchers utilized data from the Pediatric Health Information Systems database, which includes over 100 children’s hospitals, to analyze a wide range of associated abnormalities in ARM across the United States.

The findings highlight that the most common anomalies in ARM patients include cardiac, vertebral/spinal, renal and gynecologic (in females). While many of these anomalies are diagnosed at birth, the study suggests that some are identified only later in a patient’s care, pointing to a gap in early screening, particularly for spinal cord and gynecologic issues.

Graphic explaining VACTE(G)RLS acronym

Based on the study’s results, the authors propose an expansion of the VACTERL acronym to VACTE(G)RLS to stress the importance of gynecologic (G) and spinal cord anomalies (S) in ARM patients.

Based on the study’s results, the authors propose an expansion of the VACTERL acronym to VACTE(G)RLS to stress the importance of gynecologic (G) and spinal cord anomalies (S) in ARM patients. This expanded acronym would help ensure that both surgical and non-surgical providers are aware of these often-missed malformations, improving early diagnosis and intervention.

Why it matters

Although other studies have examined the prevalence of VACTERL anomalies in ARM patients, this is the first to compare diagnosis rates at birth with diagnoses made later during subsequent hospital admissions. Timely identification of these associated malformations is crucial for early intervention in females, as untreated gynecologic anomalies can lead to reproductive issues later in life and for patients with spinal conditions that require intervention.

The proposed change to the standard usage VACTERL acronym underscores the significance and frequency of these malformations happening in combination, potentially leading to improved screening protocols and, ultimately, better patient outcomes. By emphasizing the importance of comprehensive screening at birth, the study advocates for a more thorough approach to diagnosing ARM-associated anomalies, which can significantly enhance long-term care for these patients.

Authors from Children’s National include – Thomas Xu, MD, Andrea Badillo, MD, Briony Varda, MD, MPH, Christina Feng, MD, and Marc Levitt, MD.

You can read the full study, VACTERL screening in newborns with anorectal malformations – an opportunity to optimize screening practices, add gynecologic and spinal conditions, and utilize a new acronym: VACTE(G)RLS, in the Journal of Pediatric Surgery.

colorectal 5 year infographic

Division of Colorectal & Pelvic Reconstruction: 5 year highlights

colorectal 5 year infographic

Dr. Marc Levitt with a young patient

Marc Levitt, M.D., reflects on the Colorectal & Pelvic Reconstruction Program

Dr. Marc Levitt with a young patient

Dr. Levitt shares insights into the program’s journey, key successes and future goals.

This September, the Colorectal and Pelvic Reconstruction Program at Children’s National proudly marks five years of commitment to patient-centered care for children and their families. Under the guidance of Division Chief Marc Levitt, M.D., the program has achieved remarkable advancements in clinical care, improving patient outcomes and enhancing family experiences.

Dr. Levitt shares insights into the program’s journey, key successes and future goals, highlighting the importance of collaboration among specialists and the continuous pursuit of innovative treatments.

Q: What was your vision for the program when it first launched? Has the vision changed?

A: When the Colorectal Program first launched, we aimed to establish a comprehensive program for colorectal patient care. This included integrating specialists across multiple disciplines, such as pediatric general surgery, urology, gynecology, gastroenterology, nursing, neurosurgery, orthopedics, pathology, radiology, anesthesia, psychology and pelvic floor therapy. Our efforts have exceeded expectations; the team has developed a cohesive and collaborative dynamic where each specialist contributes effectively to patient care. This integrated approach enhances outcomes, as patients and their families are at the center of our model, surrounded by a network of dedicated caregivers and coordinators, all focused on improving the patients’ quality of life.

Q: Can you highlight some key successes or achievements of the program?

A: The creation of our integrated colorectal care program at Children’s National has been a significant success, bolstered by strong institutional support. While this model requires considerable effort, it ultimately attracts patients and leads to outstanding outcomes. We’ve received patient inquiries from 48 states (AK,AL, AR, AZ, CA, CO, CT, D.C., DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, VT, WA, WI, WV) and 68 countries (Australia, Bahamas, Bangladesh, Bulgaria, Canada, Chile, Croatia, Cyprus, Dominican Republic, Ecuador, Egypt, England, Ethiopia, France, Germany, Greece, Guatemala, Haiti, Hong Kong, India, Ireland, Israel, Jamaica, Jordan, Kazakhstan, Kenya, Kuwait, Lithuania, Maldives, Mauritania, Mexico, Monaco, Morocco, Myanmar, The Netherlands, New Zealand, Nepal, Nigeria, Northern Ireland, Norway, Oman, Palestine, Pakistan, Paraguay, Papua New Guinea, Peru, Philippines, Portugal, Romania, Russia, Saint Lucia, Saudi Arabia, Scotland, Serbia, Singapore, Slovakia, Slovenia, Spain, Sri Lanka, South Korea, St. Kitts & Nevis, Sudan, Sweden, Ukraine, Uzbekistan, United Arab Emirates, Venezuela, Wales).

Some key successes include the development of innovative surgical procedures for conditions such as imperforate anus and anorectal malformations, advanced repair techniques for cloacal malformations, integrated care strategies for colonic dysmotility, and novel approaches for the newborn care of patients with cloacal exstrophy. All these new approaches were developed at Children’s National over the past five years.

In addition to clinical innovations, we have significantly enhanced our academic environment. Over the last five years, our team has authored more than one hundred articles and three well-regarded books, helping health care professionals around the world improve the care they provide to their patients. We have also trained surgical fellows and nurses in colorectal care and welcomed clinicians from over 30 countries for specialized training. This outreach is especially fulfilling, as it enables us to influence the care of children around the globe whom we may never meet, by sharing valuable skills and knowledge with these practitioners. 

Q: Can you share examples of particularly challenging cases or high-profile cases that have influenced the program’s clinical approach?

A: The way we care for a patient with a cloaca is unique – the entire team joins together in the operating room to assess the anatomy, and every member then gives their thoughts on how to approach the reconstruction. The very next day we perform that surgery, with the understanding of the anatomy in mind, and what plays out in that operating room is quite magical. This collaborative approach frequently leads to exceptional outcomes, as our diverse ideas come together to form a cohesive plan. Through this teamwork, we have developed creative ways to solve complex anatomical problems that no one individual surgeon would have thought of on their own.

Q: How have patient outcomes improved over time?

A: We have optimized the collaborative experience so that patients only need a single visit to see all the specialists they require. Our outcomes for complex colorectal surgeries have significantly improved, particularly for conditions like cloaca, Hirschsprung disease and anorectal malformations. Advances in surgical techniques and enhancements in nursing care have led to dramatically better results. We have reduced, and in some cases eliminated, complications from these surgeries, while also seeing improvements in bowel continence and kidney health. Our nursing teams — outpatient, operating room and inpatient — play a crucial role, offering unique insights into pre- and post-operative care that are vital for achieving successful outcomes.

Q: What have been the biggest challenges or barriers faced by the program and how have you addressed these challenges?

A: One of the biggest challenges we face is ensuring that patients can get to us. Many patients encounter obstacles with insurance companies that restrict travel outside their network, or they deal with the difficulties of traveling from far away for their surgery. We have worked diligently to address these issues by improving our insurance approval process and making families comfortable during their stay in Washington, D.C., including assistance with accommodations, necessary medical supplies, etc. If we can remove these barriers, we can care for more patients and make the experience easier for them and their families.

Q: How does the colorectal program collaborate with other departments or services? How has the program integrated from various specialties (e.g., urology, gynecology, GI) to enhance patient care?

A: We have specialists who are fully integrated in their roles on the colorectal and pelvic reconstruction team. General pediatric surgeons, urologists, gynecologists and gastroenterologists work both in the colorectal program and in their home program in a uniquely integrated fashion. For example, our urologists each spend half of their time in general urology and the other half in colorectal, handling the urologic aspects of colorectal patients’ care. In this way collaboration is enhanced and encouraged.

Q: What are the future goals or plans for the colorectal program?

A: Our future goals for the colorectal program are focused on expanding our impact and enhancing patient care. First and foremost, we aim to help as many patients as possible. We plan to collaborate with other colorectal centers worldwide to share knowledge and best practices. Training surgeons and nurses remains a priority, as we want to equip as many healthcare professionals as possible with the skills needed in this field. Additionally, we are committed to traveling to the developing world to provide care for children who cannot access services at Children’s National. Finally, we intend to enhance our research efforts, leveraging basic science to investigate and address conditions related to the colon, ultimately seeking to reduce or eliminate associated illnesses.

pediatric colorectal surgeons at Children’s National Hospital

Multi-disciplinary collaboration key in any approach to refractory functional constipation

pediatric colorectal surgeons at Children’s National HospitalFor the last several years, the physicians, advance practice providers, and nurses within the Division of Colorectal and Pelvic Reconstruction at Children’s National Hospital have sought to establish standardized protocols for diagnosing and treating children with severe constipation unresponsive to medical management. Their work seeks to create a collaborative approach that brings gastroenterologists with motility expertise and colorectal surgeons together from the start to streamline testing, analysis, and to avoid unnecessary surgical procedures.

To that end, the team has published several studies that make the case for such a protocol based on their experiences managing this unique population.

What it means

In a 2022 study, the team conducted a retrospective review of children referred for retractable functional constipation to the Division of Colorectal and Pelvic Reconstruction at Children’s National. A unique algorithm for assessment and treatment was created based on the data analysis.

The resulting proposed protocol for medically refractory constipation provided a collaborative framework to standardize the work-up and treatment. This protocol led to the use of antegrade flushes via appendicostomy to empty the colon and was able to in most cases avoid a colonic resection, something done much more commonly in the past

A 2023 study further reiterated the importance of these collaborative approaches, stating, “It is vitally important to recognize that constipation exists on a spectrum of severity with multiple potential etiologic factors and therefore treatment must be customized based on the individual’s symptom, anatomic and manometric findings.”

The 2023 study also introduced an enhanced standardized algorithm to evaluate and treat refractory constipation, with the central idea being a consolidation of evaluation and initiation of treatment into a single combined procedure. This means collaboration between gastroenterology and colorectal surgery in the operating room by including anorectal manometry at the start to rule out anatomic anomalies as the cause of the constipation and to test motility.

Why it matters

In the 2023 study, the authors wrote, “While algorithms for initial evaluation and treatment of functional constipation in children have been described, most articles in the pediatric literature lack details about the work-up and management of those refractory symptoms and the approaches described for such patients vary widely among clinicians.”

That means that children with functional constipation for whom medical treatment has failed face a drastically lower quality of life. Functional constipation and encopresis, or stool soiling, correlates with a higher prevalence of low self-esteem, social withdrawal, and depression. It is critical to correctly diagnose and efficiently treat these conditions and work together to do it quickly.

Children’s National leads the way

As one of the nation’s leaders in pediatric colorectal and pelvic reconstructive surgery, Children’s National, led by Division Chief Marc Levitt, M.D., receives more referrals asking for a surgical solution for severe pediatric constipation than any other center in the world.

Caring for such a large population positions the team to analyze evidence and establish protocols based on statistically relevant numbers of patients. The studies outlined above are the result of the innovative design of the Division of Colorectal and Pelvic Reconstruction, in which multiple divisions involved in the care of these patients, from Gastroenterology to Urology and beyond, experience an unprecedented ability to work together, including in the operating room. It is a fully integrated program with experts in colorectal surgery, GI motility, and colorectal nursing embedded into the same team.

While most children with functional constipation will respond to medical treatment, for those who need further help that includes surgical assessments, the evidence-based algorithms developed in these studies can truly be life-changing for these children and their families.

Read the studies in the Journal of Pediatric Surgery:

Pediatric Colorectal Surgery Tips and Tricks

New textbook offers pediatric colorectal surgery tips and tricks

Pediatric Colorectal Surgery Tips and Tricks

The cover of the new Pediatric Colorectal Surgery Tips and Tricks textbook, written and edited by Marc A. Levitt, M.D.

The first edition of Pediatric Colorectal Surgery Tips and Tricks, a textbook written and edited by Marc A. Levitt, M.D., is now available.

The book, Dr. Levitt’s fourth textbook, focuses on sharing the knowledge he’s earned as the most experienced active pediatric colorectal surgeon in the world. The book provides inside expert information about the surgical and medical care of children with colorectal conditions.

The book includes surgical techniques and tips for medical management of:

  • Anorectal and cloacal malformations
  • Hirschsprung disease
  • Function constipation & fecal incontinence
  • Post-PSARP and Post Hirschsprung disease pull-through problems
  • Bowel management
  • Nursing care and contributions

The Pediatric Colorectal Surgery Tips and Tricks, 1st edition textbook can be purchased here.

Dr. Levitt is chief of the Division of Pediatric Colorectal and Pelvic Reconstruction at Children’s National Hospital. He has cared for children from all 50 states and 76 countries and has performed more than 15,000 pediatric colorectal procedures, which is more surgeries covering the entire spectrum of problems involving the colon and rectum than any other surgeon in the world.

He is also a driving force around the world in enhancing the care of children with colorectal and pelvic reconstructive needs through the development of specialized, integrated and collaborative surgical centers. He is internationally recognized as an expert in conditions affecting the newborn, pediatric and adolescent population affected with anorectal malformations (imperforate anus), cloacal malformations, Hirschsprung disease, as well as a variety of conditions leading to fecal incontinence, such as spinal conditions and functional constipation.

He has written four textbooks and authored over 300 scientific articles on these subjects. His work extends beyond providing direct surgical care to educating medical students, medical doctors, surgeons and nurses, as well as developing collaborating centers throughout the world to ensure that all children have access to quality colorectal care. He has hosted hundreds of surgeons and nurses from hospitals across the globe, who have sought out education and training on advanced colorectal surgical techniques, management of patients and research outcomes. Dr. Levitt is the founder of the Colorectal Team Overseas (CTO), a group of international providers that travel to the developing world to provide care and teaching for patients with colorectal needs. He co-founded the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), which is an organization of collaborating colorectal centers across the globe.

medical symbol on a map of the world

Observership program builds worldwide expertise to treat colorectal issues

medical symbol on a map of the worldPediatric colorectal specialists are in short supply, and this is particularly true in many areas of the developing world. When Marc Levitt, M.D., travels abroad, he consistently finds eager surgeons and nurses who wish to obtain advanced colorectal skills to help their patients. To meet this need Dr. Levitt has established an international observership program that brings leading physicians and nurses from around the globe to participate in one- to three-month-long observerships.

During 2022, the program will welcome participants from 13 different countries including Spain, Belgium, Vietnam, Indonesia, Chile, Pakistan, Uganda, Iraq, Mexico, Brazil, Saudi Arabia and Singapore.

Under the colorectal team’s instruction, participating physicians and nurses will learn how to diagnose and care for children with complex colorectal conditions. They will learn about the wide range of malformations and successful treatment options so they can bring these skills to patients in their home countries. Those selected for these observerships are among the most promising providers in their communities who currently work to improve treatment for children with colorectal issues.  The patients they care for are those who would otherwise have no or limited access to this specialty care.

For information about applying for the observership program, please contact the colorectal department at ColorectalVisitors@childrensnational.org.

Briony Varda

Q&A with urologist Briony Varda

Briony Varda

Briony Varda, M.D., M.P.H., is fellowship trained in pediatric genitourinary reconstructive surgery and her subspecialty interests include the care of patients with spina bifida and the neurogenic bladder, cloacal anomalies, hydronephrosis, vesicoureteral reflux and posterior urethral valves, among others.

Children’s National Hospital recognizes many urologic disorders and illnesses that are unique to children. As such, we pride ourselves in working with top urology experts, including Briony Varda, M.D., M.P.H., pediatric urologist, who recently joined the Urology Division at Children’s National.

Dr. Varda is fellowship trained in pediatric genitourinary reconstructive surgery and her subspecialty interests include the care of patients with spina bifida and the neurogenic bladder, cloacal anomalies, hydronephrosis, vesicoureteral reflux and posterior urethral valves, among others.

Here, Dr. Varda tells us more about her work and what it means for the future of pediatric urology patients at Children’s National.

Q: Why did you decide to work in this field?

I have always thoroughly enjoyed working with children. They keep you on your toes, tell it straight, make you laugh and demonstrate unique resilience. At the same time, surgery allows me to work with my hands, while being creative and helping others. Finally, I had great mentors within pediatric urology who strongly influenced me in a positive way.

In sum, the kids, the surgery and the people led me here.

Q: What is the importance of urology care?

We have three goals in pediatric urology: protect the kidneys and bladder, prevent infection and help our patients stay dry.

Although it’s usually clear when kids have urinary tract infections or trouble with urinary accidents, it’s not always visible when there is a problem with the kidney or bladder. Urologic care is therefore important because it prevents long-term damage that might otherwise go unnoticed until it is too late. This is particularly true for patients with abnormal functioning of the bladder related to a neurologic cause, such as spina bifida or a tethered spinal cord.

Q: How has the program expanded and what are some of the most valuable changes you hope to see in the next couple of years?

Our Spina Bifida Program currently includes physicians from physical medicine and rehabilitation (PMNR), orthopedics, neurosurgery and urology. Our newest additions include a full-time nurse practitioner who facilitates care coordination and has a clinical expertise in bowel management, two new urologists (myself and Christina Ho, M.D.), and Mi Ran Shin, M.D., who is our new PMNR physician.

We are also collaborating closely with the new Pediatric Colorectal & Pelvic Reconstruction Division for patients who need advanced bowel management. These additions will go a long way to helping improve the day-to-day living of our patients and help improve their long-term medical outcomes.

In the coming year, we are anticipating welcoming another full-time nurse to our program, offering more patient-facing resources including a webpage focused on urodynamics and an array of new patient education materials. We are also hoping to establish a regional transitional care network for our adolescent and young-adult patients.

Q: The Colorectal Program at Children’s National includes three urologists. How does this collaboration allow for the care of more complex cases at this hospital?

We are fortunate to be part of the Colorectal Program here at Children’s National Hospital. We provide subspecialty expertise for patients born with anorectal malformations, including cloacal anomalies and cloacal exstrophy. Although historically considered a general surgery problem, patients with anorectal malformations have a high rate of concomitant conditions affecting their genitourinary anatomy and function. By coordinating clinical care and surgery within a multidisciplinary team, we provide comprehensive care for even the most complex patients – nothing goes unnoticed and each subspecialist provides a unique perspective on management as it relates to their field.  Along with ourselves and the colorectal surgeons, we regularly collaborate with gynecology, gastroenterology, interventional radiology and anesthesia.

Q:  What is some of the research you’re working on now that you’re looking forward to the most?

We are currently designing a set of research projects aimed at investigating low-value healthcare utilization (for example, emergency room use and inappropriate testing) among patients with spina bifida. I plan to investigate institutional patterns and then expand out to the Washington, D.C., Maryland, Virginia area and the national setting. By identifying patterns in low-value healthcare utilization and their associated factors, we can ideally improve care delivery for this special healthcare needs population.

We are also working on institutional protocols to enact recently published guidelines by the Spina Bifida Association and the CDC so that we can eventually contribute our own data to national registries. This will pave the way for increasingly rigorous spina bifida research in the future.

inqueries have come from 21 countries

A look back at the first year of the Colorectal & Pelvic Reconstructive Surgery Division

The Division of Colorectal & Pelvic Reconstructive Surgery celebrates its one-year anniversary this month. Here’s a look back at the team’s accomplishments as the first integrated center for pediatric colorectal care in the mid-Atlantic region.

EUPSA joint congress flyer

Decision making in pediatric colorectal surgery webinars

EUPSA joint congress flyer

Due to the global COVID-19 pandemic, the 1st Joint Congress of European Pediatric Surgeons’ Association (EUPSA), International Pediatric Endosurgery Group (IPEG), and European Society of Paediatric Endoscopic Surgeons (ESPES) in Vienna, Austria, was canceled.  Despite this, EUPSA’s Education Office continued to foster collaboration and further educational opportunities among members in order to maintain and improve high standards of surgical care for pediatric surgical patients around the globe.

This included a webinar of case discussions on “Decision Making in Pediatric Colorectal Surgery,” led by Marc Levitt, M.D., Colorectal and Pelvic Reconstructive Surgeon at Children’s National Hospital. The international panel included Giulia Brisighelli (Johannesburg, ZA) Martin Lacher (Leipzig, Germany), Paula Midrio (Triviso, Italy), Carlos Reck (Vienna, Austria), Pim Sloots (Rotterdam, Netherlands), Gaia Tamaro (EUPSA Education Office), Alejandra Villanova (Madrid, Spain), and Tomas Wester (Stockholm, Sweden).

Dr. Levitt has since presented follow-up webinars on the following topics:

  • Abnormal perineum
  • Twisted pullthrough in Hirschprung disease
  • Duhamel pullthrough in Total Colonic Hirschsprung
  • Vaginal atresia in a newborn with ARM 2

You can view the full webinars below:

ARM index webinar

Colorectal team presents virtual conference sessions

The 6th Annual Alex Pediatric Surgery Congress and 1st Nile of Hope Hospital Congress conference, in cooperation with Colorectal Team Overseas (CTO), provides updates in colorectal, urogenital disorders and pelvic reconstructions in pediatrics. The Children’s National Hospital colorectal team was due to present at the conference in Alexandria, Egypt, in April 2020, but due to the global COVID-19 pandemic the event was indefinitely postponed. Despite this, Marc Levitt, M.D., Colorectal and Pelvic Reconstructive Surgeon at Children’s National, and Founder and Head of the CTO, presented educational sessions virtually to Egyptian surgeons throughout the month of April.

Anorectal malformation case presentation

Surgeons assemble in a virtual Zoom session for a case presentation on anorectal malformations by Marc Levitt, M.D., and the Children’s National colorectal team.

The video conferences allowed surgeons and experts to come together and foster the global collaboration that benefits colorectal teams and patients worldwide. The first session included 70 pediatric surgeons from Egypt and grew to over 128 attendees in the last session. The presentations spanned a variety of topics and can be accessed at the links below:

Joining Dr. Levitt in the discussion were members of the Children’s National colorectal nursing team, including Julie Choueiki, Program Manager, Justine Garofalo, CPNP, Meghan Mesa, Tara Garbarino, CPNP, and Katherine Worst, CPNP-AC. The integrated Children’s National colorectal team elevates the significance of the nursing role in caring for complex patients. For example, cases in the Bowel Management Program require hours of ongoing nursing care. The team demonstrated the partnership that benefits children when surgeons include and value nursing presence in the care of colorectal patients.

Moving forward, the team will bring continued virtual, telehealth collaboration and education. Doing so will expand the potential for more colorectal patients to receive the care they need.

Colorectal Textbook cover

Pediatric Colorectal and Pelvic Reconstructive Surgery textbook now available

Colorectal Textbook cover

The cover of the new Pediatric Colorectal and Pelvic Reconstructive Surgery textbook, edited by Marc A. Levitt, M.D., and Alejandra Vilanova-Sánchez, M.D.

The first edition of the Pediatric Colorectal and Pelvic Reconstructive Surgery textbook, edited by Marc A. Levitt, M.D., and Alejandra Vilanova-Sánchez, M.D., is now available.

The textbook provides comprehensive coverage of the anatomical and physiological aspects of complex colorectal and pelvic malformations presented in a practical and clinically focused way. Some of the topics explored include surgical protocols, the benefits of high-level collaboration between surgical services when treating these anomalies, treatment algorithms and care of complications.

The book also includes content on:

  • Evaluation and management of the newborn
  • Surgical interventions of the newborn, and when a primary repair versus a staged approach is required
  • The value of laparoscopy and when to use it
  • The importance of a transition program to adulthood

The Pediatric Colorectal and Pelvic Reconstructive Surgery, 1st edition textbook can be purchased here, and will benefit colorectal teams worldwide.

About the Editors

Marc Levitt

Marc Levitt, M.D., leads the colorectal program at Children’s National Hospital and is editor of the new Pediatric Colorectal and Pelvic Reconstructive Surgery textbook.

Marc Levitt, M.D., currently leads the colorectal program at Children’s National Hospital, the first in the mid-Atlantic region to fully integrate surgery, urology, gynecology and gastroenterology into one cohesive program for children. He has been the driving force around the world in enhancing the care of children with colorectal and pelvic reconstructive needs through the development of specialized, integrated and collaborative surgical centers. He is internationally recognized as specializing in conditions affecting the newborn, pediatric and adolescent population affected with anorectal malformations (imperforate anus), cloacal malformations, Hirschsprung disease, as well as a variety of conditions leading to fecal incontinence, such as spinal conditions and functional constipation. Dr. Levitt has written three textbooks, and has authored over 200 scientific articles on these subjects.

Dr. Levitt is the founder of the Colorectal Team Overseas (CTO), which is a group of international providers that travel to the developing world to provide care and teaching for patients with colorectal needs. He co-founded the creation of the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), which is an organization of collaborating colorectal centers across the globe.

Alejandra Vilanova-Sánchez, M.D., is a pediatric surgeon in the urogenital and colorectal unit at the University Hospital La Paz, Madrid. After finishing her training, she completed a fellowship in Pelvic Reconstruction Surgery at the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital. Her focus was on complex colorectal and pelvic surgery involving the gynecological and urological systems. Dr. Vilanova-Sánchez is a member of the Spanish Association of Pediatric Surgeons, European Pediatric Surgical Association (EUPSA) and ARM-net. She is a frequent speaker in international meetings and she has organized several national and international meetings on the topic of pediatric colorectal care. She participates annually in surgical brigades collaborating with nonprofit organizations, Colorectal Team Overseas and Helping Hands for Anorectal Malformations International, where she helps patients with colorectal conditions around the world.

child writing question marks on chalkboard

Test your knowledge of pediatric colorectal and pelvic reconstructive surgery!


Marc Levitt

Premier pediatric colorectal program opens doors at Children’s National

Marc Levitt

“With the broad range of expertise at Children’s National, including the nation’s best NICU, I’m confident that colorectal patients will get better, integrated care faster and more effectively here than anywhere else in the world,” says Marc Levitt, M.D.

World-renowned surgeon opens first program for care and treatment of colorectal conditions in the mid-Atlantic.

A new, highly-specialized surgical program at Children’s National Hospital is expected to draw patients from around the world. The colorectal surgery program is the first in the mid-Atlantic region to fully integrate surgery, urology, gynecology and gastroenterology into one cohesive program for children. The program is led by Marc Levitt, M.D., an internationally recognized expert in the surgical care and treatment of pediatric colorectal disorders who has performed over 10,000 surgeries to address a wide spectrum of problems involving the colon and rectum – more than any other full time practicing pediatric surgeon in the world.

“In the 25 years that I’ve been passionate about helping children with colorectal and pelvic conditions, I’ve learned that collaborative and integrated programs are the best way to care for them,” says Dr. Levitt. “With the broad range of expertise at Children’s National, including the nation’s best NICU, I’m confident that colorectal patients will get better, integrated care faster and more effectively here than anywhere else in the world.”

The program provides diagnosis and treatment for every type of colorectal disorder occurring in infants, children and adolescents, from the most common to the most complex. Every necessary specialty is integrated into the program in one convenient location to provide seamless care for all colon and rectum conditions, with particular expertise in:

  • Anorectal malformations
  • Cloacal malformations
  • Chronic constipation and fecal incontinence
  • Fecal and urinary incontinence related to spinal conditions such as spina bifida
  • Hirschsprung disease
  • Motility disorders

“Every child receives a customized treatment plan to address his or her unique needs,” Dr. Levitt says about the program. “Additionally, our surgeons often combine complex procedures across specialties to reduce the number of surgeries a child requires. It isn’t unusual for us to include urology, gynecology, and gastroenterology teams in the operating room alongside the colorectal surgeons so multiple issues can be addressed in a single procedure – we know that when possible, fewer surgeries is always better for the child.”

Dr. Levitt has cared for children from 50 states and 76 countries. He is the founder of Colorectal Team Overseas (CTO), a group of international providers who travel to the developing world to provide care for patients and teaching of their physicians and nurses. He co-founded the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), an organization of collaborating colorectal centers across the globe.

“We’re absolutely thrilled to welcome Marc Levitt and launch the comprehensive colorectal program under his expert leadership,” adds Anthony Sandler, M.D., surgeon-in-chief and vice president of the Joseph E. Robert, Jr., Center for Surgical Care at Children’s National. “There are few in the world who can provide the expertise and leadership in colorectal diagnoses and treatment that Marc brings with him to Children’s. Many children and families from the region and from around the world will benefit from his expertise and from the program in general.”