Tag Archive for: Hirschsprung disease

Colorectal surgeons ensure recognition for surgical innovation of Dr. Asa Yancey

Asa Yancey, M.D.

Dr. Asa Yancey’s pioneering operation went unrecognized for over half a century due to discriminatory publishing practices in academic medicine.

A group of international pediatric colorectal surgery leaders called for the renaming of a surgical procedure for Hirschsprung disease after finding evidence that an African American surgeon, Asa Yancey, M.D., had pioneered the procedure 12 years before its’ current namesake, Franco Soave, M.D. Dr. Yancey was not recognized previously due to discriminatory practices in academic medical publishing.

What it means

A literature review published in the Journal of Surgical Research conducted by the American Pediatric Surgical Association Hirschsprung disease interest group, including Marc Levitt, M.D., chief of Colorectal and Pelvic Reconstruction at Children’s National Hospital, identified that Dr. Yancey’s work describing pull-through of normal colon through a cuff of aganglionic colon as a treatment for Hirschsprung disease was published in 1952. The paper by Soave was published in 1962 and from that work, the “Soave” procedure bore his name.

The authors point out that Dr. Yancey’s pioneering operation went unrecognized for over half a century because of the discriminatory segregation in the publishing practices of academic medicine dating back to the 1950s.

Moving the field forward

Dr. Levitt and his colleagues in the interest group suggested active changes to give posthumous credit to Dr. Yancey, including renaming the procedure to the Yancey-Soave pull-through technique.

Together with Dr. Yancey’s family, including his children, three of whom are physicians, the interest group and other surgeons have started using the procedure’s new name in presentations, operative notes, articles and book chapters.

At the end of their literature review recommending the update, the authors wrote, “Posthumous acknowledgment of Yancey was long overdue but signifies improvements in the inclusion of underrepresented groups in academic medicine while simultaneously reminding physicians that there is still much work to be done.”

Read the article The Story of Dr. Asa G. Yancey and Surgical Innovation in the Face of Discrimination in the Journal of Surgical Research.

Pediatric colorectal experts gather: 2024 PCPLC Conference

The Division of Colorectal & Pelvic Reconstruction team from Children’s National Hospital at the 2024 PLPLC Conference.

The Division of Colorectal & Pelvic Reconstruction team from Children’s National Hospital at the 2024 PLPLC Conference.

Medical professionals from across the world gathered in Atlanta, Georgia, for the 2024 Pediatric Colorectal and Pelvic Reconstruction Conference. This esteemed course, hosted by the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), provided comprehensive educational experiences to those caring for children with colorectal and pelvic disorders.

Children’s National Hospital staff showcased their expertise by leading in-depth discussions, presenting accepted abstracts and designing course programming across multiple specialty areas while highlighting the program’s focus on collaborative care. Led by Chief Marc Levitt, M.D., the division of Pediatric Colorectal and Pelvic Reconstruction is the first in the mid-Atlantic region to fully integrate surgery, urology, gynecology and gastroenterology into one cohesive program for children.

Presenters and topics from Children’s National included:

Course organizers:

  • Marc Levitt, M.D., Education Committee member, Surgical Conference planner
  • Briony Varda, M.D., M.P.H., Urology Committee chair, Cloaca Committee member, Documentation Committee member
  • Andrea Badillo, M.D., Documentation Committee member, Education Committee member
  • Julie Choueiki, M.S.N., R.N., Allied Health Care Professionals Conference (AHCP) co-chair
Dr. Marc Levitt leads a hands-on simulation lab using validated surgical models for treating Anorectal Malformations and Hirschsprung Disease.

Dr. Marc Levitt leads a hands-on simulation lab using validated surgical models for treating Anorectal Malformations and Hirschsprung Disease.

Invited speakers and topics:

  • Marc Levitt, M.D., Cloaca Advanced; Anorectal Malformations/Hirschsprung Disease Hands-On Course; Hirschsprung disease and Constipation
  • Briony Varda, M.D., M.P.H., Genitourinary Complications & Creative Solutions: A Case Based Discussion of Patients with ARM; Cloaca Basics; Challenging Case Presentations in Colorectal Care
  • Katherine Worst, N.P., CPNP-AC, Functional Constipation, Motility, Bowel Management Basics; Bowel Management of the Colorectal Patient Including Psychosocial Care and Pelvic Floor Physical Therapy; Cloaca Review Session for Allied Health Care Professionals
  • Allison Mayhew, M.D., Genitourinary Complications & Creative Solutions: A Case Based Discussion of Patients with ARM; Advanced Cloaca; Cloaca Exstrophy, Gynecologic Evaluation and Follow Up
  • Andrea Badillo, M.D., Functional Constipation, Motility, Bowel Management Basics; Genitourinary Complications & Creative Solutions: A Case Based Discussion of Patients with ARM; Pediatric Colorectal Knowledge Competition at Course Conclusion
  • Christina Ho, M.D., Urological Care for the Colorectal Patient for Allied Health Care Professionals
  • Meghan Mesa, B.S.N., R.N., C.P.N., Performing Colorectal Clinic Skills for Allied Health Care Professionals
  • Justine Gagnon, B.S.N., R.N., Performing Colorectal Clinic Skills for Allied Health Care Professionals

Oral Plenary Scientific Session:

  • Thomas Xu, Hospital Volume and Region Associated with Variation in Vacterl Screening Among Newborns with Anorectal Malformation An Opportunity to Optimize Screening Practices
  • Kirsten Das, Gynecologic Anomalies in Patients with Anorectal Malformations and Associated Anomalies: A National Retrospective Cohort from 2016-2023
  • Eugénie Lehembre-Shiah, Cloacal Malformation And Mullerian Agenesis: Management Of The Gynecologic Reconstruction For This Rare Situation
Dr. Andrea Badillo on the panel for Functional Constipation, Motility, Bowel Management Basics.

Dr. Andrea Badillo on the panel for Functional Constipation, Motility, Bowel Management Basics.

Scientific Poster “Oral Quick Shot” Session (abstracts accepted):

  • Thomas Xu, Frequency of Vacte(G)Rls Associated Anomalies in Newborns with Anorectal Malformations Across Hospitals within the Pediatric Health Information Systems Database: Neonatal Diagnoses and Beyond; Malone Antegrade Continence Enema (Mace) – Reassessment of Complications with Advancements in Technique; Antegrade Continence Enemas for Patients with Spina Bifida to Treat Fecal Incontinence, a Comparison with Patients with Non-Neurogenic Causes
  • Jessica McAuliffe, N.P., F.N.P., Frequency and Severity of Diaper Dermatitis in Children Following Stoma Closure
  • Kirsten Das, Predicting The Need For Vaginal Augmentation In Patients Undergoing Cloacal Reconstruction

As a globally recognized expert in enhancing care of children with colorectal and pelvic reconstructive needs, Dr. Levitt,  , along with Alejandra Vilanova-Sanchez, M.D., edited the textbook Pediatric Colorectal and Pelvic Reconstructive Surgery. As part of his commitment to advancing education about colorectal surgery, Dr. Levitt provided a copy of the textbook to every conference attendee.

Division of Colorectal & Pelvic Reconstruction: 5 year highlights

colorectal 5 year infographic

Better standardized care for total colonic Hirschsprung disease

Marc Levitt, M.D., in the operating room.

Clinicians can better manage care for children with total colonic Hirschsprung disease by drawing on the collective expertise from the people who have seen and treated patients with this condition, says Marc Levitt, M.D.

Clinicians can better manage care for children with total colonic Hirschsprung disease, a rare form of the condition, by drawing on the collective expertise from the people who have seen and treated patients with this condition, says Marc Levitt, M.D., chief of Colorectal and Pelvic Reconstruction at Children’s National Hospital.

What is it?

Dr. Levitt and fellow experts within the APSA Hirschsprung Disease Interest group are working together to develop recommendations based on their collective experiences managing the condition. Their recommendations will include specifics for the diagnosis and management of total colonic Hirschsprung disease (a rare type of Hirschsprung disease that involves the entire colon) before and after reconstruction, such as diagnostic criteria, surgical approaches, bowel management, diet, antibiotic prophylaxis, colonic irrigations and post-surgical considerations.

Specifically, the group’s consensus findings and recommendations include:

  • Specific information about using a contrast enema for this diagnosis — namely that there is no obvious transition zone identified.
  • The importance of a surgical approach of colonic mapping to obtain definitive pathology and ileostomy at the time of diagnosis, which is key to getting a child with this condition feeding and growing.
  • Monitoring that growth with nutritional assessment and oral sodium supplementation are vital to their care.
  • High output stomas and loose stool after pull-through can be more readily treated now with anti-motility agents, and better care of the parastomal and perineal skin.

Why does it matter?

Children with total colonic Hirschsprung disease are unique among children with Hirschsprung disease. They present specific pre- and post-operative management challenges. Creating and sharing consensus guidelines will create a rational, expert-based approach to diagnosing and managing the condition based on direct clinical experience, that others can draw from. Because the condition is relatively rare, care decisions historically have been made based mainly on literature about it. However, that literature often shows a lack of clear consensus on how to approach the condition.

Children’s National leads the way

Dr. Levitt and his colleagues collectively have seen more cases of total colonic Hirschsprung disease than any other clinicians in the world and have helped to author better guidelines specifically to try to standardize the pre- and post-operative management of this patient group. The goal is to improve the likelihood of a better outcome for the child no matter where a family goes for care.

Why a colorectal transition program matters

Erin Teeple

Erin Teeple, M.D.

Children’s National Hospital recently welcomed pediatric and adult colorectal surgeon Erin Teeple, M.D., to the Division of Colorectal and Pelvic Reconstruction. Dr. Teeple is the only person in the United States who is board-certified as both a pediatric surgeon and adult colorectal surgeon, uniquely positioning her to care for people with both acquired and congenital colorectal disease and help them transition from pediatric care to adult caregivers.

What is the Colorectal Transition Program?

The Colorectal Transition Program helps young adults with congenital or acquired colorectal conditions transition their care from pediatric care providers to adult care providers. It is critical that they receive guided transitional care because they often have complex medical and surgical histories from the time they are born affecting more than one organ system. A transitional care team which knows the patient on the pediatric side and can help deliver them to the right doctors and care providers in an adult setting will smooth the transition. Collaborative care across specialties including colorectal surgery, gynecology, urology and gastroenterology helps ensure continued care of all organ systems affected. Similar transition programs already exist for other conditions such as congenital heart disease and cystic fibrosis.

What’s new about this program?

I am both a pediatric surgeon and an adult colorectal surgeon, which means I can care for these children even prenatally and continue that care throughout adulthood. There is no other program in the United States led by a practicing pediatric surgeon who is also board-certified in adult colorectal surgery.

In addition, the collaboration between Children’s National Hospital and Medstar means we can bring unprecedented partnerships with urology, gynecology and gastroenterology on the adult side to offer collaborative care akin to the kind of care we offer our pediatric patients in the Division of Colorectal and Pelvic Reconstruction.

Who will benefit from this program?

Teenagers and adults with congenital and acquired colorectal disease, such as cloaca and other anorectal malformations, Hirschsprung disease, inflammatory bowel disease (IBD), pelvic floor dysfunction, familial adenomatous polyposis (FAP), those who have cecostomy or have had in their past a complex reconstruction will benefit the most from this program.

We have started to transition our existing young adults into this program. We also have seen many adults who have struggled to find care since leaving a pediatric care setting decades ago. These people have come from the local area as well as nationally and internationally to find experienced and collaborative care they have desperately sought.

How is Children’s National Hospital leading the way?

By recruiting the only U.S. surgeon boarded in both pediatric surgery and colorectal surgery, Children’s National will offer unique expertise to both initial surgical reconstruction and care and add a wealth of experience to the care of these children as they age into adulthood.

Having a devoted clinician with a foot in both the pediatric and adult worlds will foster long term relationships and build the depth of the team providing clinical care to all our patients and their families.

Why do you think it is so important to involve a surgeon with your training in the care of these kids?

A pediatric colorectal surgeon is critical to the initial care of an infant with congenital colorectal disease. My knowledge as an adult colorectal surgeon adds a different perspective to the treatment plan for our young patients but also will bring key insight to the process of transitioning that care to providers who specialize in adults later down the road. I also bring the knowledge and experience of a pediatric surgeon to the adult side, which gives me the ability to know the complex congenital anatomy that needed to be reconstructed when the patient was a child and to bring together a team optimized for the care of often complex conditions. Adults with these conditions also have unique needs that are different from the typical adult colorectal patient, and my specific expertise gives me the right skills to help them.

Sphincter reconstruction offers new hope for children with Hirschsprung disease

girl playing basketball

After surgery, patients reported sleeping better, higher productivity, the ability to participate in sports and be away from home with confidence.

A new surgical procedure successfully addresses a common lingering challenge — incontinence – faced by some families with young children who have undergone surgery for Hirschsprung disease. This first-of-its kind procedure was pioneered by surgeons in the Division of Colorectal and Pelvic Reconstruction at Children’s National Hospital, led by Division Chief Marc Levitt, M.D.

The 12-month outcomes for early recipients of the procedure appear in the Journal of Pediatric Surgery.

Why it matters

“The goal of surgery for Hirschsprung disease is to give a child a chance to have normal bowel function, which plays a significant role in their quality of life,” says Dr. Levitt, who served as senior author on the study. “But sometimes after a child receives their pull-through operation — the first surgical step to treat Hirschsprung — they continue to be incontinent. This novel follow-up procedure is offering these kids and their families new hope for a more normal life.”

Hirschsprung disease is a congenital condition that affects one in 5,000 children each year. Children with this condition develop a host of health problems including intestinal blockage and severe constipation, caused by the inability of the colon, or large intestine, to work properly.

The pull-through procedure is the best treatment for children with Hirschsprung disease. The procedure removes the portion of the intestine that does not function so that the child can regain control.

However, after the procedure, some children continue to experience incontinence that requires routine enemas for their entire lives. Before now there was no solution to this problem.

Why we’re excited

The new pilot study shows long-term outcomes for seven patients between the ages of 2 and 18 who underwent the novel technical approach called sphincter reconstruction. Each of the seven were diagnosed with an anatomic or physical issue contributing to their incontinence. It was during a repair procedure for the first patient that Dr. Levitt and his team had the idea of a technique for sphincter reconstruction. After that, six more patients with similar anatomy were offered the procedure.

Four of the six now have normal bowel function. They reported sleeping better, higher productivity, the ability to participate in sports and be away from home with confidence. The remaining two have behavioral conditions that have delayed their progress but are on their way to similar success.

The patient benefit

“Parents and caregivers have told us repeatedly about how much enemas negatively impact their family quality of life,” says Dr. Levitt. “That’s what makes this exciting — this validated surgical approach offers new hope for families who previously thought their child would face a lifetime of issues that would limit their freedom. Now, we finally have something to offer.”

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.

Early promise of sphincter reconstruction for Hirschsprung disease

Colorectal clinic with Marc Levitt, MD, and patient families

A team of surgeons, led by international pediatric colorectal expert Marc Levitt, M.D., has developed a new surgical approach to tighten, or reconstruct, the sphincters of Hirschsprung patients who have true fecal incontinence after a pull-through procedure.

A team of surgeons, led by international pediatric colorectal expert Marc Levitt, M.D., has developed a new surgical approach to tighten, or reconstruct, the sphincters of Hirschsprung patients who have true fecal incontinence after a pull-through procedure.

Early cases using this approach were outlined in a study published in the Journal of Pediatric Surgery. Though only performed in a handful of patients so far, the authors write, “We feel confident to offer this procedure to other patients with a similar anatomic concern.”

The people who care for Hirschsprung disease patients, including the team at the Pediatric Colorectal and Pelvic Reconstruction Division at Children’s National, continue to seek better approaches for these issues because soiling and fecal incontinence are rare but devastating complications that can occur after children have a pull-through procedure.

“In the presence of an intact continence mechanisms, the anal sphincters and the dentate line, patients with Hirschsprung disease should do well and have bowel control.  For some with soiling, this can be improved with treatment of constipation or hypermotility,” the authors write. “However, patients with a damaged anal canal and/or sphincter mechanism are unable to sense stool and distension of the neorectum or hold the stool in, which can lead to true fecal incontinence.”

Currently, there is no optimal treatment for the fecal incontinence that these patients experience. This repair procedure pioneered by surgeons at Children’s National offers a promising option to help get children with Hirschsprung disease one step closer to a happier, less stressful life.

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.

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.

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