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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.

Reflections on Seminars in Pediatric Surgery December 2020

Cover of the December issue of Seminars on Pediatric Surger

Marc Levitt, M.D., served as guest editor of a special December Seminars in Pediatric Surgery dedicated to the care and treatment of anorectal malformations.

By Marc Levitt, M.D., chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National Hospital

I was honored to serve as the Guest Editor on the topic of “Anorectal Malformations” in the prestigious Seminars in Pediatric Surgery Volume 29, Issue 6, December 2020.

We had 64 contributing authors from 12 countries; Australia, Austria, Germany, Ghana, Italy, Israel, the Netherlands, Nigeria, Spain, South Africa, the United Kingdom and the United States, and 12 U.S. colorectal collaborating programs; Children’s National, Boston Children’s, Children’s Mercy, Children’s Wisconsin, C.S. Mott Children’s, Cincinnati Children’s, Nationwide Children’s, Nicklaus Children’s, Omaha Children’s, Primary Children’s, Seattle Children’s, and UC Davis Children’s.

There were eight authors from the Children’s National team; myself, Colorectal Director Andrea Badillo, M.D., Colorectal Program Manager Julie Choueiki, MSN, RN, Surgical Center Director Susan Callicott, Katie Worst, CPNP-AC, Grace Ma, M.D., Chief of Urology Hans Pohl, M.D., and Chief of Gynecology Veronica Gomez-Lobo, M.D.

The series of articles included in this collection illustrate new techniques and ideas that over time have made a dramatic and positive impact on the care and quality of life of children who suffer from colorectal problems. With an integrated approach to the care of this complex group of patients, great things can be achieved. As we endeavor to advance this field, we need to always remember that, as Alberto Pena, M.D., often said, “it is not the unanswered questions, but rather the unquestioned answers that one must pursue.”

In my own article on advances in the field, a 2021 update, I reproduce a piece by my daughter, Jess Levitt, who wrote something applicable to the care of children with colorectal problems, with the message that helping to create order is vital to improve a somewhat chaotic medical process traditionally available for the care of complex care. Her essay is reproduced here:

“A” must come before “B,” which must come before “C,” everybody knows that. But what if the Millercamp’s of this world did not have to sit next to the Millerchip’s when it comes to seating arrangements? Can Pat Zawatsky be called before Jack Aaronson when the teacher is taking attendance? Do those 26 letters that make up all the dialogue, signs, thoughts, books, and titles in the English-speaking departments of the world need their specific spots in line? Everyone can sing you the well-known jingle from A to Z, but not many people can tell you why the alphabet is the way it is. For almost as long as humans have had the English language, they have had the alphabet. The good ole ABCs.

However, the alphabet represents the human need for order and stability. I believe that the same thinking that went into the construct of time and even government went into the alphabet. Justifiably, lack of order leads to chaos. Knife-throwing, gun-shooting chaos, in the case of lack of governmental order. Listen to me when I tell you that there is absolutely no reason that the alphabet is arranged the way that it is. Moreover, the alphabet is simply a product of human nature and how it leads people to establish order for things that do not require it. 

Now I know this sounds crazy but bear with me. Only if you really peel away the layers of the alphabet will you find the true weight it carries. People organized the letters of our speech into a specific order simply because there wasn’t already one. Questioning this order will enlighten you on the true meaning of it. Really dig deep into the meaning behind the social construct that is the alphabet. Short and sweet as it may be, the order of the ABCs is much less than meets the eye. There is no reason that “J” should fall before “K!” Understand this. Very important as order is, it is only a result of human nature.  What’s next? X-rays become independent of Xylophones in children’s books of ABCs? 

You know what the best part is? Zero chance you even noticed that each sentence in this essay is in alphabetical order.

Her literary contribution inspired me to do something similar. Take a look at the list of articles in this Seminars edition:

  1. Creating a collaborative program for the care of children with colorectal and pelvic problems. Alejandra Vilanova-Sánchez, Julie Choueiki, Caitlin A. Smith, Susan Callicot, Jason S. Frischer and Marc A. Levitt
  2. Optimal management of the newborn with an anorectal malformation and evaluation of their continence potential. Sebastian K. King, Wilfried Krois, Martin Lacher, Payam Saadai, Yaron Armon and Paola Midrio
  3. Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management. Rebecca M. Rentea, Andrea T. Badillo, Stuart Hosie, Jonathan R. Sutcliffe and Belinda Dickie
  4. Long-term urologic and gynecologic follow-up and the importance of collaboration for patients with anorectal malformations. Clare Skerritt, Daniel G. Dajusta, Molly E. Fuchs, Hans Pohl, Veronica Gomez-Lobo and Geri Hewitt
  5. Assessing the previously repaired patient with an anorectal malformation who is not doing well. Victoria A. Lane, Juan Calisto, Ivo Deblaauw, Casey M. Calkins, Inbal Samuk and Jeffrey R. Avansino
  6. Bowel management for the treatment of fecal incontinence and constipation in patients with anorectal malformations. Onnalisa Nash, Sarah Zobell, Katherine Worst and Michael D. Rollins
  7. Organizing the care of a patient with a cloacal malformation: Key steps and decision making for pre-, intra-, and post-operative repair. Richard J. Wood, Carlos A. Reck-Burneo, Alejandra Vilanova-Sanchez and Marc A. Levitt
  8. Radiology of anorectal malformations: What does the surgeon need to know? Matthew Ralls, Benjamin P. Thompson, Brent Adler, Grace Ma, D. Gregory Bates, Steve Kraus and Marcus Jarboe
  9. Adjuncts to bowel management for fecal incontinence and constipation, the role of surgery; appendicostomy, cecostomy, neoappendicostomy, and colonic resection. Devin R. Halleran, Cornelius E.J. Sloots, Megan K. Fuller and Karen Diefenbach
  10. Treating pediatric colorectal patients in low and middle income settings: Creative adaptation to the resources available. Giulia Brisighelli, Victor Etwire, Taiwo Lawal, Marion Arnold and Chris Westgarth-Taylor
  11. Importance of education and the role of the patient and family in the care of anorectal malformations. Greg Ryan, Stephanie Vyrostek, Dalia Aminoff, Kristina Booth, Sarah Driesbach, Meghan Fisher, Julie Gerberick, Michel Haanen, Chelsea Mullins, Lori Parker and Nicole Schwarzer
  12. Ongoing care for the patient with an anorectal malfromation; transitioning to adulthood. Alessandra Gasior, Paola Midrio, Dalia Aminoff and Michael Stanton
  13. New and exciting advances in pediatric colorectal and pelvic reconstructive surgery – 2021 update. Marc A. Levitt

The first letter of each article forms an acrostic of the word “COLLABORATION” which is the secret sauce behind any success in the field of pediatric colorectal care.

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.