Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
After 3 years of age, if the child has not potty trained, formal bowel management should start: enemas for children with bad prognosis, enemas on temporary basis for borderline bowel control, and laxatives for children with bowel control and constipation. — Andrea Bischoff, Anorectal Malformations with Dr. Andrea Bischoff · 31:13
The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
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Pediatric colorectal surgeons Dr. Marc Levitt and Dr. Jason Frischer discuss a case of a new born with a low anorectal malformation. Listen as they take you through the workup, diagnosis, and treatment of an ARM with an ending that you migh
podcast15:45 · Jan 2021
Anorectal Malformations with Dr. Andrea Bischoff
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Discussion with Dr Andrea Bischoff and Dr Todd Ponsky regarding anorectal malformations.Evaluation of the male baby with possible anorectal malformation (01:19) Dr. Ponsky: Let’s get into it Andrea. I want to give you a case and tell me how
podcast47:46 · Dec 2020
Initial urgent management priorities in cloaca are: ensure kidney and urine decompression, diagnose hydrocolpos, and confirm patient is safe for anesthesia (cardiac assessment, TEF screen). — Richard Wood, Colorectal Quiz Episode 17: Cloaca Part 1 · 7:56
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Dec 2020
Colorectal Quiz Episode 33: Cloaca Extrophy
podcast · Aug 2022Private
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky
Edited by Nicholas Bruns, MD and Ian C. Glenn, MD
In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast48:09 · Dec 2020
Colorectal Quiz Episode 14: ARM Newborn Part 3
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Surgeons, neonatologists, pediatricians, and anyone who cares for the newborn child needs to understand how to evaluate anorectal malformations. To clear things up, Dr. Marc Levitt and Dr. Jason Frischer explain how to make sense of various
podcast10:03 · Jun 2021
Colorectal Quiz Episode 2: When to redo a PSARP
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In the second installment of the Colorectal quiz, Dr. Jason Frischer and Dr. Marc Levitt discuss a topic of debate - when is the right time to redo an anorectoplasty? Listen as they walk you through their thought process on 2 different case
podcast18:15 · Jan 2021
Colorectal Quiz Episode 17: Cloaca Part 1
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today's episode, Dr. Marc Levitt and Dr. Jason Frischer talk to Dr. Richard Wood about the initia
podcast27:29 · Jul 2021
Colorectal Quiz Episode 18: Cloaca Part 2
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today's episode, Dr. Marc Levitt and Dr. Jason Frischer talk to Dr. Richard Wood about the operat
podcast23:10 · Jul 2021
Colorectal Quiz Episode 24: Cloaca Part 3
podcast · Dec 2021Private
Every surgeon caring for anorectal malformations should know the malformation type, spinal status (tethered cord, myelomeningocele, or normal), and sacral anatomy including sacral ratio. — Marc Levitt, Colorectal Quiz Episode 28: Female ARM Management - Perineal Fistula · 17:44
Colorectal Quiz Episode 28: Female ARM Management - Perineal Fistula
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Join Dr. Kathy van Leeuwen and Dr. Christine Velazco at Phoenix Children’s as they discuss a specific case of a perineal fistula that leads to further discussion with Dr. Marc Levitt and Dr. Jason Frischer on the different potential finding
podcast19:59 · Feb 2022
Colorectal Quiz Episode 29: Female ARM-Post Op Management
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Join Dr. Kathy van Leeuwen and Dr. Cristine Velazco at Phoenix Children’s as they discuss the nuances of post-operative anorectal malformation management following the PSARP procedure with Dr. Marc Levitt and Dr. Jason FrischerHosted by Ama
podcast25:09 · Mar 2022
Comparing 30-day outcomes between early versus delayed repair of anorectal malformations with perineal or rectovestibular fistulas: An analysis of the ACS NSQIP-Pediatric database
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AbstractBackgroundAnorectal malformations (ARMs) have a wide spectrum of presentation ranging from mild defects with perineal fistulas to more severe defects requiring complex management. A primary repair of ARMs with perineal or rectovesti
article · Oct 2020
Anatomy of the Rectourethral Fistula in ARM
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Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula comm
article · Sep 2019
The target part of the colon to create the stoma is in the most proximal part of the sigmoid colon, as high as possible close to the descending colon, to avoid future stoma prolapse. Descending Colostomy for Anorectal Malformations Dr. Tamer Ashraf Wafa · 0:00
Descending Colostomy for Anorectal Malformations Dr. Tamer Ashraf Wafa
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In this video, a creation of a descending colostomy is demonstrated in a newborn with ano-rectal malformation.The video shows the surgeon's point of view (POV). And the surgeon is standing on the patient’s left side. This video is intended
video5:09 · May 2021
Laparoscopic pull-through for Hirschsprung disease updated 2024
video7:49 · Jul 2024Private
Technique: Female PSARP
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Female Posterior Sagital AnoRectoPlasty technique by Dr. Marc Levitt.
video · Nov 2018
Technique: PSARP in female with no fistula
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Posterior Sagital AnoRectoPlasty in a female patient with no fistula by Dr. Marc Levitt.
video · Jan 2019
Technique: PSARP in Male with Rectobulbar Fistula
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Posterior Sagital AnoRectoPlasty in a male patient with rectobulbar fistula by Dr. Marc Levitt.
video · Jan 2019
Featured picks for families are being prepared — the summaries above are written for you.
Expert statements from the recordings in this collection.
Complications of Anorectal Malformations with Dr. Marc Levitt
Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period.
Marc Levitt2:57
Male babies with perineal fistula may pass meconium and no one notices anything wrong with their anorectal anatomy, typically presenting in the first year of life with severe constipation.
Marc Levitt3:06
A newborn anus should accept a size 12 Hagar dilator and a 1-year-old should accept a size 15.
Marc Levitt6:13
Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation; patients will inherently have some constipation requiring aggressive treatment.
Marc Levitt4:54
If a perineal fistula is not centered in the sphincter, patients with loose stool will soil, and athletic activity will cause soiling because sphincter squeeze cannot completely close the hole.
Marc Levitt5:38
In females, diagnostic criteria for perineal fistula are: hole too close to vagina (inadequate perineal body), inadequate hole size by Hagar dilators, and hole not centered in sphincter.
Marc Levitt8:02
If a female's anal opening is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, no surgery is needed; the perineal body will lengthen with growth.
Marc Levitt8:47
The standard practice of checking temperature on forehead or ear rather than rectally makes it easier to miss anorectal malformations in newborns.
An anesthesia nerve stimulator costing $150 with appropriate needle probes works as well as commercial $15,000 stimulators for identifying sphincter muscles.
Marc Levitt11:06
The most common colostomy error is opening too distal in the sigmoid, restricting the ultimate pull-through by the location of the colostomy or mucous fistula.
Marc Levitt17:18
Incompletely diverting loop colostomies allow stool to spill across and contaminate the distal segment, leading to urinary tract infections.
Marc Levitt17:45
With transverse colostomy and large rectourethral fistula, the left colon absorbs urine which doesn't exit the mucous fistula, potentially causing acidosis from urine absorption.
Marc Levitt18:38
Prolapse risk depends on colostomy location: mid-transverse allows bilateral prolapse, hepatic flexure allows only distal prolapse, proximal sigmoid allows only distal prolapse because left colon is fixed to retroperitoneum.
Marc Levitt19:58
Marking the sphincter ellipse on skin surface before making any incision prevents confusion from muscle stimulation after dissection is open, avoiding misplaced anoplasty.
Marc Levitt21:30
A distal colostogram showing flattening of the rectum corresponding to the pubococcygeal line indicates insufficient contrast or pressure; more pressure is needed to overcome the sphincters and reveal the true rectal position and fistula.
Marc Levitt24:26
Fistula level is determined by viewing the urethra as a reverse C or elbow: fistula at or below the elbow is bulbar, above the elbow is prostatic, at bladder neck is bladder neck fistula.
Marc Levitt25:23
Bulbous rectum on colostogram may be reachable posterior sagittally and difficult laparoscopically; tapered rectum is better approached laparoscopically.
Marc Levitt25:55
Opening posterior sagittally without knowing exact rectal location risks finding and potentially mobilizing bladder neck instead of rectum.
Marc Levitt27:00
Bulbar and low prostatic fistulas with bulbous rectum are best approached posterior sagittally; high prostatic with tapered rectum and bladder neck fistulas are best approached laparoscopically.
Marc Levitt30:09
Attempting laparoscopy for bulging rectum below peritoneal reflection at low prostatic or bulbar level risks leaving behind a remnant of the original fistula (roof) if the surgeon is timid.
Marc Levitt30:43
Laparoscopy replaces laparotomy, not PSARP; a mini-PSARP during laparoscopy allows safe entry through peritoneal reflection and tacking rectum to posterior muscle complex to prevent prolapse.
Rectal prolapse occurs in about 3% of cases, particularly in patients without great muscles.
Marc Levitt33:35
Rectal prolapse more than 3 millimeters should be treated because it causes bleeding, mucus, and can inhibit bowel control in patients with good muscle potential.
Marc Levitt34:14
Circumferential prolapse can be trimmed in two separate ambulatory sessions (half circumference each), avoiding hospitalization and eliminating need for dilation since half the circumference remains untouched.
Marc Levitt34:48
Perineal body dehiscence is the most common cause of reoperation in female ARM repairs.
Marc Levitt36:03
Complete anterior rectal wall mobilization to the areolar plane between rectum and vagina is essential to avoid tension on the anoplasty that can lead to perineal body dehiscence.
Marc Levitt35:41
Clear liquids only for one week postoperatively prevents hard stool formation while allowing more stool volume, showing good perineal body healing results without traditional 7-day NPO period.
Marc Levitt36:45
If perineal body dehiscence is recognized on days 5-8, taking the patient back to OR to re-suture can salvage the repair; by 3-4 weeks the entire perineal body is dehisced and unsalvageable.
Marc Levitt37:48
During laparoscopic approach for high rectums, the IMA must be preserved because prior colostomy may have disrupted collaterals down the left colic, making the rectum completely dependent on IMA blood supply.
Marc Levitt39:33
Continence potential in ARM patients is predicted by three factors: original malformation type, sacral ratio, and spine quality (ARM continence index). Three A's predicts continence, three C's predicts incontinence.
Marc Levitt42:14