# Functional Colorectal Disorders & Bowel Management — GCMD Library living collection

Updated: n/a · 34 episodes · 229 cited statements

## Episodes
### Functional Constipation
- [Current Treatment Options for Children with Functional Constipation-What Is in the Pipeline?](https://qa.library.globalcastmd.com/article/current-treatment-options-for-children-with-functional-constipation-what-is-in-t-13759) — article · [machine version](https://qa.library.globalcastmd.com/article/current-treatment-options-for-children-with-functional-constipation-what-is-in-t-13759.md)
- [State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation](https://qa.library.globalcastmd.com/article/state-of-the-art-bowel-management-for-pediatric-colorectal-problems-functional-c-13764) — article · [machine version](https://qa.library.globalcastmd.com/article/state-of-the-art-bowel-management-for-pediatric-colorectal-problems-functional-c-13764.md)
- [Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study](https://qa.library.globalcastmd.com/article/antegrade-continence-enema-alone-for-the-management-of-functional-constipation-a-13763) — article · [machine version](https://qa.library.globalcastmd.com/article/antegrade-continence-enema-alone-for-the-management-of-functional-constipation-a-13763.md)
- [Surgical Interventions for Functional Constipation: An Update](https://qa.library.globalcastmd.com/article/surgical-interventions-for-functional-constipation-an-update-13801) — article · [machine version](https://qa.library.globalcastmd.com/article/surgical-interventions-for-functional-constipation-an-update-13801.md)

### Pelvic Floor Disorders
- [Colorectal Quiz: Episode 45 -  Pelvic Floor Dyssynergia](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822) — video · 18:33 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822.md)

### Special Topics
- [More evidence against appendectomy at the time of a Ladd procedure](https://qa.library.globalcastmd.com/article/more-evidence-against-appendectomy-at-the-time-of-a-ladd-procedure-13814) — article · [machine version](https://qa.library.globalcastmd.com/article/more-evidence-against-appendectomy-at-the-time-of-a-ladd-procedure-13814.md)
- [Colorectal Quiz: Episode 43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850) — podcast · 23:29 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850.md)
- [Battery Ingestion with Colonic Perforation after Colostomy Closure in a Toddler](https://qa.library.globalcastmd.com/article/battery-ingestion-with-colonic-perforation-after-colostomy-closure-in-a-toddler-13766) — article · [machine version](https://qa.library.globalcastmd.com/article/battery-ingestion-with-colonic-perforation-after-colostomy-closure-in-a-toddler-13766.md)
- [The Story of Dr. Asa G. Yancey and Surgical Innovation in the Face of Discrimination](https://qa.library.globalcastmd.com/article/the-story-of-dr-asa-g-yancey-and-surgical-innovation-in-the-face-of-discriminati-13761) — article · [machine version](https://qa.library.globalcastmd.com/article/the-story-of-dr-asa-g-yancey-and-surgical-innovation-in-the-face-of-discriminati-13761.md)
- [Pediatric Colorectal and Pelvic Surgery | Case Studies](https://qa.library.globalcastmd.com/article/pediatric-colorectal-and-pelvic-surgery-case-studies-13815) — article · [machine version](https://qa.library.globalcastmd.com/article/pediatric-colorectal-and-pelvic-surgery-case-studies-13815.md)
- [Journal of Pediatric Surgery Article Review: March 2023](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-march-2023-13854) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-march-2023-13854.md)
- [Colorectal Quiz: Episode 47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846) — podcast · 22:19 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846.md)

### Educational Resources
- [Colorectal Quiz Ep. 50 -16th Annual European Pediatric Colorectal & Pelvic Reconstruction Conference](https://qa.library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstru-13817) — video · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstru-13817.md)
- [Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820) — video · 40:41 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820.md)
- [Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845) — podcast · 40:45 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845.md)
- [Episode 19 - Interview with Dr Marc Levitt, Chief of Colorectal & Pelvic Reconstruction, Children‘s](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825) — video · 54:32 · [machine version](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825.md)
- [2019 Chandler Lecture: Dr. Marc Levitt](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827) — video · 41:23 · [machine version](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827.md)
- [Time for some patient driven change | Marc Levitt | TEDxColumbus](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828) — video · 10:41 · [machine version](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828.md)
- [Tell Me a Story: Pediatric Surgeons Putting Colorectal Center on the Map](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829) — video · 2:20 · [machine version](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829.md)
- [cincinnati children's hospital medical team in Korle Bu](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830) — video · 2:49 · [machine version](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830.md)
- [Introducing Dr. Marc Levitt: Pediatric Colorectal Surgeon Profile](https://qa.library.globalcastmd.com/watch/introducing-dr-marc-levitt-pediatric-colorectal-surgeon-profile-13831) — video · [machine version](https://qa.library.globalcastmd.com/watch/introducing-dr-marc-levitt-pediatric-colorectal-surgeon-profile-13831.md)
- [Andrea Kesar Discusses Marc Levitt's Contributions to Pediatric Colorectal Surgery](https://qa.library.globalcastmd.com/watch/andrea-kesar-discusses-marc-levitt-s-contributions-to-pediatric-colorectal-surge-13832) — video · [machine version](https://qa.library.globalcastmd.com/watch/andrea-kesar-discusses-marc-levitt-s-contributions-to-pediatric-colorectal-surge-13832.md)
- [Meeting with Marc Levitt: Clinical Discussion with Ivon Martinez](https://qa.library.globalcastmd.com/watch/meeting-with-marc-levitt-clinical-discussion-with-ivon-martinez-13833) — video · [machine version](https://qa.library.globalcastmd.com/watch/meeting-with-marc-levitt-clinical-discussion-with-ivon-martinez-13833.md)
- [Dr. Marc Levitt on the CTO Mission in Pediatric Colorectal Surgery](https://qa.library.globalcastmd.com/watch/dr-marc-levitt-on-the-cto-mission-in-pediatric-colorectal-surgery-13834) — video · [machine version](https://qa.library.globalcastmd.com/watch/dr-marc-levitt-on-the-cto-mission-in-pediatric-colorectal-surgery-13834.md)
- [Colorectal and Pelvic Reconstruction Techniques with Dr. Marc Levitt](https://qa.library.globalcastmd.com/watch/colorectal-and-pelvic-reconstruction-techniques-with-dr-marc-levitt-13835) — video · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-and-pelvic-reconstruction-techniques-with-dr-marc-levitt-13835.md)
- [Keynote Address on Pediatric Colorectal Surgery by Dr. Marc Levitt](https://qa.library.globalcastmd.com/watch/keynote-address-on-pediatric-colorectal-surgery-by-dr-marc-levitt-13836) — video · [machine version](https://qa.library.globalcastmd.com/watch/keynote-address-on-pediatric-colorectal-surgery-by-dr-marc-levitt-13836.md)
- [Integrated Care Concept in Pediatric Colorectal Surgery by Marc Levitt](https://qa.library.globalcastmd.com/watch/integrated-care-concept-in-pediatric-colorectal-surgery-by-marc-levitt-13837) — video · [machine version](https://qa.library.globalcastmd.com/watch/integrated-care-concept-in-pediatric-colorectal-surgery-by-marc-levitt-13837.md)
- [Addressing Ministers of Health: Pediatric Colorectal Surgery Advocacy and Global Healthcare Priorities](https://qa.library.globalcastmd.com/watch/addressing-ministers-of-health-pediatric-colorectal-surgery-advocacy-and-global-13838) — video · [machine version](https://qa.library.globalcastmd.com/watch/addressing-ministers-of-health-pediatric-colorectal-surgery-advocacy-and-global-13838.md)
- [Patient Outreach and Communication in Pediatric Colorectal Surgery](https://qa.library.globalcastmd.com/watch/patient-outreach-and-communication-in-pediatric-colorectal-surgery-13839) — video · [machine version](https://qa.library.globalcastmd.com/watch/patient-outreach-and-communication-in-pediatric-colorectal-surgery-13839.md)
- [Connecting Surgeons and Nurses: Collaborative Care in Pediatric Surgery](https://qa.library.globalcastmd.com/watch/connecting-surgeons-and-nurses-collaborative-care-in-pediatric-surgery-13840) — video · [machine version](https://qa.library.globalcastmd.com/watch/connecting-surgeons-and-nurses-collaborative-care-in-pediatric-surgery-13840.md)
- [The History of International Colorectal Surgery Team Development](https://qa.library.globalcastmd.com/watch/the-history-of-international-colorectal-surgery-team-development-13841) — video · [machine version](https://qa.library.globalcastmd.com/watch/the-history-of-international-colorectal-surgery-team-development-13841.md)
- [How the Colorectal and Pelvic Reconstruction Center Uses Donor Support](https://qa.library.globalcastmd.com/watch/how-the-colorectal-and-pelvic-reconstruction-center-uses-donor-support-13842) — video · [machine version](https://qa.library.globalcastmd.com/watch/how-the-colorectal-and-pelvic-reconstruction-center-uses-donor-support-13842.md)
- [Introduction to Dr. Marc Levitt's Pediatric Colorectal Surgery Practice](https://qa.library.globalcastmd.com/watch/introduction-to-dr-marc-levitt-s-pediatric-colorectal-surgery-practice-13843) — video · [machine version](https://qa.library.globalcastmd.com/watch/introduction-to-dr-marc-levitt-s-pediatric-colorectal-surgery-practice-13843.md)
- [The value and weakness of Medical Mission Work in ARM](https://qa.library.globalcastmd.com/watch/the-value-and-weakness-of-medical-mission-work-in-arm-13844) — video · [machine version](https://qa.library.globalcastmd.com/watch/the-value-and-weakness-of-medical-mission-work-in-arm-13844.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=0) Introduction to AI-Generated Medical Podcasts and NotebookLM Technology (Ep 15)
- [9:44](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=584) The Need for Multidisciplinary Colorectal Care (Ep 15)
- [11:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=712) Building the Core Team: Leadership, Nursing, and Key Specialties (Ep 15)
- [16:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1017) Expanding the Team: Radiology, Pathology, and Interdisciplinary Coordination (Ep 15)
- [20:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1226) Continuous Learning and Knowledge Development Strategies (Ep 15)
- [24:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1451) Clinical Infrastructure: Education, Supplies, and Nursing Competencies (Ep 15)
- [27:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1666) Data Collection and Demonstrating Program Value (Ep 15)
- [29:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1787) Building Referral Relationships and Collaborative Partnerships (Ep 15)
- [32:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1923) Program Infrastructure: Staffing, Support Services, and Resource Allocation (Ep 15)
- [35:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2110) Making the Business Case: Strategic Planning and Payment Considerations (Ep 15)
- [36:38](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2198) Operational Excellence: Weekly Workflow in an Established Program (Ep 15)
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=0) Introduction and case presentation initiation (Ep 12)
- [1:34](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=94) Three-system evaluation framework for cloaca patients (Ep 12)
- [3:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=235) Perineal examination and anatomic assessment (Ep 12)
- [5:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=352) Prior workup and imaging findings (Ep 12)
- [8:42](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=522) Contrast enema findings and mega-rectosigmoid anatomy (Ep 12)
- [11:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=691) Importance of rectal preservation and historical context (Ep 12)
- [14:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=887) Surgical management options debate (Ep 12)
- [18:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1129) Proposed management plan and decision factors (Ep 12)
- [20:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1258) Closing and colorectal joke (Ep 12)
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=0) Case presentation: 21-year-old with leaking Malone appendicostomy (Ep 7)
- [3:33](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=213) Patient selection and initial surgical planning considerations (Ep 7)
- [5:37](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=337) Appendix allocation and sharing strategies between Malone and Mitrofanoff (Ep 7)
- [10:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=600) Plication techniques and volvulus prevention (Ep 7)
- [14:06](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=846) Troubleshooting leakage, stenosis, and prolapse (Ep 7)
- [18:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1090) Salvage techniques for difficult or lost Malone access (Ep 7)
- [20:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1252) Special considerations: appendicitis risk and pathology (Ep 7)
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=0) Introduction to AI-Generated Medical Content and Notebook LM Technology (Ep 14)
- [9:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=585) Building Collaborative Colorectal Programs: A Comprehensive Framework (Ep 14)
- [0:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=0) Introduction and case presentation (Ep 5)
- [2:25](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=145) Clinical history and importance of sphincter evaluation (Ep 5)
- [5:40](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=340) Pelvic floor dysfunction versus distal anismus and diagnostic challenges (Ep 5)
- [7:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=478) Diagnostic workup: SIS markers and defecography (Ep 5)
- [11:40](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=700) Treatment approach and Botox injection technique (Ep 5)
- [15:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=903) Differential diagnosis and multidisciplinary collaboration (Ep 5)
- [0:00](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=0) Introduction and Career Origins in Pediatric Colorectal Surgery (Ep 16)
- [6:19](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=379) Global Training Mission and Center Development (Ep 16)
- [8:12](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=492) Major Clinical Advances in ARM Care (Ep 16)
- [10:44](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=644) Transition to Adult Care Challenges (Ep 16)
- [14:07](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=847) Initial Family Counseling and Surgical Philosophy (Ep 16)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- NotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people. — Todd Ponsky (clinical) [Ep 15 · 1:18](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=78)
- NotebookLM creates an expert from only the provided document, not pulling information from external sources like other chatbots. — Marc Levitt (clinical) [Ep 15 · 5:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=347)
- A review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles. — Todd Ponsky (clinical) [Ep 15 · 6:39](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=399)
- NotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps. — Todd Ponsky (clinical) [Ep 15 · 7:30](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=450)
- A 13-year-old cloaca patient would often show up with kidney damage in the past, and many unfortunately ended up with renal transplant. (epidemiological) [Ep 12 · 3:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=191)
- Cloaca patients require cesarean section for childbirth. — Chris Gayer (clinical) [Ep 12 · 3:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=235)
- Every patient with an anorectal malformation needs a gynecology colleague to ensure they are doing well. (guideline) [Ep 12 · 3:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=235)
- Even with an excellent anatomical repair, anorectal malformation patients may still have soiling. (clinical) [Ep 12 · 5:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=309)
- The first thing to check in a soiling ARM patient is whether the anus is okay (well-located, without stricture, without prolapse). (guideline) [Ep 12 · 5:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=309)
- Anorectal manometry is not part of the standard initial workup for anorectal malformation patients. (guideline) [Ep 12 · 6:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=389)
- You should be able to tell if the anus is properly positioned by looking and by electrical stimulation during exam under anesthesia. (clinical) [Ep 12 · 7:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=434)
- The rectosigmoid can be inert in ARM patients even when the anus is not strictured. (clinical) [Ep 12 · 9:05](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=545)
- Mega-rectosigmoid in ARM can be both inherent (motility problem) and acquired from failure to aggressively treat constipation over many years. (clinical) [Ep 12 · 10:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=619)
- Most ARM patients need constipation treatment. (clinical) [Ep 12 · 10:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=619)
- In general, you want to keep the rectum in ARM patients because the rectum is vital for bowel control. (guideline) [Ep 12 · 11:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=713)
- ARM patients don't really have anal canal sensation or an anal canal. (clinical) [Ep 12 · 11:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=713)
- ARM patients don't really have any form of internal sphincter unless the very distal aspect of the rectum was saved. (clinical) [Ep 12 · 11:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=713)
- Distention of the rectum (proprioception) provides the cue for ARM patients to squeeze their external sphincter and hold in stool. (clinical) [Ep 12 · 11:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=713)
- If you remove the rectum in an ARM patient, you lose the capacity for proprioception. (clinical) [Ep 12 · 11:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=713)
- Prior to the PSARP, an abdominal perineal pull-through was done for ARM (same concept as Hirschsprung's disease): throw the rectum away and pull the sigmoid down. That was wrong. (clinical) [Ep 12 · 13:48](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=828)
- In older ARM patients who had abdominal perineal pull-through, you see haustral markings at the anus and in the pelvis on contrast study because they pulled through sigmoid (the rectum has no haustral markings). (clinical) [Ep 12 · 13:48](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=828)
- Dr. Geyer has tapered mega-rectosigmoids in ARM patients both laparoscopically and open, at time of colostomy closure and after failed bowel management, with relatively good success in fewer than ten cases. — Chris Gayer (clinical) [Ep 12 · 14:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=887)
- After rectal tapering, Dr. Geyer's patients' bowel management became more manageable, and anatomy studied one year after showed no re-dilation. — Chris Gayer (clinical) [Ep 12 · 16:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=976)
- In many ARM kids, even with the best operative plans, they still have trouble with incontinence, frequently due to their anatomy and musculature. (clinical) [Ep 12 · 16:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1009)
- A patient with sacral ratio of 0.45 has poor sacral development, so the perineum and musculature are probably not great, making them likely a bowel management candidate who will probably never achieve successful bowel control. (clinical) [Ep 12 · 16:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1009)
- Dr. Levitt's approach for this unique case would be to remove the entire mega-rectosigmoid, pull through the proximal sigmoid, make a well-sized anaplasty, and do a Malone at the same time. (opinion) [Ep 12 · 16:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1009)
- Some patients with sigmoid pull-through are able to feel distension in the sigmoid and achieve continence, but it is not the expectation. (clinical) [Ep 12 · 17:42](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1062)
- For a redo PSARP with mega-rectosigmoid, Dr. Levitt would remove all the perineal rectum, dissect it out, go into the abdomen, dissect out the dilated segment, pull through the proximal sigmoid, close the posterior sagittal incision, and do a Malone. This is a 0.1% case. (clinical) [Ep 12 · 17:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1072)
- In 99+ percent of ARM cases, a sigmoid resection is usually not necessary; usually a Malone only is all you need. (clinical) [Ep 12 · 17:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1072)
- Colons can empty surprisingly well with antegrade enemas only, potentially avoiding resection. (clinical) [Ep 12 · 17:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1072)
- Dr. Geyer's plan is to try Malone only first, telling the family it might not succeed and more definitive surgery (removing colon) may be needed. — Chris Gayer (clinical) [Ep 12 · 18:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1129)
- Very often a mega-rectosigmoid patient's anaplasty is not good (strictured, mislocated, or prolapsed), requiring redo of the anaplasty. (clinical) [Ep 12 · 19:24](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1164)
- If the anus has only a stricture, making the anus bigger might give the colon a chance to decompress and improve. (clinical) [Ep 12 · 20:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1214)
- If the mega-rectosigmoid is not strictured and is enormous, it was probably an inherent problem present since birth, and resection is appropriate. (clinical) [Ep 12 · 20:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1214)
- About 60% of the time there is success with using a split appendix for both Malone and Mitrofanoff, but about 40% of the time you cannot make it work. — Jason Frischer (epidemiological) [Ep 7 · 5:37](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=337)
- If appendix is short and stumpy, it is best for the Malone and the Mitrofanoff should be made from small bowel. — Jason Frischer (clinical) [Ep 7 · 9:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=543)
- If appendix is 5 to 7 centimeters, that is not enough to share and should go for the Mitrofanoff because long term the Mitrofanovs do much better, requiring a neo-Malone. — Jason Frischer (clinical) [Ep 7 · 9:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=543)
- If appendix is 7 centimeters or greater it can be split, requiring minimum 2 centimeters for the Malone and 5 centimeters minimum for the Mitrofanoff. — Jason Frischer (clinical) [Ep 7 · 9:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=543)
- Dr. Frischer and Levitt did 10 Malones in a row without plicating and five leaked, so they decided to plicate them all and have not had a leakage in several years. — Jason Frischer (clinical) [Ep 7 · 8:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=515)
- The longer the appendix, the less likely it will leak based on Poiseuille's law (flow through a tube based on radius to fourth power and length). — Jason Frischer (clinical) [Ep 7 · 7:37](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=457)
- If patient with Malone is not doing well and flushes are not working or they are getting significant symptoms like nausea, you must do a contrast study through the Malone to check for reflux into the terminal ileum. — Jeffrey Avansino (clinical) [Ep 7 · 14:44](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=884)
- Using a 10 French tube (not 8), leaving it in for a month, and cathing twice a day can minimize stenosis rate. — Jason Frischer (clinical) [Ep 7 · 16:13](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=973)
- Leaving indwelling tubes in Malones increases the amount of prolapse, likely due to pressure on the appendiceal base pushing up mucosa. — Jason Frischer (clinical) [Ep 7 · 16:54](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1014)
- Urologists almost never get stenosis of Mitrofanovs because they catheterize every four hours; applying this to Malones by cathing twice daily has reduced stenosis rate. — Jason Frischer (clinical) [Ep 7 · 17:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1065)
- Small bowel volvulus around the appendix can occur but is rare, seen in only two or three cases. — Marc Levitt (epidemiological) [Ep 7 · 13:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=794)
- Appendicitis in a Malone is impossible unless the hole closes, because there is no obstruction in pathophysiology. — Marc Levitt (clinical) [Ep 7 · 20:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1255)
- Do not take out the appendix in a first Crohn's or ARM patient or a kid with spine issues or absent sacrum or spina bifida, as they may need it for future Malone or Mitrofanoff. — Marc Levitt (clinical) [Ep 7 · 21:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1286)
- Appendix tips should be sent to pathology because neuroendocrine tumors (carcinoids) can be found; one was discovered three months after pathology insisted on receiving specimens. — Marc Levitt (clinical) [Ep 7 · 22:01](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1321)
- When doing plication, pass the tube after each stitch to ensure it passes in the desired direction. — Marc Levitt (clinical) [Ep 7 · 15:17](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=917)
- Using a 10 French coude catheter as a bougie during plication and checking passage afterward usually prevents single offending stitches from causing obstruction. — Jeffrey Avansino (clinical) [Ep 7 · 15:32](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=932)
- For lost Malone access, blow up a balloon on a Foley catheter to occlude the umbilicus and inject dye under pressure to find any micro hole tract. — Jason Frischer (clinical) [Ep 7 · 20:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1200)
- Ultrasound can be used to find the appendix around the umbilicus and needle localize the lumen for access rescue. — Marc Levitt (clinical) [Ep 7 · 20:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1231)
- Lone Star ring and pins can be placed in the umbilicus to get excellent exposure to visualize a tiny Malone hole. — Marc Levitt (clinical) [Ep 7 · 19:33](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1173)
- For patients who cannot catheterize their Malone after surgery, a Malone plug can be used for a few months with gradual tapering of the time the tract is allowed without the plug. — Jeffrey Avansino (clinical) [Ep 7 · 19:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1143)
- For leaking Malones, first ensure patient is cleaning themselves out with effective enemas and consider thickening stool with water-soluble fiber before attempting surgical plication. — Jeffrey Avansino (clinical) [Ep 7 · 6:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=406)
- When doing a neo-Malone, try to orient the channel so the catheter enters into the right colon rather than refluxing into the ileum. — Marc Levitt (clinical) [Ep 7 · 14:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=871)
- In South Africa, appendix is never removed as part of laparoscopic appendectomy for appendicitis; it is a United States practice. — Marc Levitt (clinical) [Ep 7 · 21:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1286)
- Notebook LM is a free Google offering that can upload any document and create a realistic-sounding podcast between two people — Todd Ponsky (clinical) [Ep 14 · 2:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=136)
- The AI-generated podcast from the uploaded article was exceedingly accurate and featured human-sounding voices that foreshadowed content coming later in the article — Marc Levitt (opinion) [Ep 14 · 2:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=177)
- Notebook LM has perfected human-sounding conversation better than any other available tools — Todd Ponsky (opinion) [Ep 14 · 4:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=250)
- The limitation of Notebook LM is that it uses the same two voices (one man and one woman) and is not customizable — Todd Ponsky (clinical) [Ep 14 · 4:22](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=262)
- Notebook LM beta version allows users to join the conversation and interact with the AI hosts in real-time — Todd Ponsky (clinical) [Ep 14 · 5:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=303)
- A neurologist colleague produced a review article outline in minutes using Notebook LM with 30 articles that previously took 2 weeks to complete manually — Marc Levitt (clinical) [Ep 14 · 6:48](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=408)
- Notebook LM identified gaps in knowledge from the uploaded articles and could recognize when new articles filled those gaps — Marc Levitt (clinical) [Ep 14 · 7:08](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=428)
- AI can now create functional apps from descriptions alone, with code generated instantly, threatening developer jobs — Todd Ponsky (opinion) [Ep 14 · 7:50](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=470)
- Medical teams should triangulate multiple AI platforms, using the intelligence of one with the audio of another and video of another to create the best product — Todd Ponsky (opinion) [Ep 14 · 8:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=491)
- Human oversight with medical writers is necessary to ensure AI-generated medical content is correct — Todd Ponsky (opinion) [Ep 14 · 8:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=506)
- Aaron Teeple is the only person in the United States with both pediatric surgery and adult colorectal surgery credentials; Mark Molota from Munich, Germany also holds both credentials. — Marc Levitt (clinical) [Ep 5 · 0:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=45)
- Pelvic floor dysfunction is underrecognized in pediatric surgery and requires consideration of sexual, urinary, and bowel dysfunction together. — Aaron Teeple (opinion) [Ep 5 · 1:43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=103)
- Urinary retention in an otherwise healthy young man is extremely rare and should raise red flags. — Jason Fisher (clinical) [Ep 5 · 3:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=199)
- Testicular pain triggered by large hard bowel movements and anal penetrative sex are significant indicators of pelvic floor tightness. — Aaron Teeple (clinical) [Ep 5 · 4:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=275)
- Many constipated patients have been treated with laxatives, Malone procedures, ileostomies, or stomas without anyone evaluating their sphincters. — Marc Levitt (clinical) [Ep 5 · 5:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=300)
- The majority of constipated patients without congenital reasons (excluding anorectal malformations and Hirschsprung disease) have pelvic floor dysfunction. — Jason Fisher (opinion) [Ep 5 · 5:44](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=344)
- Pelvic floor dysfunction differs from distal anismus, which involves the external sphincter; withholding behavior in potty-training toddlers represents one pattern, while patients with behavioral considerations or developmental delays may exert control through voluntary anal sphincter contraction. — Aaron Teeple (clinical) [Ep 5 · 6:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=376)
- Digital rectal exam can mimic anal manometry by asking the patient to squeeze and bear down; feeling puborectalis squeeze during bearing down indicates dysynergia. — Aaron Teeple (clinical) [Ep 5 · 7:08](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=428)
- Defecography is not available in many pediatric institutions; in Philadelphia it goes through adult centers, and at MedStar defecographies are obtained at the adult center. — Aaron Teeple (clinical) [Ep 5 · 7:32](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=452)
- History-taking is important for diagnosing pelvic floor dysfunction because anorectal manometry data is often unreliable in children. — Marc Levitt (clinical) [Ep 5 · 7:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=478)
- A patient with external sphincter tightness and gas retention had a flat abdomen every morning after passing gas successfully during sleep, demonstrating behavioral impact on sphincter control. — Marc Levitt (clinical) [Ep 5 · 8:06](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=486)
- When SIS markers stack up against the puborectalis and pelvic floor, this indicates outlet dysfunction. — Aaron Teeple (clinical) [Ep 5 · 9:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=554)
- In defecography, the vagina and anus are retrograde filled and the patient takes contrast to visualize enterocele or sigmoidocele and assess pelvic floor function. — Aaron Teeple (clinical) [Ep 5 · 9:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=575)
- In pelvic floor dysynergia, the puborectalis tightens during defecation, increasing the anorectal angle instead of relaxing and straightening the rectum. — Aaron Teeple (clinical) [Ep 5 · 9:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=597)
- Most defecography studies are MRI-based these days; pediatric patients typically do not need vaginal filling or small bowel filling when evaluating for pelvic floor dysynergia. — Aaron Teeple (clinical) [Ep 5 · 10:42](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=642)
- If anal manometry and SIS marker study cannot provide diagnostic information, physical therapy has failed, and dysynergia is suspected, Botox of the pelvic floor can be both diagnostic and therapeutic; defecography can be obtained if proof is needed for insurance coverage. — Aaron Teeple (clinical) [Ep 5 · 11:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=672)
- Initial treatment for pelvic floor dysfunction includes fiber, optimized water intake, laxatives, thorough age-appropriate pelvic floor physical therapy, and screening for trauma history including sexual abuse with psychological intervention. — Aaron Teeple (clinical) [Ep 5 · 11:40](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=700)
- After optimization with diet, fiber, water, laxatives, and psychological/psychiatric intervention, the next step is pelvic floor Botox injection. — Aaron Teeple (clinical) [Ep 5 · 12:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=730)
- Pelvic floor Botox technique: 100 units diluted in 10 mL, divided into ten 1-mL aliquots; using an operative anal scope or nasal speculum for smaller children, palpate the puborectalis sling digitally, then inject each 1-mL aliquot with a spinal needle into the posterior puborectalis sling just above the palpating finger. — Aaron Teeple (clinical) [Ep 5 · 12:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=777)
- The puborectalis should feel like a guitar string or violin string; if it cannot be felt, it is probably not a tight pelvic floor. — Aaron Teeple (clinical) [Ep 5 · 13:18](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=798)
- The puborectalis does not come anteriorly; it fixates on the pubic symphysis. — Aaron Teeple (clinical) [Ep 5 · 13:50](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=830)
- During Botox injection, the needle is sunk into the belly of the puborectalis muscle, which can be felt as tenseness; the technique involves hooking the muscle with a finger, creating an indent with bulging muscle above, then injecting above the finger. — Aaron Teeple (clinical) [Ep 5 · 14:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=854)
- Often the right side of the puborectalis is tighter. — Aaron Teeple (clinical) [Ep 5 · 15:04](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=904)
- Sacral nerve stimulator is used for fecal incontinence and occasionally for constipation, but it fails most of the time for constipation; it has not been seen used for non-relaxing puborectalis. — Aaron Teeple (clinical) [Ep 5 · 15:07](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=907)
- Terminology creates confusion: levator syndrome should be called non-relaxing puborectalis; pudendal neuropathy can present as weakness or pain. — Aaron Teeple (opinion) [Ep 5 · 15:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=935)
- Non-relaxing puborectalis can present as significant deep aching pelvic pain precipitated by hard bowel movements trying to pass the tight puborectalis. — Aaron Teeple (clinical) [Ep 5 · 15:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=955)
- Defecography helps identify the level of obstructive defecation when it is unclear whether the problem is poor motility or outlet obstruction. — Aaron Teeple (clinical) [Ep 5 · 16:13](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=973)
- Solitary rectal ulcer syndrome occurs when failure to relax the puborectalis causes continual valsalva to traumatize the posterior rectal wall, leading to obliteration of the lamina propria at the level of the puborectalis. — Aaron Teeple (clinical) [Ep 5 · 16:38](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=998)
- Constipation patients should be screened for urinary dysfunction and urinary dysfunction patients should be screened for constipation because there is significant overlap between bowel and bladder dysfunction, some of which is in the pelvic floor itself. — Aaron Teeple (clinical) [Ep 5 · 17:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=1039)
- The multidisciplinary approach with multiple disciplines represented to help complicated ARM patients was conceived during Levitt's medical school elective with Alberto Pena. — Marc Levitt (opinion) [Ep 16 · 3:58](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=238)
- The first ever colorectal center was launched in Cincinnati in 2005 by Levitt and Pena. — Marc Levitt (clinical) [Ep 16 · 4:48](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=288)
- Training surgeons in ARM specialty provides greater impact than individual patient care because trained surgeons help hundreds or thousands more patients. — Marc Levitt (opinion) [Ep 16 · 6:50](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=410)
- The bowel management program with focused nursing attention for 4-5 days plus long-term follow-up is a major advance in ARM care. — Marc Levitt (clinical) [Ep 16 · 8:40](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=520)
- Integration of urology and bladder management has revolutionized ARM care, with kidney transplant now exceedingly rare compared to previously being not uncommon. — Marc Levitt (clinical) [Ep 16 · 9:12](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=552)
- Better urologic care has dramatically reduced renal disease in ARM patients. — Marc Levitt (clinical) [Ep 16 · 9:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=571)
- The standard PSARP incision has gotten smaller and understanding of anatomy has improved since 2005. — Marc Levitt (clinical) [Ep 16 · 10:14](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=614)
- Laparoscopy has been added to many kinds of ARM cases as a technical innovation. — Marc Levitt (clinical) [Ep 16 · 10:29](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=629)
- Transition programs for ARM patients moving to adult care are the most behind aspect of the field compared to other areas like congenital heart disease and cystic fibrosis. — Marc Levitt (opinion) [Ep 16 · 11:06](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=666)
- There are only 3 surgeons in the entire world trained in both pediatric and adult colorectal surgery: Ali Gisher in Columbus Ohio, Erin Teeple in Wilmington Delaware, and a surgeon named Mark in Munich Germany. — Marc Levitt (clinical) [Ep 16 · 12:12](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=732)
- Paris at Necker Children's Hospital has done an amazing job with formal transition to adult programs, with teenagers meeting pediatric and adult providers together before transitioning to adult facility visits. — Marc Levitt (clinical) [Ep 16 · 13:16](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=796)
- No parent has ever known anything about ARM when their baby is born, creating shock when a colorectal problem is announced. — Marc Levitt (opinion) [Ep 16 · 15:51](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=951)
- ARM surgery typically requires 3 surgeries within the first year of life: colostomy, reconstructive operation, and colostomy closure. — Marc Levitt (clinical) [Ep 16 · 16:41](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1001)
- ARM surgery requires months to years of tinkering and may require lifelong adjustments, unlike typical surgery where the problem is immediately solved. — Marc Levitt (opinion) [Ep 16 · 17:57](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1077)
- Parents care more about functional results than anatomic reconstruction, but surgeons are often very proud of their anatomic creations. — Marc Levitt (opinion) [Ep 16 · 18:20](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1100)
- A complex colorectal operation takes about 4 hours, but delivering a good result requires 96 more hours of tinkering, almost all of which is nursing care. — Marc Levitt (opinion) [Ep 16 · 19:27](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1167)
- If a proper colostomy is made, most families would agree they'd rather change a colostomy bag than a diaper. — Marc Levitt (opinion) [Ep 16 · 20:01](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1201)
- If the anus is misaligned with sphincters due to surgical error, the problem won't be discovered until potty training fails 4 years later, making it difficult for surgeons to improve their technique. — Marc Levitt (clinical) [Ep 16 · 20:44](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1244)
- Studies have shown cardiac surgery in adults gets better results with higher surgical volume. — Marc Levitt (epidemiological) [Ep 16 · 22:20](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1340)
- In typical US pediatric surgery training, fellows do approximately 12 ARM cases over 2 years of training. — Marc Levitt (epidemiological) [Ep 16 · 22:30](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1350)
- The average finished pediatric surgeon performs 1 ARM case per year. — Marc Levitt (epidemiological) [Ep 16 · 22:57](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1377)
- Levitt advocates strongly for pull-through surgery and colostomy closure rather than permanent colostomy, stating he wants every kid to be typical and normal without a colostomy. — Marc Levitt (opinion) [Ep 16 · 24:25](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1465)
- With proper bowel management and good nursing care, Levitt is very confident patients can be gotten clean mechanically. — Marc Levitt (opinion) [Ep 16 · 24:40](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1480)
- The Malone appendicostomy is an advance that allows patients without innate anatomy or sphincters to be cleaned mechanically by emptying the colon once daily. — Marc Levitt (clinical) [Ep 16 · 24:56](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1496)
- Most patients would prefer being cleaned through the Malone route than having a permanent stoma. — Marc Levitt (opinion) [Ep 16 · 25:20](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1520)
- Permanent colostomy may be more practical for rare patients who don't ambulate. — Marc Levitt (clinical) [Ep 16 · 25:29](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1529)
- The vast majority of ARM patients can be perfectly clean with stool flowing through the normal anal route via bowel management. — Marc Levitt (clinical) [Ep 16 · 25:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1531)
- Many patients actually develop bowel control even if predicted they would never achieve it, with proper nursing care and medical regimen tinkering. — Marc Levitt (clinical) [Ep 16 · 25:54](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1554)
- Levitt and Richard Wood conducted a randomized controlled trial comparing standard dilation protocol versus no dilation after primary PSARP. — Marc Levitt (clinical) [Ep 16 · 26:39](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1599)
- The dilation study found that whether dilations were done or not, there was a similar 15% risk of developing a stricture. — Marc Levitt (clinical) [Ep 16 · 32:26](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1946)
- Strictures can be treated straightforwardly with a minor Heineke-Mikulicz anoplasty to enlarge the stricture at the time of colostomy closure. — Marc Levitt (clinical) [Ep 16 · 32:49](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=1969)
- Levitt's center no longer performs routine dilations, allowing families to avoid daily dilation burden and accept the 10-15% stricture risk manageable at colostomy closure. — Marc Levitt (clinical) [Ep 16 · 33:29](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2009)
- Doing a good anoplasty with no tension and good blood supply affects the likelihood of getting a stricture. — Marc Levitt (clinical) [Ep 16 · 33:52](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2032)
- Skin irritation after colostomy closure is a short-term problem lasting about 2 weeks because the skin has never seen stool. — Marc Levitt (clinical) [Ep 16 · 35:09](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2109)
- The distal unused bowel segment needs to learn to adapt and absorb water to thicken stool after colostomy closure. — Marc Levitt (clinical) [Ep 16 · 35:15](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2115)
- Post-closure skin irritation is managed with good perineal creams, frequent diaper changes, and preventing stool from sitting on skin, typically resolving by 3 weeks. — Marc Levitt (clinical) [Ep 16 · 35:33](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2133)
- At 3 weeks post-closure, the problem switches to constipation, which many surgeons fail to manage aggressively. — Marc Levitt (clinical) [Ep 16 · 35:56](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2156)
- Unrecognized constipation causes colonic dilation over time, making the colon harder to empty by age 4 when potty training begins. — Marc Levitt (clinical) [Ep 16 · 36:14](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2174)
- Almost all of Levitt's patients are on laxatives about 3-4 weeks after colostomy closure to keep them flowing. — Marc Levitt (clinical) [Ep 16 · 36:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2191)
- Starting at about age 2.5 years, the goal is achieving a good bowel movement pattern of 1-2 well-formed stools per day. — Marc Levitt (clinical) [Ep 16 · 36:50](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2210)
- Achieving good bowel pattern requires diet with bulk fiber, water-soluble fiber, and a laxative with senna or bisacodyl that provokes stool. — Marc Levitt (clinical) [Ep 16 · 37:08](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2228)
- Stool softeners do not help ARM children and actually make them worse because they prevent sensation development needed for potty training. — Marc Levitt (clinical) [Ep 16 · 37:33](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2253)
- ARM children have a surgically created anal canal without typical sensation and somewhat good or not-so-good sphincters, missing two key continence components. — Marc Levitt (clinical) [Ep 16 · 37:47](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2267)
- ARM patients are dependent on feeling rectal stretch from stool filling to develop bowel control. — Marc Levitt (clinical) [Ep 16 · 38:17](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2297)
- Loose stool from stool softeners prevents feeling stretch, preventing development of bowel control. — Marc Levitt (clinical) [Ep 16 · 38:26](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2306)
- Bulky stool (not constipated but with enough bulk to feel stretch) allows most patients to translate into successful potty training with one stool per day. — Marc Levitt (clinical) [Ep 16 · 38:35](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2315)
- If potty training doesn't succeed, bowel management should begin at age 3-4 to get children clean and in normal underwear. — Marc Levitt (clinical) [Ep 16 · 38:51](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2331)
- Enemas should be introduced when the child should be in normal underwear according to family choice, which varies but should be by age 4-5 for all children. — Marc Levitt (clinical) [Ep 16 · 39:09](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2349)
- Bowel management is nursing-run by nurse practitioners or advanced practice providers. — Marc Levitt (clinical) [Ep 16 · 40:10](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2410)
- The first responsibility in bowel management is assessing patient anatomy, which should be fixed first if there are anatomic issues. — Marc Levitt (clinical) [Ep 16 · 40:25](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2425)
- Bowel management with enemas can still be done even without perfect anatomy, with anatomic correction performed later. — Marc Levitt (clinical) [Ep 16 · 40:39](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2439)
- Bowel management involves mechanical emptying of the colon with an enema containing saline plus an additive that provokes stool emptying. — Marc Levitt (clinical) [Ep 16 · 41:17](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2477)
- The Malone procedure connects the appendix to the umbilicus for more comfortable and independent enema administration. — Marc Levitt (clinical) [Ep 16 · 41:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2491)
- The goal of bowel management is to empty the colon with a flush, then have nothing pass for the next 24 hours, achieving a clean child in normal underwear for 23.5 hours. — Marc Levitt (clinical) [Ep 16 · 42:01](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2521)
- Bowel management program typically lasts about a week, with 4-5 days of X-rays. — Marc Levitt (clinical) [Ep 16 · 42:24](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2544)
- An early Cincinnati study claimed 95% bowel management success at one week, but this short-term result is misleading. — Marc Levitt (clinical) [Ep 16 · 42:32](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2552)
- Levitt and Wood's follow-up study documented bowel management results at 1 year, showing over 80% success for ARM patients. — Marc Levitt (clinical) [Ep 16 · 43:12](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2592)
- Among the 4 patient categories (ARM, Hirschsprung's, spinal disorders, functional constipation), Hirschsprung's patients are the hardest for bowel management because they don't have good functioning sphincters or their sphincters are sometimes too good. — Marc Levitt (clinical) [Ep 16 · 43:33](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2613)
- A lot of tinkering is required during the year after bowel management initiation, with X-rays and flush adjustments when accidents occur. — Marc Levitt (clinical) [Ep 16 · 44:02](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2642)
- About 75% of ARM patients should be able to develop their own bowel control and have voluntary bowel movements based on good operation, good quality sacrum, and good quality spine. — Marc Levitt (clinical) [Ep 16 · 44:29](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2669)
- About 25% of ARM patients will not achieve their own bowel control even with perfect operation because they don't have the best sphincters or have spinal issues affecting bowel function. — Marc Levitt (clinical) [Ep 16 · 44:47](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2687)
- Many patients choose the Malone appendicostomy route to the umbilicus rather than rectal enemas for bowel management. — Marc Levitt (clinical) [Ep 16 · 45:04](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2704)
- In Europe, many patients use Peristeen for enema administration. — Marc Levitt (clinical) [Ep 16 · 45:18](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2718)
- Levitt performs over 100 Malone procedures per year laparoscopically as a one-hour procedure with most patients staying one night in hospital. — Marc Levitt (clinical) [Ep 16 · 45:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2731)
- The Malone procedure is very low investment of patient time and surgical morbidity, and is straightforward if done frequently. — Marc Levitt (opinion) [Ep 16 · 45:41](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2741)
- The Malone makes it much easier for older children to administer their own enema without parental help. — Marc Levitt (clinical) [Ep 16 · 45:54](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2754)
- A full-fledged colorectal center requires integrated psychology, child life services, and social work rather than surgeons calling them only when help is needed. — Marc Levitt (opinion) [Ep 16 · 46:30](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2790)
- An integrated psychologist should meet every patient and decide whether they can be of use rather than waiting for surgeon referral. — Marc Levitt (opinion) [Ep 16 · 46:37](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2797)
- The burden of therapy has been ignored but is an enormous component of ARM care that every collaborative center should recognize. — Marc Levitt (opinion) [Ep 16 · 47:19](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2839)
- The dilation study was prompted by investigating burden of therapy and recognizing the cost to families of achieving correct anus size. — Marc Levitt (clinical) [Ep 16 · 47:31](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2851)
- Many ARM problems are physiologic rather than psychologic, requiring anatomic correction and bowel management first before psychological intervention. — Marc Levitt (opinion) [Ep 16 · 48:22](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2902)
- Many patients who received significant psychological help actually needed re-operation and good bowel management, after which psychological and emotional problems resolved. — Marc Levitt (clinical) [Ep 16 · 48:39](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2919)
- One week of proper bowel management can transform an entire family's emotional state. — Marc Levitt (clinical) [Ep 16 · 49:01](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2941)
- Fecal incontinence is a physiologic problem, not a psychologic problem, though psychology still needs to be managed. — Marc Levitt (opinion) [Ep 16 · 49:17](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=2957)
- Patient engagement through family networks and social media has dramatically improved ARM care worldwide. — Marc Levitt (opinion) [Ep 16 · 50:11](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=3011)
- Greg Ryan did not meet another ARM patient until his adult life, 52 years after his surgery. — Marc Levitt (clinical) [Ep 16 · 51:16](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=3076)
- The origin of modern ARM care began in Melbourne Australia with Dr. Kelly, who learned from Dr. Stevens and taught Dr. Pena, who revised and improved the operation and launched it in 1980. — Marc Levitt (clinical) [Ep 16 · 52:56](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=3176)
- Dr. Stevens operated on Greg Ryan when he was a baby. — Greg Tiao (clinical) [Ep 16 · 53:30](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=3210)
- In medicine, the colorectal surgeon may take care of a colorectal problem and not really worry about the bladder issue, and 6 months later the urologist meets the patient and realizes they have to do some intervention after the patient already had a laparotomy for their colon problem—completely uncoordinated care. — Marc Levitt (opinion) [Ep 17 · 1:18](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=78)
- There are about 600 newborns with an anorectal malformation born per year in the United States. — Marc Levitt (epidemiological) [Ep 17 · 8:05](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=485)
- A pediatric surgery fellow does about 14 anorectal malformation cases in 2 years, and a graduate does about 1 case per year. — Marc Levitt (epidemiological) [Ep 17 · 8:05](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=485)
- Complications of anorectal malformations include fecal incontinence, urinary incontinence, renal dysfunction and the need for renal transplant, sexual dysfunction, and infertility. — Marc Levitt (clinical) [Ep 17 · 8:20](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=500)
- In colorectal surgery, if you do an operation as a 6 month old and put the anus outside of the sphincters, the 6 month old won't know that until they are 4 years old and trying to potty train—the surgeon will never figure out they didn't do a great job and will keep doing the same mistake over and over again. — Marc Levitt (clinical) [Ep 17 · 8:47](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=527)
- The speaker's current practice is about 60% reoperative surgery. — Marc Levitt (clinical) [Ep 17 · 11:13](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=673)
- Patients with anorectal malformations many times have associated spinal problems, and if you don't collaborate upfront with neurosurgery, you may discover a neurologic problem 5 years later when the patient already has renal damage. — Marc Levitt (clinical) [Ep 17 · 22:04](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1324)
- Patients with cloacal malformations many times have Mullerian anomalies and hemisystems—if you don't think about gynecology when they're 6 months old during cloacal reconstruction, you're setting yourself up for a very difficult problem 13 years down the road when they have pelvic pain because their Mullerian structure is not draining menstrual blood. — Marc Levitt (clinical) [Ep 17 · 22:40](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1360)
- Knowing the associated sacral and spinal problems allows us to predict continence and have a conversation with a family in the neonatal unit about whether their child will very likely be continent with proper management, or whether there's not really a lot of chance for continence because of the associated spinal problem. — Marc Levitt (clinical) [Ep 17 · 23:07](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1387)
- Rectourethral fistulas are classified as bladder neck fistula (at the deltoid level), prostatic fistula (at the tricep level), or bulbar fistula (at the elbow level)—each diagnosis has a different surgical approach and a different potential outcome. — Marc Levitt (clinical) [Ep 17 · 24:24](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1464)
- Common technical errors in anorectal malformation repair include anus placed too far posterior (outside the sphincter), stricture, remnant of the original fistula left behind, and rectal prolapse—these are solvable with better technique. — Marc Levitt (clinical) [Ep 17 · 25:23](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1523)
- Redoing patients with misplaced anus can dramatically improve their functional outcome and quality of life—we were able to convert a good number of these patients to continence by making them have better anatomy. — Marc Levitt (clinical) [Ep 17 · 25:55](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1555)
- The surgeon's responsibility is to get good anatomy, but after achieving that goal there's a functional outcome that's relevant—you can do a perfectly good Nissen but it requires some tinkering over time to try to get the best possible result for that patient. — Marc Levitt (opinion) [Ep 17 · 26:16](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1576)
- The colostomy and ileostomy closure surgical site infection rate was 22.4%, which is pretty standard in the literature. — Marc Levitt (clinical) [Ep 17 · 27:03](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1623)
- Implementing a GI bundle—most importantly changing instruments and gloves before closing the fascia—reduced the wound infection rate to 7.9%. — Marc Levitt (clinical) [Ep 17 · 27:11](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1631)
- The organism that ultimately grew in the wounds was resistant to the preoperative antibiotic (cefoxitin) given within an hour of incision in every circumstance. — Marc Levitt (clinical) [Ep 17 · 27:22](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1642)
- Changing the preoperative antibiotic from cefoxitin to Unasyn (chosen with infectious disease collaboration based on wound culture data) reduced the wound infection rate to 2.2%. — Marc Levitt (clinical) [Ep 17 · 27:53](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1673)
- In cloacal malformation repair, you have to measure both the common channel length and the urethral length and make a plan accordingly—if the urethra is going to ultimately be shorter than 1.5 centimeters, bringing the bladder neck down to the perineum makes a wet (incontinent) patient. — Marc Levitt (clinical) [Ep 17 · 29:45](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1785)
- If you leave enough of the urethra behind at the end of cloacal reconstruction (>1.5 cm), you could have a dry patient 4 years hence. — Marc Levitt (clinical) [Ep 17 · 30:03](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1803)
- In a 6 year old with myelomeningocele who has urinary and fecal incontinence, you can take out the sigmoid to improve bowel care but keep it on its mesentery and roll it over to use for bladder augmentation, and share the appendix between Malone (antegrade enema) and Mitrofanoff (catheterizable channel)—the only way to do that is with coordinated care between urology and colorectal surgery. — Marc Levitt (clinical) [Ep 17 · 32:09](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1929)
- The proximal appendix becomes the antegrade access for enemas for patients that are fecally incontinent but can be made clean by a flush every single day, and the distal piece stays on its blood supply and can be implanted into the bladder for intermittent catheterization for urine—they can be rendered dry and clean for urine and stool in a single operation. — Marc Levitt (clinical) [Ep 17 · 33:39](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2019)
- There are certain patients with severe functional constipation that need surgical solutions—in the adult world that's a subtotal colectomy ileorectal anastomosis, but in the pediatric world before the entire colon has dilated up we may be able to get away with just a segmental resection of the sigmoid. — Marc Levitt (clinical) [Ep 17 · 34:42](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2082)
- In medicine, complex problems are often approached without coordinated planning, analogous to building a bridge by having cement layers arrive Monday, steel workers Tuesday, architect Wednesday, and engineers Thursday. — Marc Levitt (opinion) [Ep 18 · 0:22](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=22)
- Some children are born without an opening for stool (anorectal malformation). — Marc Levitt (clinical) [Ep 18 · 1:32](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=92)
- A cloacal malformation is a condition where the bladder, gynecologic system, and colon all converge into one opening. — Marc Levitt (clinical) [Ep 18 · 2:00](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=120)
- Cloacal malformation is not compatible with life without surgical intervention. — Marc Levitt (clinical) [Ep 18 · 2:20](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=140)
- Once surgically corrected, cloacal malformation has unique implications on the child's quality of life. — Marc Levitt (clinical) [Ep 18 · 2:28](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=148)
- In cloacal malformation, the bladder, gynecologic, and colorectal structures are anatomically adjacent to each other, and each is handled by a different type of doctor. — Marc Levitt (clinical) [Ep 18 · 2:39](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=159)
- Effective management of cloacal malformation requires doctors from different specialties to work together. — Marc Levitt (opinion) [Ep 18 · 2:42](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=162)
- Twenty-five years ago, the speaker's mentor attempted to provide colorectal surgery, urology, and gynecology care for these patients as a single provider. — Marc Levitt (clinical) [Ep 18 · 2:53](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=173)
- As medicine became more complicated, a single provider became incapable of solving all problems in complex malformation cases without gathering a multidisciplinary team. — Marc Levitt (opinion) [Ep 18 · 3:15](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=195)
- The speaker's vision was to unite GI motility specialists, colorectal surgeons, gynecologic surgeons, and urologic surgeons to work together in a unified approach for complex children. — Marc Levitt (opinion) [Ep 18 · 3:50](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=230)
- Surgeons, particularly, like to be in charge and do not like to share patients or be told they cannot go first in an operation when another team needs to go first for the patient's benefit. — Marc Levitt (opinion) [Ep 18 · 5:47](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=347)
- Hospitals face logistical challenges with collaborative care including billing, clinic scheduling with all doctors present on the same day, and managing surgeon productivity when a 10-hour operation requires a specialist for only 2 hours. — Marc Levitt (opinion) [Ep 18 · 6:12](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=372)
- When a surgeon is needed for a portion of a long operation, they cannot leave to do other work because they must be available when needed while the patient is under anesthesia. — Marc Levitt (clinical) [Ep 18 · 6:33](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=393)
- Patients with complex malformations face significant burdens when specialists are in different cities, including scheduling multiple appointments at different times and dates, travel costs, and sibling care logistics. — Marc Levitt (opinion) [Ep 18 · 6:45](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=405)
- There are clinical circumstances where a child benefits from one operation where tissues can be shared between surgical teams. — Marc Levitt (clinical) [Ep 18 · 7:06](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=426)
- In a case where a segment of colon was not working and the bladder was too small, a section of colon could be removed from the fecal stream and added to the bladder to augment it, performed simultaneously in one operation. — Marc Levitt (clinical) [Ep 18 · 7:20](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=440)
- Typically, bladder augmentation would be performed first, and 6 months later someone would perform the colonic work as a separate operation. — Marc Levitt (clinical) [Ep 18 · 7:46](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=466)
- Implementing collaborative care requires deep infrastructure including coordinators, administrative assistants, schedulers, and multiple types of specialized nurses (floor, operating room, clinic). — Marc Levitt (opinion) [Ep 18 · 8:00](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=480)
- Nationwide Children's Hospital provided institutional support for the collaborative care model, whereas other institutions where the speaker had attempted this approach did not successfully adopt it. — Marc Levitt (opinion) [Ep 18 · 8:36](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=516)
- The siloed approach to subspecialty care was the traditional way of practicing medicine. — Marc Levitt (opinion) [Ep 18 · 8:46](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=526)
- In the collaborative model, 1 + 1 equals 3, meaning the sum is greater than the individual parts. — Marc Levitt (opinion) [Ep 18 · 8:55](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=535)
- The collaborative care model could be applied to other hospital programs, such as a limb program requiring orthopedic surgery and rehabilitation medicine, where teams meet before the patient arrives and see the patient together on the same day. — Marc Levitt (opinion) [Ep 18 · 9:06](https://qa.library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=546)
- Ghana was selected as an ideal location to create a West African center for colorectal problems because they already had very good expertise and infrastructure to handle complex cases. — Marc Levitt (opinion) [Ep 20 · 1:24](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=84)
- The vision is to create in Ghana a center where children from all of Africa could come for colorectal problems. — Marc Levitt (opinion) [Ep 20 · 1:46](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=106)
- Dr. Alberto Peña is the director of the Colorectal Center at Cincinnati Children's Hospital. — Alberto Peña (clinical) [Ep 19 · 0:26](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=26)
- Dr. Peña developed a new surgical procedure in the 1970s. (clinical) [Ep 19 · 0:34](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=34)
- In most institutions, the operation is called the Peña procedure, but at Cincinnati Children's it is called the posterior sagittal anorectoplasty due to Dr. Peña's humility. (clinical) [Ep 19 · 0:43](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=43)
- The posterior sagittal anorectoplasty put colorectal surgery on the map and particularly Dr. Peña's name on the map. (opinion) [Ep 19 · 0:54](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=54)
- Over approximately 20 years following the procedure's development, patients came to have the procedure and surgeons came to learn it. (clinical) [Ep 19 · 0:59](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=59)
- The expansion of the colorectal center's work to all other fields has occurred in the last 6 to 10 years. (clinical) [Ep 19 · 1:07](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=67)
- The center's expansion came from hard work, dedication, passion about the patient, commitment to writing about results, careful patient follow-up, and communicating their work to the world. (opinion) [Ep 19 · 1:16](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=76)
- The Colorectal Center has seen patients from 80 countries. (epidemiological) [Ep 19 · 1:38](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=98)
- Dr. Peña advises young surgeons asking about the key to success to focus on doing the best version of whatever operation they are performing, even routine procedures like hernias. — Alberto Peña (opinion) [Ep 19 · 1:45](https://qa.library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=105)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Colorectal and pelvic disorders in children are often intricate and can have effects that last their entire lives, frequently involving a network of connected issues across digestive, urinary, reproductive, and sometimes musculoskeletal systems. — The host summarizing the discussion [Ep 15 · 10:39](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=639)
- Conditions requiring multidisciplinary approach include anorectal malformations (ARM), Hirschsprung disease, severe constipation caused by colonic motility issues, and neurogenic bladder and bowel dysfunction often seen in children with spina bifida. — The host summarizing the discussion [Ep 15 · 11:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=711)
- The initial driving forces behind colorectal programs are often strong focus, genuine passion, and deep interest from key people combined with solid work ethic, with detailed knowledge growing over time. — The host summarizing the discussion [Ep 15 · 13:21](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=801)
- A dedicated physician leader, most often a pediatric surgeon, is necessary who has genuine interest, commitment to long-term care, and clear vision for improving colorectal care quality. — The host summarizing the discussion [Ep 15 · 14:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=869)
- The program leader must understand the local healthcare landscape, assess genuine need, evaluate feasibility given existing services, and identify underserved patient populations before building. — The host summarizing the discussion [Ep 15 · 15:15](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=915)
- Initial essential specialties for a colorectal program include general surgery, urology, gynecology, GI motility specialist, and critically, a dedicated nursing team. — The host summarizing the discussion [Ep 15 · 15:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=951)
- A dedicated and passionate nurse specializing in bowel management is the backbone of the program; without this nurse, the program won't function effectively regardless of surgical expertise. — The host summarizing the discussion [Ep 15 · 16:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=972)
- For programs in non-English speaking countries, having a nurse fluent in English who can attend international meetings provides significant advantage for staying current on best practices. — The host summarizing the discussion [Ep 15 · 16:27](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=987)
- Complex colorectal cases often require combined expertise of pediatric surgery, urology, and gynecology in the operating room. — The host summarizing the discussion [Ep 15 · 17:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1023)
- Finding a pediatric gynecologist can be challenging; in those situations, a pediatric surgeon might manage gynecological aspects for female patients, or an adult gynecologist with expertise in Müllerian anomalies or disorders of sexual development may be engaged. — The host summarizing the discussion [Ep 15 · 17:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1023)
- A GI colleague with interest in motility and skill in performing manometry studies is needed, along with establishing clear guidelines for managing constipation and criteria for when standard medical treatments have failed. — The host summarizing the discussion [Ep 15 · 17:53](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1073)
- Access to anal and colonic motility studies and incorporation of pelvic floor physical therapy are key components of comprehensive care. — The host summarizing the discussion [Ep 15 · 18:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1096)
- Educating local pediatricians on when and how to refer patients to the center is crucial for building referral pathways. — The host summarizing the discussion [Ep 15 · 18:38](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1118)
- Radiologists need education on colorectal diseases and must know how to properly perform and interpret contrast enemas, colostograms, and cloacograms, with active surgeon participation in imaging studies especially initially. — The host summarizing the discussion [Ep 15 · 19:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1140)
- A pathologist with expertise in intestinal disorders like Hirschsprung disease ensures tissue samples are handled and interpreted correctly, requiring good surgeon-pathologist communication. — The host summarizing the discussion [Ep 15 · 19:41](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1181)
- Regular multidisciplinary meetings, ideally once or twice weekly, are essential for reviewing individual patient needs and developing coordinated care plans. — The host summarizing the discussion [Ep 15 · 20:25](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1225)
- A dedicated multidisciplinary outpatient clinic is ideal, but if not possible due to infrastructure limitations, coordinating same-day appointments across different locations with regular team meetings is an acceptable alternative. — The host summarizing the discussion [Ep 15 · 20:39](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1239)
- Continuous learning strategies include visiting established colorectal centers, staying current with research, watching surgical videos, and visiting other multidisciplinary programs within your own hospital. — The host summarizing the discussion [Ep 15 · 21:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1279)
- Programs should proactively ask other centers to share materials like patient intake forms or follow-up protocols, adapt them to local needs, and share their own innovations back with the broader community. — The host summarizing the discussion [Ep 15 · 22:05](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1325)
- Clinical skill development includes specialized colorectal fellowships, visiting other institutions for mentorship, international travel to learn from experts, and conference attendance for all team members, not just surgeons. — The host summarizing the discussion [Ep 15 · 22:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1346)
- Surgical videos are helpful for building confidence and understanding techniques but are not a substitute for actual hands-on surgical experience. — The host summarizing the discussion [Ep 15 · 23:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1392)
- The colorectal nurse needs solid understanding of different condition types (ARM variants, Hirschsprung disease, neurogenic bladder/bowel) and skills in preoperative/postoperative care including bowel irrigations, enemas, catheter management, and teaching families anal dilations. — The host summarizing the discussion [Ep 15 · 24:20](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1460)
- Involving and educating inpatient nursing staff through protocols and educational sessions ensures consistent high-level care and increases family comfort during hospitalization. — The host summarizing the discussion [Ep 15 · 25:02](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1502)
- Essential supplies include Hagar dilators, various catheter types and sizes, gravity bags for enemas, and specialized surgical retractors like the Lone Star retractor. — The host summarizing the discussion [Ep 15 · 25:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1531)
- Building a robust data library is essential for demonstrating clinic efficiency, establishing regional reputation, and showcasing effectiveness of new treatment techniques. — The host summarizing the discussion [Ep 15 · 26:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1571)
- Key metrics to track include total referrals, total visits, new patients, out-of-region patients, surgical cases (inpatient/outpatient), length of stay, revenues, expenses, and safety/quality metrics like complication rates. — The host summarizing the discussion [Ep 15 · 26:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1611)
- Documenting telephone encounters with patients and families is important to justify adequate nursing staff, as these patients require significant ongoing support and care plan adjustments. — The host summarizing the discussion [Ep 15 · 27:03](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1623)
- Children with colorectal and pelvic conditions often need long-term chronic care and don't follow typical surgical patient recovery paths. — The host summarizing the discussion [Ep 15 · 27:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1666)
- In private hospitals, the business case emphasizes attracting patients and downstream revenue; in public hospitals, it focuses on demonstrating cost savings through reduced complications, shorter stays, fewer ER visits, and improved quality of life. — The host summarizing the discussion [Ep 15 · 29:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1759)
- Building trust with referring physicians requires being polite and patient with colleagues hesitant to refer primary surgical cases, demonstrating value through successful management of complex cases, and offering to collaborate on surgeries. — The host summarizing the discussion [Ep 15 · 29:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1787)
- A significant portion of patients initially referred for management issues will likely need further surgical intervention down the line. — The host summarizing the discussion [Ep 15 · 30:37](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1837)
- A dedicated care coordinator or scheduler is a top priority for resource allocation to streamline patient visits and serve as central point of contact for families. — The host summarizing the discussion [Ep 15 · 31:33](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1893)
- Building bench strength by initially sharing resources from existing hospital departments (e.g., allocating portion of general surgery nurse's time) is a cost-effective way to start, applicable to social workers, child life specialists, nutritionists, and psychologists. — The host summarizing the discussion [Ep 15 · 32:02](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=1922)
- Hospital planning and data analysis departments have expertise in developing business cases and should be engaged early. — The host summarizing the discussion [Ep 15 · 33:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2037)
- A multi-year plan with clear milestones for additional resources and expected results is necessary, given that establishing a center of excellence takes sustained time and effort. — The host summarizing the discussion [Ep 15 · 35:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2109)
- All involved providers must be properly credentialed with government payers like Medicaid and private insurance companies in both home state and neighboring states, with adequate lead times for credentialing and preauthorization processes. — The host summarizing the discussion [Ep 15 · 35:43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2143)
- Weekly new patient intake meetings involve nursing gathering medical records, developing initial multidisciplinary care plan considering history, referral reasons, and psychosocial/nutritional/anesthesia concerns, then full team review including colorectal surgery, urology, gynecology, GI motility, nursing, and social work. — The host summarizing the discussion [Ep 15 · 36:44](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2204)
- For families traveling significant distances, programs try to consolidate as many appointments as possible into a single visit. — The host summarizing the discussion [Ep 15 · 37:43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845?t=2263)
- Cloaca patients require systematic evaluation of three systems: urologic, gynecologic, and colorectal. — The host summarizing the discussion [Ep 12 · 1:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=111)
- Cystatin C is helpful to check GFR (renal function) in cloaca patients. — The host summarizing the discussion [Ep 12 · 3:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=191)
- Attention to renal function is a relatively new advancement in care for cloaca patients to ensure they do not require renal transplant. — The host summarizing the discussion [Ep 12 · 3:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=191)
- Kurt Sheldon taught that spina bifida bladders and cloaca bladders need to stay empty, which made a huge difference in preventing kidney damage. — The host summarizing the discussion [Ep 12 · 3:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=191)
- The most common cause for redoing anorectal malformation patients is that the anus was placed in the wrong position. — Chris Gayer summarizing the discussion [Ep 12 · 5:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=309)
- There are many ways to tell if the anus is in the proper position, such as electrical stimulation and rectal ultrasound or MRI. — Chris Gayer summarizing the discussion [Ep 12 · 6:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=389)
- The PSARP operation for anorectal malformations was introduced in 1980, which is relatively new from a surgical point of view. — Chris Gayer summarizing the discussion [Ep 12 · 13:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=809)
- The tapering technique involves going in laparoscopically or open, finding the large rectosigmoid, and tapering on the anti-mesenteric side with a stent or dilator in the rectum to ensure good lumen size, using stapling and sometimes over-sewing. — The host summarizing the discussion [Ep 12 · 15:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=945)
- The most common complication of Malone procedure is stricture occurring in 17 to 20% of patients. — Philippa Jalus summarizing the discussion [Ep 7 · 6:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=389)
- Dr. Frischer's research has shown that a neo-Malone does just as well as a Malone. — Philippa Jalus summarizes what Dr. Jason Frischer said [Ep 7 · 9:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=586)
- An appendix-based Mitrofanoff does much better than a small bowel Monty. — Philippa Jalus summarizing the discussion [Ep 7 · 9:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=586)
- If interventional radiology cannot replace a catheter into a Malone, the patient may need to return to surgery to identify where the tract is kinked. — The host summarizing the discussion [Ep 7 · 18:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1132)
- In the late 2000s, urologists used deflux procedure (biodegradable gel injection) for Malone leakage, extrapolated from ureter reflux management. — Philippa Jalus summarizing the discussion [Ep 7 · 7:23](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=443)
- Visualizing a floppy cecum with laparoscope means checking alignment of Treitz ligament before completing the case, as patient could have malrotation and volvulus risk. — Philippa Jalus summarizing the discussion [Ep 7 · 13:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=831)
- Only 10 to 20% of patients will have problems with their Malone post-procedure. — Philippa Jalus summarizing the discussion [Ep 7 · 16:01](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=961)
- When documents are uploaded to Notebook LM, it creates an expert based solely on the provided document without searching external sources — Em Gootee summarizing the discussion [Ep 14 · 5:56](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=356)
- Colorectal and pelvic disorders in children are intricate, often lifelong, and involve interconnected issues across digestive, urinary, reproductive, and sometimes musculoskeletal systems — The host summarizing the discussion [Ep 14 · 11:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=705)
- Conditions requiring multidisciplinary approach include anorectal malformations (ARM), Hirschsprung disease, severe constipation from colonic motility issues, and neurogenic bladder and bowel dysfunction seen in spina bifida — The host summarizing the discussion [Ep 14 · 12:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=736)
- Collaborative programs lead to better treatment plans, improved communication between specialists, fewer complications, and better overall health outcomes — The host summarizing the discussion [Ep 14 · 13:22](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=802)
- Initial driving forces for establishing colorectal programs are strong focus, genuine passion, deep interest from key people, and solid work ethic, with detailed knowledge developing over time — The host summarizing the discussion [Ep 14 · 14:09](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=849)
- A dedicated physician leader, most often a pediatric surgeon, is necessary with genuine interest, commitment to long-term care, and clear vision for improving colorectal care quality — The host summarizing the discussion [Ep 14 · 14:34](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=874)
- Program leaders must understand the local healthcare landscape, assess genuine need, evaluate feasibility given existing services, and identify underserved patient populations — The host summarizing the discussion [Ep 14 · 15:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=916)
- Initial core specialties for multidisciplinary colorectal programs are general surgery, urology, gynecology, GI motility specialist, and critically, a dedicated nursing team — The host summarizing the discussion [Ep 14 · 15:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=958)
- A dedicated, passionate nurse specializing in bowel management is the backbone of the program; without this nurse, the program won't function effectively regardless of surgeon expertise — The host summarizing the discussion [Ep 14 · 16:19](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=979)
- For non-English speaking countries, having a nurse fluent in English who can attend international meetings provides significant advantage for staying current on best practices — The host summarizing the discussion [Ep 14 · 16:42](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1002)
- Complex colorectal cases often require combined expertise of pediatric surgery, urology, and gynecology in the operating room — The host summarizing the discussion [Ep 14 · 17:11](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1031)
- Finding a pediatric gynecologist can be challenging; in those situations, a pediatric surgeon might manage gynecological aspects for female patients — The host summarizing the discussion [Ep 14 · 17:18](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1038)
- Adult gynecologists involved in the program need specific expertise in Müllerian anomalies or disorders of sexual development — The host summarizing the discussion [Ep 14 · 17:28](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1048)
- GI colleagues need interest in motility and capability to perform manometry studies, which involve inserting a thin flexible tube to measure muscle contractions in the digestive tract — The host summarizing the discussion [Ep 14 · 17:58](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1078)
- Programs need clear guidelines for managing constipation, criteria for referral to the multidisciplinary team, and definitions of when standard medical treatments have failed — The host summarizing the discussion [Ep 14 · 18:16](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1096)
- Access to anal and colonic motility studies and incorporation of pelvic floor physical therapy to strengthen bowel control muscles are essential program components — The host summarizing the discussion [Ep 14 · 18:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1111)
- Radiologists need education on colorectal diseases through educational sessions to understand specific imaging needs, including proper performance and interpretation of contrast enemas, colostograms, and cloacograms — The host summarizing the discussion [Ep 14 · 19:04](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1144)
- Active surgeon participation in imaging studies, especially initially, ensures everyone is aligned on interpretation — The host summarizing the discussion [Ep 14 · 19:32](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1172)
- Pathologists with expertise in intestinal disorders like Hirschsprung disease ensure tissue samples are handled and interpreted correctly — The host summarizing the discussion [Ep 14 · 19:43](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1183)
- Regular multidisciplinary meetings, ideally once or twice weekly, are essential for reviewing individual patient needs and developing coordinated care plans — The host summarizing the discussion [Ep 14 · 20:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1231)
- A dedicated multidisciplinary outpatient clinic is ideal, but if not possible due to infrastructure limitations, coordinating same-day appointments across different locations is an acceptable alternative — The host summarizing the discussion [Ep 14 · 20:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1245)
- Continuous learning strategies include visiting established colorectal centers, staying current with research, watching surgical videos, and visiting other multidisciplinary programs within the same hospital — The host summarizing the discussion [Ep 14 · 21:32](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1292)
- Programs should proactively ask other centers to share materials like patient intake forms and follow-up protocols, then adapt them to their own needs — The host summarizing the discussion [Ep 14 · 22:05](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1325)
- Surgical videos are helpful for building confidence and understanding techniques but are not a substitute for actual hands-on surgical experience — The host summarizing the discussion [Ep 14 · 23:21](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1401)
- Systematically collecting data on patients and joining research networks or consortia is key to advancing the field — The host summarizing the discussion [Ep 14 · 23:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1411)
- The colorectal nurse needs strong foundational knowledge of anorectal malformations, Hirschsprung disease, and neurogenic bladder and bowel, plus skills in preoperative and postoperative care including bowel irrigations, enemas, catheter management, and teaching families anal dilations — The host summarizing the discussion [Ep 14 · 24:21](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1461)
- The colorectal nurse must understand treatment plans from all specialists to effectively communicate with families — The host summarizing the discussion [Ep 14 · 24:50](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1490)
- Educating inpatient nursing staff through protocols and educational sessions ensures consistent high-level care and increases family comfort during hospitalization — The host summarizing the discussion [Ep 14 · 25:08](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1508)
- Essential physical supplies include Hegar dilators, various catheter types and sizes, gravity bags for enemas, and specialized surgical retractors like the Lone Star retractor — The host summarizing the discussion [Ep 14 · 25:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1545)
- Building a robust data library is essential for demonstrating clinic efficiency, establishing regional reputation, and showcasing effectiveness of new treatment techniques — The host summarizing the discussion [Ep 14 · 26:23](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1583)
- Key data metrics include total referrals, total visits, new patients, out-of-region patients, surgical cases (inpatient and outpatient), length of stay, revenues, expenses, and safety/quality metrics like complication rates — The host summarizing the discussion [Ep 14 · 26:56](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1616)
- Documenting telephone encounters with patients and families is important to justify adequate nursing staff, as these patients require significant ongoing support and care plan adjustments — The host summarizing the discussion [Ep 14 · 27:26](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1646)
- Children with colorectal and pelvic conditions often need long-term chronic care and don't follow typical surgical patient recovery paths — The host summarizing the discussion [Ep 14 · 27:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1672)
- In private hospitals, business case emphasis is on attracting patients and downstream revenue; in public hospitals, focus is on demonstrating cost savings through reduced complications, shorter stays, fewer ER visits, and improved quality of life — The host summarizing the discussion [Ep 14 · 29:20](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1760)
- Building trust with referring physicians requires patience and politeness, especially with colleagues who have managed these conditions themselves for years — The host summarizing the discussion [Ep 14 · 30:02](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1802)
- Successfully managing patients referred for focused care like bowel management gradually demonstrates the value of the multidisciplinary approach — The host summarizing the discussion [Ep 14 · 30:21](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1821)
- A significant portion of patients initially referred for management issues will likely need further surgical intervention down the line — The host summarizing the discussion [Ep 14 · 30:44](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1844)
- A dedicated care coordinator or scheduler is a top priority resource allocation to streamline patient visits and serve as a central family contact point — The host summarizing the discussion [Ep 14 · 31:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1895)
- Building bench strength by initially sharing resources from existing hospital departments (allocating partial nurse time from general surgery) is a cost-effective way to start — The host summarizing the discussion [Ep 14 · 32:10](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1930)
- Hospital planning and data analysis departments have expertise in developing business cases and should be engaged early — The host summarizing the discussion [Ep 14 · 33:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2037)
- A multi-year plan with clear milestones for additional resources and expected results is necessary, as establishing a center of excellence takes sustained time and effort — The host summarizing the discussion [Ep 14 · 35:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2112)
- All involved providers must be properly credentialed with government payers like Medicaid and private insurance companies in both home state and neighboring states — The host summarizing the discussion [Ep 14 · 35:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2147)
- Telemedicine plays an increasingly important role in reaching patients, particularly for initial introductory visits and follow-up care — The host summarizing the discussion [Ep 14 · 36:18](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2178)
- Well-functioning programs typically have regular weekly meetings focused on new patient intake and returning patient follow-up, with nursing team proactively gathering records and developing initial multidisciplinary care plans — The host summarizing the discussion [Ep 14 · 36:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2206)
- The entire multidisciplinary team (colorectal surgery, urology, gynecology, GI motility, nursing, social work) reviews the nurse's proposed plan collaboratively to streamline diagnostics and reduce separate visits — The host summarizing the discussion [Ep 14 · 37:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2251)
- Orgasmalgia is pain with ejaculation in males or females. — Thomas Xu summarizing the discussion [Ep 5 · 3:14](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=194)
- Botox and pelvic floor physical therapy can help improve constipation in patients with pelvic floor dysfunction. — Thomas Xu summarizing the discussion [Ep 5 · 5:32](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=332)
- Anal manometry in children is difficult because getting a child to hold a balloon in their bottom is often unsuccessful at certain ages and not a reliable measure of sphincter tone. — Thomas Xu summarizing the discussion [Ep 5 · 7:23](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=443)
- SIS marker study is a colonic transit study where radio-opaque markers are ingested and tracked with serial X-rays over days; retained markers may indicate colonic dysmotility or slowness. — Thomas Xu summarizing the discussion [Ep 5 · 8:57](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=537)
- A pelvic floor consortium is held annually in conjunction with the American Society of Colorectal Surgeons, American Urologic Association, and American College of Obstetrics and Gynecology. — Thomas Xu summarizing the discussion [Ep 5 · 17:35](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=1055)
- Dr. Marc Levitt has cared for children from 50 states and 76 countries and performed more than 10,000 pediatric colorectal procedures. — Greg Tiao summarizes what Dr. Marc Levitt said [Ep 16 · 0:51](https://qa.library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstructi-13825?t=51)
- In the UK, biliary atresia and bladder exstrophy can only be cared for at certain medical centers because they recognized that gaining experience was going to improve outcomes. — Marc Levitt summarizing a resource [Ep 17 · 6:30](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=390)
- Walmart sends employees anywhere in the United States to Cleveland Clinic for coronary surgery because they've decided that is their go-to place for open heart surgery. — Marc Levitt summarizing a resource [Ep 17 · 7:09](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=429)
- In adult rectal cancer, the American College of Surgeons has designated that you need center of excellence care—you can't just do rectal cancer surgery wherever you want because the colorectal surgeons made the argument that you need radiation therapy and oncology and a whole list of things in order to provide best outcomes. — Marc Levitt summarizing a resource [Ep 17 · 16:38](https://qa.library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=998)
- 34 doctors from the US, the Netherlands, Israel, and South Africa came to Ghana to perform surgery on children with complex surgical problems. — The host summarizes what Dr. Marc Levitt said [Ep 20 · 0:16](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=16)
- More than 25 children with birth defects benefited from operations at Korle Bu Teaching Hospital. — The host summarizes what Dr. Marc Levitt said [Ep 20 · 0:26](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=26)
- The team donated medical items and equipment worth $75,000 US dollars to the hospital. — The host summarizes what Dr. Marc Levitt said [Ep 20 · 0:33](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=33)
- The medical outreach was carried out at the pediatric Colorectal Center, which handles deformities associated with the colon, rectum and anus. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 0:41](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=41)
- This was the second time the Cincinnati Children's Hospital team has operated in Ghana. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 0:56](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=56)
- The colorectal deformities are such that a child cannot pass bowel movements naturally through the anus. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 1:04](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=64)
- Dr. Mark Levitt says if emergency surgery is not conducted in such cases, the complication may be life threatening. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 1:11](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=71)
- Some colorectal deformities could be genetic. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 1:21](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=81)
- The hospital has collaborated with the Cincinnati Children's Hospital medical team for the past 4 years. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 1:57](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=117)
- During the medical camps, complex colorectal cases are taken care of. — Thomas Nsoeje summarizes what Dr. Marc Levitt said [Ep 20 · 1:57](https://qa.library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=117)

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