Collection
Anorectal Malformations & Cloacal Reconstruction
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Irrigating the distal colostomy segment by passing a large Foley catheter under laparoscopic visualization allows confirmation of meconium removal and distal segment decompression. — Marc Levitt, Colorectal Quiz: Episode 41 - Perineal Hypospadias · 6:51
Associated Anomalies & Screening4 items
VACTERL Screening in Newborns With Anorectal Malformations - An Opportunity to Optimize Screening Practices, add Gynecologic and Spinal Conditions, and Utilize a New Acronym: VACTE(G)RLS
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Thomas O Xu, Rachel E Hanke, Kirsten Das, Melanie Bowser, Butool Hisam, Inbal Samuk, Hussein Wissanji, Erin Teeple, Allison Mayhew, John S Myseros, Andrea Badillo, Marc A Levitt, Briony K Varda, Christina Feng
Introduction: Spinal cord a
article · Jun 2025
A Genetics-First Approach Revealed Monogenic Disorders in Patients With ARM and VACTERL Anomalies
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Background: The VATER/VACTERL association (VACTERL) is defined as the non-random occurrence of the following congenital anomalies: Vertebral, Anal, Cardiac, Tracheal-Esophageal, Renal, and Limb anomalies. As no unequivocal candidate gene ha
article · Jul 2026
Corrigendum: Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations
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[This corrects the article DOI: 10.3389/fped.2021.732524.].
article · Jul 2026
Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations
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Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARM). This study proposes sacral curvature (SC) as a new indicator to qualitatively as
article · Jul 2026
Classification & Anatomy2 items
The cutback revisited - The posterior rectal advancement anoplasty for certain anorectal malformations with rectoperineal fistula
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Background: The repair of rectoperineal fistulae can pose a significant challenge to the pediatric surgeon given the proximity of the fistula to the urethra in males and vagina in females. In these children, a simple cutback procedure may l
article · Nov 2022
Colorectal Quiz: Episode 41 - Perineal Hypospadias
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In this episode of the Colorectal Quiz, research fellow Filipa Jalles from Children's National Hospital is joined by Dr. Marc Levitt, Dr. Jason Frisher, and Dr. Paola Midrio to discuss a challenging case involving perineal hypospadias and a
video17:35 · Aug 2026
Fetal & Newborn Management1 item
Fetal and Newborn Management of Cloacal Malformations
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Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with fi
article · Jul 2026
Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. — Richard Wood, Colorectal Quiz Episode 17: Cloaca Part 1 · 24:36
Primary Repair Approaches3 items
Laparoscopic Approach in Anorectal Malformations: How We Do It
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Laparoscopy has a major role in the treatment of anorectal malformations (ARM) since Georgeson et al. introduced the laparoscopic assisted anorectoplasty in 2000. The majority of ARM can be repaired through a posterior sagittal incision wit
article · Jul 2026
The Role of Laparoscopy in Anorectal Malformations
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The use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we deta
article · Jul 2026
Redo Posterior Sagittal Anorectoplasty for Lateral Mislocation in Patients with Anorectal Malformations
video · Jun 2023Private
Cloacal Reconstruction8 items
Colorectal Quiz Episode 33: Cloaca Exstrophy
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Dr. Payam Saadai joins Dr. Marc Levitt and Dr. Jason Frischer to discuss the management of cloacal exstrophy covering traditional, and newer techniques.
Don't forget to like and subscribe to see more entertaining medical educational videos
video22:24 · Jul 2026
Preliminary Use of Indocyanine Green Fluorescence Angiography and Value in Predicting the Vascular Supply of Tissues Needed to Perform Cloacal, Anorectal Malformation, and Hirschsprung Reconstructions
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ICG-FA correctly identified patients who might have developed a complication from poor tissue perfusion. Employing this technology to assess rectal or neovaginal pull-throughs in cloacal reconstructions, complex HD, and ARM cases may be a v
article · Jul 2026
Factors predicting the need for vaginal replacement at the time of primary reconstruction of a cloacal malformation
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Case series with no comparison groups.
article · Jul 2026
233. The timing of gynecologic management during cloaca repair with co-existing Müllerian agenesis: a paradigm shift
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… We believe these patients do not require gynecologic surgery during the primary repair, and thus our reconstructive team has shifted away from early vaginal grafting to delayed …
article · Aug 2026
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Dec 2020
Colorectal Quiz Episode 18: Cloaca Part 2
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today
podcast23:10 · Jul 2026
Colorectal Quiz Episode 17: Cloaca Part 1
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today
podcast27:32 · Jul 2026
Complications and Long-Term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina...
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Dr. Megan Reed Ivaturi from Nationwide Children's Hospital discusses a recent study published in the Journal of Pediatric Surgery on the long-term outcomes of bowel neovagina creation for patients with cloacal malformations. The study evalu
video1:05 · Jun 2026
Redo & Revision Surgery2 items
Colorectal Quiz: Episode 2
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In the second installment of the Colorectal quiz, Dr. Jason Frischer and Dr. Marc Levitt discuss a topic of debate - when is the right time to redo an anorectop
podcast18:15 · Jul 2026
Transanal full thickness rectal mobilization with an ischiorectal fat pad to repair an H-Type rectovaginal fistula
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Center for Colorectal and Pelvic Reconstruction, Department of Pediatric Surgery, Nationwide Children's Hospital,
Carlos A. Reck MD, Victoria A. Lane MBChB, Richard J. Wood MD, Alessandra Gassior MD, Marc A. Levitt MD
video · Oct 2023
Dilations can be traumatic for families, with one family member typically responsible for performing them, sometimes leading to relationship strain and reluctance to attend clinic visits. — Kathy, Colorectal Quiz Episode 29: Female ARM · 12:06
Global Practices & Protocols2 items
Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers
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Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers - PubMed Clipboard, Search History, and several other advanced features are temporarily unavailable. Skip
article · Jul 2026
Colorectal Quiz Episode 29: Female ARM
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Join Dr. Kathy van Leeuwen and Dr. Cristine Velazco at Phoenix Childrenâs as they discuss the nuances of post-operative anorectal malformation management follow
podcast25:08 · Jul 2026
Complications Management2 items
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky
Edited by Nicholas Bruns, MD and Ian C. Glenn, MD
In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast48:09 · Dec 2020
Battery Ingestion with Colonic Perforation after Colostomy Closure in a Toddler
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Disc and button battery ingestion in children is common. In fact, data reports a dramatic increase in battery ingestion during the coronavirus disease 2019 pandemic likely as a result of increased household population density and electronic
article · Jul 2026
Cross-table lateral x-ray should be obtained at approximately 24 hours of life to assess gas column height and guide surgical planning — Jason Frischer, The Colorectal Quiz: Episode 1 · 5:05
Case Discussions & Webinars5 items
Decision making in pediatric colorectal surgery
video28:25 · Dec 2021Private
Decision making in Pediatric Colorectal Surgery - A webinar of case discussions
video15:25 · Dec 2021Private
Colorectal Quiz Episode 1 - Low Bulbar Fistua
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Pediatric colorectal surgeons Dr. Marc Levitt and Dr. Jason Frischer discuss a case of a new born with a low anorectal malformation. Listen as they take you through the workup, diagnosis, and treatment of an ARM with an ending that you migh
video15:45 · Jul 2026
Colorectal Quiz: Episode 40
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In this insightful podcast, Drs. Marc Levitt, Jason Frischer, and Chris Westgarth-Taylor discuss the challenging anatomy and surgical strategies for complex fem
podcast18:43 · Jul 2026
The Colorectal Quiz: Episode 1
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Pediatric colorectal surgeons Dr. Marc Levitt and Dr. Jason Frischer discuss a case of a new born with a low anorectal malformation. Listen as they take you thr
podcast15:45 · Jul 2026
Conferences & Updates4 items
Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
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In this special 50th episode of the Colorectal Quiz Podcast, Dr. Marc Levitt and an international panel including Filipa Jalles, MD, Lindsey Clarke, PA-C and Meghan Mesa, BSN, RN, CPN review key takeaways from the 16th European Pediatric Co
podcast24:17 · Mar 2026
Colorectal Quiz Ep. 50 -16th Annual European Pediatric Colorectal & Pelvic Reconstruction Conference
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In this special 50th episode of the Colorectal Quiz Podcast, Dr. Marc Levitt and an international panel review key takeaways from the 16th European Pediatric Colorectal Reconstruction Meeting in Stockholm, highlighting emerging ideas, evolv
video · Jul 2026
Update Course Rewind: Pediatric Colorectal Consortium 2021
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Did you miss the Pediatric Colorectal and Pelvic Learning Consortium session from our 2021 Pediatric Surgery Update Course? Don’t worry, in this Update Course Rewind Dr. Rebecca Rentea from Children's Mercy at Kansas City and Dr. Caitlin Sm
podcast14:55 · Apr 2022
New and exciting advances in pediatric colorectal and pelvic reconstructive surgery - 2021 update
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Publication date: Available online 9 November 2020Source: Seminars in Pediatric SurgeryAuthor(s): Marc A. Levitt
article · Nov 2020
Interviews & Lectures5 items
Episode 19 - Interview with Dr Marc Levitt, Chief of Colorectal & Pelvic Reconstruction, Children‘s
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Source:
https://www.podbean.com/eau/pb-hnps7-10ff7e9
For episode 19, we are joined by Dr Marc Levitt MD, Chief of Colorectal & Pelvic Reconstruction, Children's National Hospital, Washington DC USA who is internationally recognised as spec
video54:32 · Jul 2026
2019 Chandler Lecture: Dr. Marc Levitt
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The Division of Pediatric Surgery hosts an annual lecture in honor of Dean Loren "Yank" Chandler. This year's speaker, Dr. Marc Levitt, chief of the Colorectal and Pelvic Reconstruction Surgery Section at Nationwide Children's Hospital, pre
video41:23 · Jul 2026
Time for some patient driven change | Marc Levitt | TEDxColumbus
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Patient driven care - how a patient made me a better doctor, how a collaborative process improves care, and why this is so rare and hard to achieve in medicine.
Marc Levitt, MD, is the Surgical Director of the Center for Colorectal and Pel
video10:41 · Jul 2026
Tell Me a Story: Pediatric Surgeons Putting Colorectal Center on the Map
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http://www.cincinnatichildrens.org/service/c/colorectal/default/
Dr. Marc Levitt was a medical student when he first met Dr. Alberto Peña and decided to study under him. Over the years, the mentoring turned into a friendship. They develope
video2:20 · Jul 2026
The value and weakness of Medical Mission Work in ARM
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Marc Levitt interviewed by Carlos Reck Presentation during the European Colorectal Congress in Vienna - December 2019 Organized by: Carlos A. Reck-Burneo Alexander Springer Annita Budzanowski
video · Jul 2026
Colorectal and Pelvic Reconstruction Techniques with Dr. Marc Levitt
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This is "01 CTO-Georgia_Marc Levitt_h264_1080p25_20k_230207.mov" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Keynote Address on Pediatric Colorectal Surgery by Dr. Marc Levitt
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This is "Keynote_speech_by_DR._Marc_Levitt_july_2022.mov" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Patient Outreach and Communication in Pediatric Colorectal Surgery
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This is "01_Marc_Levitt_05 Patients, please reach out to us_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
(500) Days of Summer (classic Movie Review: Zooey Deschanel, Joseph Gordon-Levitt, Marc Webb) by The Cory Baker Show
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A movie review of "(500) Days of Summer" written by Scott Heustadter and Michael H. Weber, and directed by Marc Webb. Starring Zooey Deschanel, Joseph Gordon-Levitt, Geoffrey Arend, Chloe Grace Moretz, Matthew Gray Gubler, Clark Gregg, and
podcast · Aug 2026
Introducing Dr. Marc Levitt: Pediatric Colorectal Surgeon Profile
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This is "01_Marc_Levitt_01 About Dr. Marc Levitt_Introducing Marc_Levitt_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Andrea Kesar Discusses Marc Levitt's Contributions to Pediatric Colorectal Surgery
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This is "10_Andrea_Kesar_about Marc Levitt" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Meeting with Marc Levitt: Clinical Discussion with Ivon Martinez
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This is "16_Ivon_Martinez_02_Meeting_Marc_Levitt" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Dr. Marc Levitt on the CTO Mission in Pediatric Colorectal Surgery
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This is "01_Marc_Levitt_06 Marc about a CTO Mission_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Integrated Care Concept in Pediatric Colorectal Surgery by Marc Levitt
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This is "01_Marc_Levitt_02 The Concept of Integrated Care_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Addressing Ministers of Health: Pediatric Colorectal Surgery Advocacy and Global Healthcare Priorities
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This is "01_Marc_Levitt_07 To all Ministers of Health_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Connecting Surgeons and Nurses: Collaborative Care in Pediatric Surgery
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This is "01_Marc_Levitt_04 Connect with all Surgeons and Nurses_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
The History of International Colorectal Surgery Team Development
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This is "01_Marc_Levitt_03 The History of Colorectal Team Overseas_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
How the Colorectal and Pelvic Reconstruction Center Uses Donor Support
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This is "01_Marc_Levitt_08 What CTO does with your support_h264_15k_1080p25_cc_220807" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Introduction to Dr. Marc Levitt's Pediatric Colorectal Surgery Practice
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This is "01_Marc_Levitt_01 About Dr Marc Levitt_for_music / Introducing Dr. Marc Levitt" by CTO on Vimeo, the home for high quality videos and the people who love them.
video · Jul 2026
Featured picks for families are being prepared — the summaries above are written for you.
Expert statements from the recordings in this collection.
Complications of Anorectal Malformations with Dr. Marc Levitt
Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period.
Marc Levitt2:57
Male babies with perineal fistula may pass meconium and no one notices anything wrong with their anorectal anatomy, typically presenting in the first year of life with severe constipation.
Marc Levitt3:06
A newborn anus should accept a size 12 Hagar dilator and a 1-year-old should accept a size 15.
Marc Levitt6:13
Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation; patients will inherently have some constipation requiring aggressive treatment.
Marc Levitt4:54
If a perineal fistula is not centered in the sphincter, patients with loose stool will soil, and athletic activity will cause soiling because sphincter squeeze cannot completely close the hole.
Marc Levitt5:38
In females, diagnostic criteria for perineal fistula are: hole too close to vagina (inadequate perineal body), inadequate hole size by Hagar dilators, and hole not centered in sphincter.
Marc Levitt8:02
If a female's anal opening is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, no surgery is needed; the perineal body will lengthen with growth.
Marc Levitt8:47
The standard practice of checking temperature on forehead or ear rather than rectally makes it easier to miss anorectal malformations in newborns.
An anesthesia nerve stimulator costing $150 with appropriate needle probes works as well as commercial $15,000 stimulators for identifying sphincter muscles.
Marc Levitt11:06
The most common colostomy error is opening too distal in the sigmoid, restricting the ultimate pull-through by the location of the colostomy or mucous fistula.
Marc Levitt17:18
Incompletely diverting loop colostomies allow stool to spill across and contaminate the distal segment, leading to urinary tract infections.
Marc Levitt17:45
With transverse colostomy and large rectourethral fistula, the left colon absorbs urine which doesn't exit the mucous fistula, potentially causing acidosis from urine absorption.
Marc Levitt18:38
Prolapse risk depends on colostomy location: mid-transverse allows bilateral prolapse, hepatic flexure allows only distal prolapse, proximal sigmoid allows only distal prolapse because left colon is fixed to retroperitoneum.
Marc Levitt19:58
Marking the sphincter ellipse on skin surface before making any incision prevents confusion from muscle stimulation after dissection is open, avoiding misplaced anoplasty.
Marc Levitt21:30
A distal colostogram showing flattening of the rectum corresponding to the pubococcygeal line indicates insufficient contrast or pressure; more pressure is needed to overcome the sphincters and reveal the true rectal position and fistula.
Marc Levitt24:26
Fistula level is determined by viewing the urethra as a reverse C or elbow: fistula at or below the elbow is bulbar, above the elbow is prostatic, at bladder neck is bladder neck fistula.
Marc Levitt25:23
Bulbous rectum on colostogram may be reachable posterior sagittally and difficult laparoscopically; tapered rectum is better approached laparoscopically.
Marc Levitt25:55
Opening posterior sagittally without knowing exact rectal location risks finding and potentially mobilizing bladder neck instead of rectum.
Marc Levitt27:00
Bulbar and low prostatic fistulas with bulbous rectum are best approached posterior sagittally; high prostatic with tapered rectum and bladder neck fistulas are best approached laparoscopically.
Marc Levitt30:09
Attempting laparoscopy for bulging rectum below peritoneal reflection at low prostatic or bulbar level risks leaving behind a remnant of the original fistula (roof) if the surgeon is timid.
Marc Levitt30:43
Laparoscopy replaces laparotomy, not PSARP; a mini-PSARP during laparoscopy allows safe entry through peritoneal reflection and tacking rectum to posterior muscle complex to prevent prolapse.
Rectal prolapse occurs in about 3% of cases, particularly in patients without great muscles.
Marc Levitt33:35
Rectal prolapse more than 3 millimeters should be treated because it causes bleeding, mucus, and can inhibit bowel control in patients with good muscle potential.
Marc Levitt34:14
Circumferential prolapse can be trimmed in two separate ambulatory sessions (half circumference each), avoiding hospitalization and eliminating need for dilation since half the circumference remains untouched.
Marc Levitt34:48
Perineal body dehiscence is the most common cause of reoperation in female ARM repairs.
Marc Levitt36:03
Complete anterior rectal wall mobilization to the areolar plane between rectum and vagina is essential to avoid tension on the anoplasty that can lead to perineal body dehiscence.
Marc Levitt35:41
Clear liquids only for one week postoperatively prevents hard stool formation while allowing more stool volume, showing good perineal body healing results without traditional 7-day NPO period.
Marc Levitt36:45
If perineal body dehiscence is recognized on days 5-8, taking the patient back to OR to re-suture can salvage the repair; by 3-4 weeks the entire perineal body is dehisced and unsalvageable.
Marc Levitt37:48
During laparoscopic approach for high rectums, the IMA must be preserved because prior colostomy may have disrupted collaterals down the left colic, making the rectum completely dependent on IMA blood supply.
Marc Levitt39:33
Continence potential in ARM patients is predicted by three factors: original malformation type, sacral ratio, and spine quality (ARM continence index). Three A's predicts continence, three C's predicts incontinence.
Marc Levitt42:14