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

Updated: n/a · 34 episodes · 199 cited statements

## Episodes
### Functional Constipation
- [Current Treatment Options for Children with Functional Constipation-What Is in the Pipeline?](https://library.globalcastmd.com/watch/current-treatment-options-for-children-with-functional-constipation-what-is-in-the-pipeline-13759) — article · [machine version](https://library.globalcastmd.com/watch/current-treatment-options-for-children-with-functional-constipation-what-is-in-the-pipeline-13759.md)
- [State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation](https://library.globalcastmd.com/watch/state-of-the-art-bowel-management-for-pediatric-colorectal-problems-functional-constipation-13764) — article · [machine version](https://library.globalcastmd.com/watch/state-of-the-art-bowel-management-for-pediatric-colorectal-problems-functional-constipation-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://library.globalcastmd.com/watch/antegrade-continence-enema-alone-for-the-management-of-functional-constipation-and-segmental-colonic-dysmotility-a-pediatric-colorectal-and-pelvic-learning-consortium-study-13763) — article · [machine version](https://library.globalcastmd.com/watch/antegrade-continence-enema-alone-for-the-management-of-functional-constipation-and-segmental-colonic-dysmotility-a-pediatric-colorectal-and-pelvic-learning-consortium-study-13763.md)
- [Surgical Interventions for Functional Constipation: An Update](https://library.globalcastmd.com/watch/surgical-interventions-for-functional-constipation-an-update-13801) — article · [machine version](https://library.globalcastmd.com/watch/surgical-interventions-for-functional-constipation-an-update-13801.md)

### Pelvic Floor Disorders
- [Colorectal Quiz: Episode 45 -  Pelvic Floor Dyssynergia](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822) — video · 18:33 · [machine version](https://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://library.globalcastmd.com/watch/more-evidence-against-appendectomy-at-the-time-of-a-ladd-procedure-13814) — article · [machine version](https://library.globalcastmd.com/watch/more-evidence-against-appendectomy-at-the-time-of-a-ladd-procedure-13814.md)
- [Colorectal Quiz: Episode 43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850) — podcast · 23:29 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850.md)
- [Battery Ingestion with Colonic Perforation after Colostomy Closure in a Toddler](https://library.globalcastmd.com/watch/battery-ingestion-with-colonic-perforation-after-colostomy-closure-in-a-toddler-13766) — article · [machine version](https://library.globalcastmd.com/watch/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://library.globalcastmd.com/watch/the-story-of-dr-asa-g-yancey-and-surgical-innovation-in-the-face-of-discrimination-13761) — article · [machine version](https://library.globalcastmd.com/watch/the-story-of-dr-asa-g-yancey-and-surgical-innovation-in-the-face-of-discrimination-13761.md)
- [Pediatric Colorectal and Pelvic Surgery | Case Studies](https://library.globalcastmd.com/watch/pediatric-colorectal-and-pelvic-surgery-case-studies-13815) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-colorectal-and-pelvic-surgery-case-studies-13815.md)
- [Journal of Pediatric Surgery Article Review: March 2023](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-march-2023-13854) — podcast · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-march-2023-13854.md)
- [Colorectal Quiz: Episode 47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846) — podcast · 22:19 · [machine version](https://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://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817) — video · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817.md)
- [Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820) — video · 40:41 · [machine version](https://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://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-solutions-13845) — podcast · 40:45 · [machine version](https://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://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825) — video · 54:32 · [machine version](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825.md)
- [2019 Chandler Lecture: Dr. Marc Levitt](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827) — video · 41:23 · [machine version](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827.md)
- [Time for some patient driven change | Marc Levitt | TEDxColumbus](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828) — video · 10:41 · [machine version](https://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://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829) — video · 2:20 · [machine version](https://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://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830) — video · 2:49 · [machine version](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830.md)
- [Introducing Dr. Marc Levitt: Pediatric Colorectal Surgeon Profile](https://library.globalcastmd.com/watch/introducing-dr-marc-levitt-pediatric-colorectal-surgeon-profile-13831) — video · [machine version](https://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://library.globalcastmd.com/watch/andrea-kesar-discusses-marc-levitt-s-contributions-to-pediatric-colorectal-surgery-13832) — video · [machine version](https://library.globalcastmd.com/watch/andrea-kesar-discusses-marc-levitt-s-contributions-to-pediatric-colorectal-surgery-13832.md)
- [Meeting with Marc Levitt: Clinical Discussion with Ivon Martinez](https://library.globalcastmd.com/watch/meeting-with-marc-levitt-clinical-discussion-with-ivon-martinez-13833) — video · [machine version](https://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://library.globalcastmd.com/watch/dr-marc-levitt-on-the-cto-mission-in-pediatric-colorectal-surgery-13834) — video · [machine version](https://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://library.globalcastmd.com/watch/colorectal-and-pelvic-reconstruction-techniques-with-dr-marc-levitt-13835) — video · [machine version](https://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://library.globalcastmd.com/watch/keynote-address-on-pediatric-colorectal-surgery-by-dr-marc-levitt-13836) — video · [machine version](https://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://library.globalcastmd.com/watch/integrated-care-concept-in-pediatric-colorectal-surgery-by-marc-levitt-13837) — video · [machine version](https://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://library.globalcastmd.com/watch/addressing-ministers-of-health-pediatric-colorectal-surgery-advocacy-and-global-healthcare-priorities-13838) — video · [machine version](https://library.globalcastmd.com/watch/addressing-ministers-of-health-pediatric-colorectal-surgery-advocacy-and-global-healthcare-priorities-13838.md)
- [Patient Outreach and Communication in Pediatric Colorectal Surgery](https://library.globalcastmd.com/watch/patient-outreach-and-communication-in-pediatric-colorectal-surgery-13839) — video · [machine version](https://library.globalcastmd.com/watch/patient-outreach-and-communication-in-pediatric-colorectal-surgery-13839.md)
- [Connecting Surgeons and Nurses: Collaborative Care in Pediatric Surgery](https://library.globalcastmd.com/watch/connecting-surgeons-and-nurses-collaborative-care-in-pediatric-surgery-13840) — video · [machine version](https://library.globalcastmd.com/watch/connecting-surgeons-and-nurses-collaborative-care-in-pediatric-surgery-13840.md)
- [The History of International Colorectal Surgery Team Development](https://library.globalcastmd.com/watch/the-history-of-international-colorectal-surgery-team-development-13841) — video · [machine version](https://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://library.globalcastmd.com/watch/how-the-colorectal-and-pelvic-reconstruction-center-uses-donor-support-13842) — video · [machine version](https://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://library.globalcastmd.com/watch/introduction-to-dr-marc-levitt-s-pediatric-colorectal-surgery-practice-13843) — video · [machine version](https://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://library.globalcastmd.com/watch/the-value-and-weakness-of-medical-mission-work-in-arm-13844) — video · [machine version](https://library.globalcastmd.com/watch/the-value-and-weakness-of-medical-mission-work-in-arm-13844.md)

## Chapters
- [0:00](https://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://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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=0) Introduction and case presentation initiation (Ep 12)
- [1:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=94) Three-system evaluation framework for cloaca patients (Ep 12)
- [3:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=235) Perineal examination and anatomic assessment (Ep 12)
- [5:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=352) Prior workup and imaging findings (Ep 12)
- [8:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=522) Contrast enema findings and mega-rectosigmoid anatomy (Ep 12)
- [11:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=691) Importance of rectal preservation and historical context (Ep 12)
- [14:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=887) Surgical management options debate (Ep 12)
- [18:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1129) Proposed management plan and decision factors (Ep 12)
- [20:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=1258) Closing and colorectal joke (Ep 12)
- [0:00](https://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://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=213) Patient selection and initial surgical planning considerations (Ep 7)
- [5:37](https://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://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=600) Plication techniques and volvulus prevention (Ep 7)
- [14:06](https://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=846) Troubleshooting leakage, stenosis, and prolapse (Ep 7)
- [18:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1090) Salvage techniques for difficult or lost Malone access (Ep 7)
- [20:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=1252) Special considerations: appendicitis risk and pathology (Ep 7)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0) Conference Overview and Emerging Practices in Pediatric Colorectal Care (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=0) Introduction to AI-Generated Medical Podcasts and Notebook LM Technology (Ep 14)
- [9:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=585) Article Acknowledgment and Clinical Context (Ep 14)
- [10:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=640) Why Multidisciplinary Care Is Essential for Pediatric Colorectal Conditions (Ep 14)
- [14:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=870) Foundational Steps: Leadership, Needs Assessment, and Core Team Assembly (Ep 14)
- [18:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1131) Expanding the Team: Radiology, Pathology, and Interdisciplinary Coordination (Ep 14)
- [24:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1451) Continuous Learning Strategies and Knowledge Development (Ep 14)
- [27:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1662) Data Collection, Quality Metrics, and Demonstrating Program Value (Ep 14)
- [29:46](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1786) Building Referral Networks and Infrastructure Support (Ep 14)
- [34:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2099) Making the Business Case and Operational Planning (Ep 14)
- [39:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2367) Weekly Operational Workflow and Program Integration (Ep 14)
- [0:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=12) Introduction and Case Presentation (Ep 5)
- [2:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=144) Clinical History and Importance of Sphincter Evaluation (Ep 5)

## 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://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://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://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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/colorectal-quiz-episode-47-13846?t=619)
- Most ARM patients need constipation treatment. (clinical) [Ep 12 · 10:19](https://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=136)
- The AI-generated podcast voices were human-sounding, accurate, and foreshadowed content from later in the article — Marc Levitt (opinion) [Ep 14 · 2:41](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=161)
- Notebook LM has perfected human-sounding conversation better than any other available tools — Todd Ponsky (opinion) [Ep 14 · 4:10](https://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, one woman) and is not customizable — Todd Ponsky (clinical) [Ep 14 · 4:22](https://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 interactively and engage with the AI hosts — Todd Ponsky (clinical) [Ep 14 · 5:03](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=303)
- A neurology review article that took 2 weeks to write 5 years ago can now be produced in minutes using Notebook LM with the same 30 source articles — Marc Levitt (clinical) [Ep 14 · 6:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=399)
- Notebook LM can identify gaps in knowledge from a set of articles and recognize when new articles fill those gaps — Marc Levitt (clinical) [Ep 14 · 7:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=428)
- AI can now create functional apps from verbal descriptions alone, replacing the need for traditional coding — Todd Ponsky (clinical) [Ep 14 · 7:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=470)
- Effective AI use requires triangulation across multiple platforms, combining strengths of different tools for intelligence, audio, and video — Todd Ponsky (opinion) [Ep 14 · 8:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=491)
- Human oversight and medical writers are necessary to ensure AI-generated medical content is correct — Todd Ponsky (opinion) [Ep 14 · 8:26](https://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 — Marc Levitt (clinical) [Ep 5 · 0:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=45)
- Mark Molota from Munich, Germany is also a pediatric surgeon and colorectal surgeon — Marc Levitt (clinical) [Ep 5 · 1:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=60)
- Pediatric surgeons need to know more about pelvic floor dysfunction, while adult colorectal surgeons know this well — Marc Levitt (opinion) [Ep 5 · 1:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=91)
- Pelvic floor dysfunction is underrecognized in pediatric patients — Aaron Teeple (opinion) [Ep 5 · 1:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=119)
- Urinary retention is extremely rare in an otherwise healthy young man and should raise red flags (clinical) [Ep 5 · 3:19](https://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://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=275)
- Many patients with bad constipation have been treated with laxatives, Malone procedures, ileostomies, or stomas without anyone evaluating their sphincters — Marc Levitt (clinical) [Ep 5 · 5:00](https://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 (clinical) [Ep 5 · 5:44](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=344)
- There is a distinction between pelvic floor dysfunction and distal anismus, which is more external sphincter-related — Aaron Teeple (clinical) [Ep 5 · 6:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=376)
- Withholders are typically potty-training toddlers who are constipated — Aaron Teeple (clinical) [Ep 5 · 6:26](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=386)
- A subset of patients with behavioral considerations, delays, or nonverbality exert control through their anal sphincters, which are voluntary muscles — Aaron Teeple (clinical) [Ep 5 · 6:33](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=393)
- Dysynergic contraction of puborectalis can be detected on digital rectal exam when asking the patient to bear down and feeling the puborectalis squeeze around the finger — Aaron Teeple (clinical) [Ep 5 · 7:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=428)
- Defecography is not available at many pediatric institutions and patients must go to adult centers — Aaron Teeple (clinical) [Ep 5 · 7:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=456)
- Taking a detailed history is important because reliable data from anorectal manometry is difficult to obtain in children — Marc Levitt (clinical) [Ep 5 · 7:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=478)
- In a patient with gas retention who is distended all day but has a flat abdomen in the morning, this indicates successful gas passage during sleep when not thinking about it, suggesting behavioral impact — Marc Levitt (clinical) [Ep 5 · 8:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=501)
- In SIS marker studies showing markers stacked against the puborectalis, this indicates outlet dysfunction at the pelvic floor level — Aaron Teeple (clinical) [Ep 5 · 9:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=554)
- In defecography for pelvic floor dysfunction, the anorectal angle paradoxically tightens during defecation instead of straightening, because the puborectalis tightens rather than relaxes — Aaron Teeple (clinical) [Ep 5 · 9:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=597)
- Most defecography studies are MRI-based these days — Aaron Teeple (clinical) [Ep 5 · 10:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=648)
- For pelvic floor dysynergia defecography in children, vaginal filling and small bowel contrast are often not performed, which is acceptable since those components are not needed to evaluate for dysynergia — Aaron Teeple (clinical) [Ep 5 · 10:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=653)
- If unable to get information from anal manometry or SIS marker study, already tried physical therapy without improvement, and strongly believe dysynergia is the problem, Botox the pelvic floor; if needing to prove it for insurance coverage, send for defecography — Aaron Teeple (clinical) [Ep 5 · 11:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=672)
- Treatment progression includes starting fiber, optimizing water intake, starting laxatives, ensuring thorough age-appropriate pelvic floor physical therapy, and screening for trauma history including sexual abuse with psychological intervention before proceeding to Botox — Aaron Teeple (guideline) [Ep 5 · 11:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=702)
- Pelvic floor Botox technique uses 100 units diluted in 10 mL, divided into ten 1-mL aliquots, injected into the posterior puborectalis sling using a spinal needle — Aaron Teeple (clinical) [Ep 5 · 12:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=777)
- The puborectalis does not come anteriorly; it fixates on the pubic symphysis — Aaron Teeple (clinical) [Ep 5 · 13:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=830)
- To inject the puborectalis, palpate the muscle which should feel like a guitar string or violin string, place your finger below it, and inject with an angled spinal needle above your finger into the muscle belly — Aaron Teeple (clinical) [Ep 5 · 13:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=837)
- The right side of the puborectalis is often tighter — Aaron Teeple (clinical) [Ep 5 · 15:04](https://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 — Aaron Teeple (clinical) [Ep 5 · 15:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=912)
- Non-relaxing puborectalis should be called levator syndrome — Aaron Teeple (opinion) [Ep 5 · 15:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=939)
- Pudendal neuropathy can present as weakness or as pain — Aaron Teeple (clinical) [Ep 5 · 15:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=945)
- Pelvic floor dysfunction can present as significant deep aching pelvic pain precipitated by hard bowel movements trying to pass through tight puborectalis — Aaron Teeple (clinical) [Ep 5 · 15:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=955)
- Defecography helps identify the level of obstructive defecation — Aaron Teeple (clinical) [Ep 5 · 16:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=985)
- In solitary rectal ulcer syndrome, failure to relax the puborectalis leads to continual valsalva that traumatizes the posterior wall, causing obliteration of the lamina propria at the level of the puborectalis — Aaron Teeple (clinical) [Ep 5 · 16:38](https://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 due to significant overlap between bowel and bladder dysfunction in the pelvic floor — Aaron Teeple (guideline) [Ep 5 · 17:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=1042)
- 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 — Aaron Teeple (clinical) [Ep 5 · 17:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-45-pelvic-floor-dyssynergia-13822?t=1055)
- The first dedicated colorectal center was launched at Cincinnati Children's Hospital in 2005, 16 years before this interview. — Marc Levitt (clinical) [Ep 16 · 4:29](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=269)
- Training surgeons provides exponentially greater impact than treating individual patients because trained surgeons can help hundreds or thousands more patients in their own cities. — Marc Levitt (opinion) [Ep 16 · 6:50](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=410)
- Approximately 25 countries currently have specialized colorectal centers, but there are over 110 countries in the world requiring such programs. — Marc Levitt (epidemiological) [Ep 16 · 30:05](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1805)
- The bowel management program is a major advance in ARM care, involving focused nursing attention for 4-5 days with good long-term follow-up to achieve continence. — Marc Levitt (clinical) [Ep 16 · 8:40](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=520)
- Integration of urology and bladder management has revolutionized ARM care; kidney transplant was previously not uncommon but is now exceedingly rare due to better urologic care. — Marc Levitt (clinical) [Ep 16 · 9:12](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=552)
- Gynecologic collaboration has eliminated nervousness about menstruation problems at puberty because anatomy is now well understood through multidisciplinary care. — Marc Levitt (clinical) [Ep 16 · 9:41](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=581)
- Transition care for ARM patients into adult services is the most deficient aspect of the field, lagging behind congenital heart disease and cystic fibrosis programs. — Marc Levitt (opinion) [Ep 16 · 11:06](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=666)
- Only three surgeons worldwide are trained in both pediatric and adult colorectal surgery: Ali Gisher in Columbus Ohio, Erin Teeple in Wilmington Delaware, and Mark [last name not recalled] in Munich Germany. — Marc Levitt (clinical) [Ep 16 · 12:12](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=732)
- Paris at Necker Children's Hospital has an exemplary transition model where teenagers meet pediatric and adult providers together, then subsequent visits occur at the adult facility. — Marc Levitt (clinical) [Ep 16 · 13:16](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=796)
- In typical US pediatric surgery training programs, fellows see approximately 12 ARM cases over two years of training. — Marc Levitt (epidemiological) [Ep 16 · 22:30](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1350)
- The average practicing pediatric surgeon performs approximately one ARM case per year after completing training. — Marc Levitt (epidemiological) [Ep 16 · 22:57](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1377)
- ARM surgery differs fundamentally from typical surgery because it requires years of tinkering and medical management rather than immediate anatomic cure. — Marc Levitt (clinical) [Ep 16 · 17:48](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1068)
- The delayed feedback problem in ARM surgery: if the anus is misaligned with sphincters at 6 months, the surgical error may not be discovered until potty training fails at age 4 years. — Marc Levitt (clinical) [Ep 16 · 20:44](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1244)
- A complex colorectal operation takes about 4 hours, but delivering a good functional result requires 96 more hours of tinkering, almost all of which is nursing care. — Marc Levitt (clinical) [Ep 16 · 19:27](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1167)
- Most families would agree they would rather change a colostomy bag than a diaper if the colostomy is properly constructed. — Marc Levitt (opinion) [Ep 16 · 20:01](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1201)
- Pull-through surgery should be performed and colostomy closed in virtually all ARM patients; with proper bowel management and nursing care, patients can achieve continence mechanically. — Marc Levitt (clinical) [Ep 16 · 24:29](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1469)
- Patients without innate sphincter anatomy can still be cleaned mechanically by emptying the colon once daily through bowel management programs. — Marc Levitt (clinical) [Ep 16 · 25:03](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1503)
- Permanent colostomy may be more practical for rare patients who do not ambulate, but the vast majority can be clean with stool flowing through the normal anal route. — Marc Levitt (clinical) [Ep 16 · 25:29](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1529)
- Many patients develop bowel control even when predicted they would never achieve it, with proper nursing care and medical regimen tinkering. — Marc Levitt (clinical) [Ep 16 · 25:54](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1554)
- Family surveys identified the dilation process as the most stressful part of colorectal care for ARM patients. — Marc Levitt (epidemiological) [Ep 16 · 31:10](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1870)
- A randomized controlled trial comparing standard dilation protocol versus no dilation found similar stricture rates of approximately 15% in both groups. — Marc Levitt (clinical) [Ep 16 · 32:07](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1927)
- Strictures can be treated with a minor Heineke-Mikulicz anoplasty at the time of colostomy closure, making the downside of the no-dilation approach acceptable. — Marc Levitt (clinical) [Ep 16 · 32:49](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=1969)
- Based on the randomized trial, Levitt's centers no longer perform routine post-operative dilations, and families universally choose to avoid them when offered the choice. — Marc Levitt (clinical) [Ep 16 · 33:29](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2009)
- Skin irritation and frequent stools after colostomy closure typically last about 2 weeks as the distal colon segment learns to absorb water and thicken stool. — Marc Levitt (clinical) [Ep 16 · 35:09](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2109)
- The problem switches to constipation at approximately 3 weeks post-closure; surgeons who don't aggressively manage this allow colon dilation that makes later potty training harder. — Marc Levitt (clinical) [Ep 16 · 35:56](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2156)
- Almost all ARM patients should be on laxatives about 3-4 weeks after colostomy closure to maintain stool flow and prevent colon dilation. — Marc Levitt (clinical) [Ep 16 · 36:36](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2196)
- The goal by age 2-3 years is establishing a pattern of one to two well-formed stools per day using diet with bulk fiber and senna-based laxatives. — Marc Levitt (clinical) [Ep 16 · 36:58](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2218)
- Stool softeners make ARM patients worse, not better, because loose stool prevents the rectal stretch sensation needed to develop bowel control in patients with surgically created anal canals. — Marc Levitt (clinical) [Ep 16 · 37:33](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2253)
- ARM patients lack typical anal canal sensation and may have inadequate sphincters, making them dependent on rectal stretch from bulky stool to feel the urge to defecate. — Marc Levitt (clinical) [Ep 16 · 37:56](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2276)
- Bowel management with enemas should be introduced when the child should be in normal underwear according to family circumstances, typically age 3-5 years, certainly by age 5. — Marc Levitt (clinical) [Ep 16 · 39:09](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2349)
- Bowel management programs are nurse practitioner-led and begin with anatomic assessment, as any anatomic issues should be corrected first, though bowel management can proceed even with imperfect anatomy. — Marc Levitt (clinical) [Ep 16 · 40:11](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2411)
- Bowel management involves mechanical colon emptying with saline plus additives that provoke stool emptying, with the goal of 24-hour cleanliness between flushes. — Marc Levitt (clinical) [Ep 16 · 41:17](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2477)
- Initial bowel management programs last approximately 4-5 days with X-ray monitoring, but success must be measured at one year, not one week. — Marc Levitt (clinical) [Ep 16 · 42:24](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2544)
- Published research showed bowel management success rates well over 80% at one year for ARM patients, with Hirschsprung's disease being the hardest group due to sphincter dysfunction. — Marc Levitt (clinical) [Ep 16 · 43:16](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2596)
- Approximately 75% of ARM patients should develop their own voluntary bowel control based on good operation, good sacrum quality, and good spine quality. — Marc Levitt (epidemiological) [Ep 16 · 44:31](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2671)
- Approximately 25% of ARM patients will not achieve voluntary bowel control even with perfect surgery due to inadequate sphincters or spinal issues and will require bowel management. — Marc Levitt (epidemiological) [Ep 16 · 44:47](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2687)
- Levitt performs over 100 Malone appendicostomies per year laparoscopically as one-hour procedures with one-night hospital stays. — Marc Levitt (clinical) [Ep 16 · 45:31](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2731)
- The Malone appendicostomy route through the umbilicus makes it easier for older children to administer enemas independently without parental help. — Marc Levitt (clinical) [Ep 16 · 45:54](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2754)
- A full-fledged colorectal center requires an integrated psychologist who meets every patient proactively rather than being called only when problems arise. — Marc Levitt (clinical) [Ep 16 · 46:30](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2790)
- Fecal incontinence is a physiologic problem, not a psychologic problem; many patients receiving extensive psychological help actually need anatomic re-operation and good bowel management first. — Marc Levitt (clinical) [Ep 16 · 48:22](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=2902)
- At dedicated colorectal centers, at least half of the surgical work is reoperative surgery for patients with anatomic issues causing soiling problems. — Marc Levitt (epidemiological) [Ep 16 · 15:21](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=921)
- Modern ARM care originated in Melbourne Australia with Dr. Kelly, who taught Dr. Stevens, who taught Dr. Pena, who revised and launched the PSARP operation in 1980. — Marc Levitt (clinical) [Ep 16 · 52:56](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=3176)
- Greg Ryan went 52 years before meeting another ARM patient, illustrating the historical isolation that modern patient networks have eliminated. — Marc Levitt (epidemiological) [Ep 16 · 51:16](https://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=3076)
- In medicine, care is often uncoordinated: a colorectal surgeon may repair a colorectal problem without addressing a bladder issue, and six months later a urologist discovers the need for intervention after the patient has already had a laparotomy. — Marc Levitt (opinion) [Ep 17 · 1:18](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=78)
- There are approximately 600 newborns with anorectal malformations born per year in the United States. — Marc Levitt (epidemiological) [Ep 17 · 8:05](https://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://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=485)
- Complications of anorectal malformation surgery include fecal incontinence, urinary incontinence, renal dysfunction requiring renal transplant, sexual dysfunction, and infertility. — Marc Levitt (clinical) [Ep 17 · 8:20](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=500)
- If a surgeon misplaces the anus outside the sphincters during surgery on a 6-month-old, the error will not be apparent until the child is 4 years old and attempting to potty train. — Marc Levitt (clinical) [Ep 17 · 8:47](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=527)
- Surgeons are slow to admit they could have a complication until it happens to them personally. — Marc Levitt (opinion) [Ep 17 · 10:38](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=638)
- Approximately 60% of Levitt's practice is reoperative surgery for anorectal malformations. — Marc Levitt (clinical) [Ep 17 · 11:13](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=673)
- In the UK, biliary atresia and bladder exstrophy can only be treated at certain designated medical centers because experience improves outcomes. — Marc Levitt (guideline) [Ep 17 · 6:15](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=375)
- Walmart sends employees anywhere in the United States to Cleveland Clinic for coronary surgery because they have designated it their go-to place for open heart surgery. — Marc Levitt (clinical) [Ep 17 · 7:09](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=429)
- In a collaborative 10-hour operation requiring urology and gynecology, traditional siloed RVU models fail because they do not account for the fact that all participants are essential and cannot do other work during the case. — Marc Levitt (opinion) [Ep 17 · 19:02](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1142)
- Patients with anorectal malformations often have associated Mullerian anomalies (e.g., hemisystems) that, if not identified and addressed during initial abdominal surgery at 6 months, will present as pelvic pain at age 13 due to obstructed menstrual blood. — Marc Levitt (clinical) [Ep 17 · 22:37](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1357)
- Knowledge of associated sacral and spinal problems allows prediction of continence in the neonatal period, enabling clinicians to tell families either that the child will likely be continent with proper management or that continence is unlikely but the child can be kept clean with bowel management. — Marc Levitt (clinical) [Ep 17 · 23:07](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1387)
- Rectourethral fistulas are classified as bladder neck (at the deltoid level), prostatic (at the tricep level), or bulbar (at the elbow level), and each has a different surgical approach and potential outcome. — Marc Levitt (clinical) [Ep 17 · 24:11](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1451)
- Common technical errors in anorectal malformation surgery include placing the anus too far posterior (outside the sphincter center), creating a stricture, leaving a remnant of the original fistula, and causing rectal prolapse. — Marc Levitt (clinical) [Ep 17 · 25:09](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1509)
- Reoperative surgery for misplaced anus and other technical errors can convert a significant number of patients to continence and improve quality of life. — Marc Levitt (clinical) [Ep 17 · 25:55](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1555)
- The baseline surgical site infection rate after colostomy and ileostomy closure was 22.4%, which is standard in the literature. — Marc Levitt (clinical) [Ep 17 · 26:43](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1603)
- Implementing a GI bundle (most importantly, changing instruments and gloves before closing the fascia) reduced the surgical site infection rate to 7.9%. — Marc Levitt (clinical) [Ep 17 · 27:11](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1631)
- Organisms growing in surgical site infections after colostomy closure were resistant to the preoperative antibiotic (cefoxitin) given within an hour of incision. — Marc Levitt (clinical) [Ep 17 · 27:22](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1642)
- Switching the preoperative antibiotic from cefoxitin to Unasyn (based on wound culture data and infectious disease consultation) reduced the surgical site infection rate to 2.2%. — Marc Levitt (clinical) [Ep 17 · 27:53](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1673)
- In cloacal malformations, if the residual urethra after reconstruction will be shorter than 1.5 cm, the patient will be urinary incontinent ('wet'); leaving adequate urethral length preserves continence. — Marc Levitt (clinical) [Ep 17 · 29:45](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1785)
- In a coordinated operation for a child with myelomeningocele and urinary and fecal incontinence, the sigmoid colon can be resected to improve bowel care but preserved on its mesentery and used for bladder augmentation, and the appendix can be divided to create both a Malone antegrade enema channel (proximal) and a Mitrofanoff catheterizable channel (distal). — Marc Levitt (clinical) [Ep 17 · 32:09](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=1929)
- The Pediatric Colorectal and Pelvic Learning Consortium has collected data on 22,200 patients across 15 centers over three years, allowing real-time queries such as the incidence of enterocolitis in Hirschsprung disease. — Marc Levitt (clinical) [Ep 17 · 36:02](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2162)
- The Sir Dennis Browne medal from the British Association of Paediatric Surgeons states that 'the aim of pediatric surgery is to set a standard, not to seek a monopoly.' — Marc Levitt (opinion) [Ep 17 · 36:30](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2190)
- In most departments of surgery, clinicians do not know their wound infection, death, or line infection rates in real time, unlike industries such as airlines, which track delay statistics daily. — Marc Levitt (opinion) [Ep 17 · 38:45](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2325)
- Tissue engineering (e.g., engineered vaginal tissue) will revolutionize cloacal reconstruction by eliminating the need to use bowel. — Marc Levitt (opinion) [Ep 17 · 39:30](https://library.globalcastmd.com/watch/2019-chandler-lecture-dr-marc-levitt-13827?t=2370)
- In medicine, complex problems are often approached in a disorganized manner analogous to building a bridge by having cement layers start on Monday, steel workers arrive Tuesday without knowing what to do, architect on Wednesday, and engineers on Thursday. — Marc Levitt (opinion) [Ep 18 · 0:22](https://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), a condition most families have never heard could go wrong. — Marc Levitt (clinical) [Ep 18 · 1:32](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=92)
- A cloacal malformation is demonstrated on fetal MRI at 20 weeks gestation, showing bladder, gynecologic system, and colon system all converging as one opening. — Marc Levitt (clinical) [Ep 18 · 1:54](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=114)
- A cloacal malformation with all urinary, gynecologic, and colonic structures coming together as one opening is not compatible with life and once surgically solved has unique implications on the child's quality of life. — Marc Levitt (clinical) [Ep 18 · 2:20](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=140)
- In cloacal malformations, all anatomic structures (urinary, gynecologic, colonic) are right next to each other, each handled by a different type of doctor, requiring collaborative work to manage the patient. — Marc Levitt (clinical) [Ep 18 · 2:39](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=159)
- Twenty-five years ago, the speaker's mentor attempted to function as colorectal surgeon, urologist, and gynecologist for these patients, but as medicine became more complicated, the speaker felt incapable of solving all problems without a unified team approach. — Marc Levitt (opinion) [Ep 18 · 2:53](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=173)
- A multidisciplinary team for complex colorectal patients should include GI motility specialists, medical colorectal specialists, colorectal surgeons, gynecologic surgeons, and urologic surgeons working together. — Marc Levitt (opinion) [Ep 18 · 3:50](https://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://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=347)
- Surgeons must park their egos at the door when sharing patients in a collaborative model. — Marc Levitt (opinion) [Ep 18 · 6:03](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=363)
- Hospital barriers to collaborative care include questions about billing, clinic scheduling with all doctors in the same place on the same day (not efficient), and productivity concerns when a specialist is needed for only 2 hours of a 10-hour operation. — Marc Levitt (opinion) [Ep 18 · 6:12](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=372)
- A specialist cannot leave during a long operation to do other work because when needed, they must be immediately available while the patient is under anesthesia. — Marc Levitt (clinical) [Ep 18 · 6:33](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=393)
- From the patient perspective, gathering multiple specialists together is difficult, especially when experts are in different cities, requiring families to schedule multiple appointments at different times and dates, possibly requiring air travel and sibling care arrangements. — Marc Levitt (opinion) [Ep 18 · 6:41](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=401)
- 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://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=426)
- In a patient (Rebecca) with both a non-functioning colon segment and a bladder that was too small, a section of colon can be removed from the fecal stream and added to the bladder to make it bigger, performed simultaneously in one operation. — Marc Levitt (clinical) [Ep 18 · 7:20](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=440)
- Normally, bladder augmentation would be performed and six months later someone would do the colon work, rather than coordinating both procedures in advance in one operation. — Marc Levitt (clinical) [Ep 18 · 7:46](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=466)
- A collaborative care model requires deep infrastructure including coordinators, administrative assistants, schedulers, and multiple types of nurses (floor, OR, clinic) with different areas of expertise. — Marc Levitt (opinion) [Ep 18 · 8:00](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=480)
- An institution must commit significant infrastructure to make collaborative care work, with the expectation that done correctly, more patients can be helped. — Marc Levitt (opinion) [Ep 18 · 8:11](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=491)
- Nationwide Children's Hospital successfully implemented the collaborative care model after the speaker had tried at other institutions where no one bought into the collaborative process. — Marc Levitt (opinion) [Ep 18 · 8:36](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=516)
- The siloed approach was the traditional way of medicine, requiring convincing to change. — Marc Levitt (opinion) [Ep 18 · 8:46](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=526)
- In the collaborative model, one plus one can equal three and the sum is greater than the individual parts. — Marc Levitt (opinion) [Ep 18 · 8:55](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=535)
- The collaborative care model could spread to other hospital areas, such as a limb program requiring orthopedic surgery, rehabilitation medicine, and other specialties meeting together before the patient arrives and seeing the patient on the same day. — Marc Levitt (opinion) [Ep 18 · 9:06](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=546)
- A patient (Rebecca) would have benefited much more from the collaborative process available today than when the speaker first met her 25 years ago. — Marc Levitt (opinion) [Ep 18 · 9:33](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=573)
- An 8-year-old patient (Michael) with daily fecal soiling was being teased at school so badly his parents pulled him out of school. — Marc Levitt (clinical) [Ep 18 · 9:50](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=590)
- The speaker promised an 8-year-old with daily soiling that in one week he would be clean and in normal underwear, and one week later the patient achieved this outcome. — Marc Levitt (clinical) [Ep 18 · 10:07](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=607)
- Because of the collaborative process, the team is able to make promises to patients and keep them. — Marc Levitt (opinion) [Ep 18 · 10:34](https://library.globalcastmd.com/watch/time-for-some-patient-driven-change-marc-levitt-tedxcolumbus-13828?t=634)
- Ghana was selected as an ideal location to create a West African center for colorectal problems because it already had very good expertise and infrastructure to handle complex cases — Marc Levitt (opinion) [Ep 20 · 1:24](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=84)
- The goal is to create in Ghana a center where children from all of Africa could come for colorectal problems — Marc Levitt (opinion) [Ep 20 · 1:43](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=103)
- Some families of children receiving treatment travel from very far distances and don't know anybody in Accra (clinical) [Ep 20 · 2:24](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=144)
- Dr. Alberto Peña is the director of the Colorectal Center at Cincinnati Children's Hospital. — Alberto Peña (clinical) [Ep 19 · 0:26](https://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=26)
- Dr. Peña advises young surgeons asking for the key to success to focus on doing each operation—even a routine hernia—as the best in the world. — Alberto Peña (opinion) [Ep 19 · 1:45](https://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=105)
- Dr. Peña's philosophy is to concentrate on what you do and leave the rest to the gods. — Alberto Peña (opinion) [Ep 19 · 2:14](https://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=134)

## 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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/colorectal-quiz-episode-43-13850?t=961)
- Some centers are beginning irrigation competency training even before ostomy takedown in Hirschsprung's disease patients. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Early irrigation training may help families and patients adapt earlier and potentially reduce post-operative enterocolitis risk. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Robotic-assisted surgery is being used in pediatric colorectal procedures. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- ICG fluorescence imaging improves visualization of blood supply during pull-through procedures. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- ICG fluorescence imaging helps surgeons reduce complications like leaks and ischemia during pull-through procedures. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- High-frequency ultrasound may help measure bowel wall muscle thickness to identify aganglionic segments in Hirschsprung's disease. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- High-frequency ultrasound may potentially support or supplement traditional biopsy-based diagnosis of Hirschsprung's disease. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Reduced mucus protection in proximal bowel segments may contribute to microbial imbalance and breakdown of the intestinal barrier in enterocolitis. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Mechanical stress on the bowel wall may contribute to microbial imbalance and breakdown of the intestinal barrier in enterocolitis. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Long-term outcomes in pediatric colorectal conditions depend not only on surgical technique but also on ongoing bowel management, education, and coordinated care. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Perineal-preserving PSARP is a new procedure for anorectal malformations that aims to reduce complications while improving functional outcomes. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Posterior rectal advancement anoplasty (PRAA) is a new procedure for anorectal malformations that aims to reduce complications while improving functional outcomes. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Stronger transition programs are needed to support patients with congenital colorectal conditions moving into adulthood. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- Multidisciplinary teams including gynecology, urology, and sexual health specialists are needed to support patients with congenital colorectal conditions into adulthood. — Marc Levitt summarizing a resource [Ep 13 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-ep-50-16th-annual-european-pediatric-colorectal-pelvic-reconstruction-conference-13817?t=0)
- When you upload documents to Notebook LM, you create your own expert from only the provided documents, not from external sources — Em Gootee summarizing the discussion [Ep 14 · 5:56](https://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 digestive, urinary, reproductive, and sometimes musculoskeletal systems — The host summarizing the discussion [Ep 14 · 11:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=705)
- Conditions requiring multidisciplinary care include anorectal malformations (ARM), Hirschsprung disease, severe constipation from colonic motility issues, and neurogenic bladder/bowel dysfunction in spina bifida — The host summarizing the discussion [Ep 14 · 12:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=736)
- These conditions significantly affect children's quality of life, create family stress, and can contribute to mental health issues — The host summarizing the discussion [Ep 14 · 12:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=775)
- 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://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 — The host summarizing the discussion [Ep 14 · 14:09](https://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 vision for improving colorectal care quality — The host summarizing the discussion [Ep 14 · 14:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=874)
- Program leaders must assess local healthcare landscape: genuine need, feasibility given existing services, and underserved patient populations — The host summarizing the discussion [Ep 14 · 15:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=916)
- Initial essential specialties for multidisciplinary colorectal programs are general surgery, urology, gynecology, GI motility specialist, and dedicated nursing team — The host summarizing the discussion [Ep 14 · 15:58](https://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 one, the program won't function effectively regardless of surgeon expertise — The host summarizing the discussion [Ep 14 · 16:19](https://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 is advantageous for staying current on best practices — The host summarizing the discussion [Ep 14 · 16:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1002)
- Complex colorectal cases often require combined surgical expertise from pediatric surgery, urology, and gynecology in the operating room — The host summarizing the discussion [Ep 14 · 17:11](https://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 cases, a pediatric surgeon may manage gynecologic aspects for female patients — The host summarizing the discussion [Ep 14 · 17:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1038)
- If involving an adult gynecologist, they must have specific expertise in Müllerian anomalies or disorders of sexual development — The host summarizing the discussion [Ep 14 · 17:28](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1048)
- GI colleagues need interest in motility and performing manometry studies, which measure muscle contractions in the digestive tract to diagnose bowel function issues — The host summarizing the discussion [Ep 14 · 17:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1078)
- Programs need clear guidelines for managing constipation, referral criteria to the multidisciplinary team, and definitions of when standard medical treatments have failed — The host summarizing the discussion [Ep 14 · 18:16](https://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 pelvic floor physical therapy to strengthen bowel control muscles are key program components — The host summarizing the discussion [Ep 14 · 18:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1111)
- Radiologists need education on colorectal diseases and proper performance/interpretation of contrast enemas, colostograms, and cloicograms — The host summarizing the discussion [Ep 14 · 19:04](https://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 interprets findings consistently — The host summarizing the discussion [Ep 14 · 19:32](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1172)
- A pathologist with expertise in intestinal disorders like Hirschsprung disease ensures correct tissue handling and interpretation — The host summarizing the discussion [Ep 14 · 19:43](https://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 patient needs and developing coordinated care plans — The host summarizing the discussion [Ep 14 · 20:31](https://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 feasible, coordinating same-day appointments across different locations is an acceptable alternative — The host summarizing the discussion [Ep 14 · 20:45](https://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 your own hospital — The host summarizing the discussion [Ep 14 · 21:32](https://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 local needs — The host summarizing the discussion [Ep 14 · 22:05](https://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 hands-on surgical experience — The host summarizing the discussion [Ep 14 · 23:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1401)
- Systematically collecting data on your own patients and joining research networks or consortia advances the field — The host summarizing the discussion [Ep 14 · 23:31](https://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, neurogenic bladder/bowel, and skills in pre/postoperative care including bowel irrigations, enemas, catheter management, and teaching families anal dilations — The host summarizing the discussion [Ep 14 · 24:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1461)
- The nurse must understand treatment plans from all specialists to effectively communicate with families — The host summarizing the discussion [Ep 14 · 24:50](https://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://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1508)
- Essential clinic 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 14 · 25:45](https://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://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/outpatient), length of stay, revenues, expenses, and complication rates — The host summarizing the discussion [Ep 14 · 26:56](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1616)
- Documenting nursing telephone encounters is important to justify adequate nursing staffing, as these patients require significant ongoing support and care plan adjustments — The host summarizing the discussion [Ep 14 · 27:26](https://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://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 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://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 those who have managed these conditions themselves for years — The host summarizing the discussion [Ep 14 · 30:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1802)
- By successfully managing patients referred for focused care like bowel management, programs gradually demonstrate the value of the multidisciplinary approach — The host summarizing the discussion [Ep 14 · 30:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1821)
- Many patients initially referred for management issues will likely need further surgical intervention later — The host summarizing the discussion [Ep 14 · 30:44](https://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 prevent nurses from spending disproportionate time on scheduling — The host summarizing the discussion [Ep 14 · 31:35](https://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 departments (e.g., allocating partial nurse time from general surgery) is a cost-effective way to start — The host summarizing the discussion [Ep 14 · 32:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=1930)
- Most hospitals have planning and data analysis staff with expertise in developing business cases; engaging these internal resources early is smart — The host summarizing the discussion [Ep 14 · 33:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2037)
- Establishing a true center of excellence takes time and sustained effort, requiring a multi-year plan with clear milestones for additional resources and expected results — The host summarizing the discussion [Ep 14 · 35:12](https://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 (Medicaid) and private insurance companies in both home state and neighboring states — The host summarizing the discussion [Ep 14 · 35:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2147)
- In established programs, weekly new patient intake meetings involve nursing-led preparation: gathering records, developing initial multidisciplinary care plans, verifying information with families, and addressing pre-certification/billing issues — The host summarizing the discussion [Ep 14 · 36:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2217)
- 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://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2251)
- For families traveling significant distances, programs consolidate as many appointments as possible into a single visit — The host summarizing the discussion [Ep 14 · 37:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-49-collaborating-for-kids-colorectal-pelvic-care-13820?t=2277)
- 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://library.globalcastmd.com/watch/episode-19-interview-with-dr-marc-levitt-chief-of-colorectal-pelvic-reconstruction-children-s-13825?t=51)
- 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 summarizing the discussion [Ep 20 · 0:16](https://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 in Accra — The host summarizing the discussion [Ep 20 · 0:26](https://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 summarizing the discussion [Ep 20 · 0:33](https://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 — The host summarizing the discussion [Ep 20 · 0:41](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=41)
- More than 25 children were treated during the surgical exercise, which is the 2nd time the Cincinnati Children's Hospital team has operated in Ghana — The host summarizing the discussion [Ep 20 · 0:56](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=56)
- Colorectal deformities prevent a child from passing bowel movements naturally through the anus — The host summarizing the discussion [Ep 20 · 1:04](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=64)
- According to Dr. Mark Levitt, if emergency surgery is not conducted in cases of anorectal malformations, the complication may be life threatening — The host summarizes what Dr. Marc Levitt said [Ep 20 · 1:11](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=71)
- Some colorectal deformities could be genetic — The host summarizing the discussion [Ep 20 · 1:21](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=81)
- Korle Bu Teaching Hospital has collaborated with the Cincinnati Children's Hospital medical team for the past 4 years — The host summarizing the discussion [Ep 20 · 1:57](https://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 — The host summarizing the discussion [Ep 20 · 1:57](https://library.globalcastmd.com/watch/cincinnati-children-s-hospital-medical-team-in-korle-bu-13830?t=117)
- Dr. Peña developed a new operation in the 1970s that no one had thought about before. — The host summarizing a resource [Ep 19 · 0:34](https://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 Pena procedure, but at Cincinnati Children's it is called the posterior sagittal anorectoplasty due to Dr. Peña's humility. — The host summarizing a resource [Ep 19 · 0:43](https://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 and Dr. Peña's name on the map. — The host summarizing a resource [Ep 19 · 0:51](https://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=51)
- Over approximately 20 years, patients came to have the procedure and surgeons came to learn it. — The host summarizing a resource [Ep 19 · 0:59](https://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 scope to all other colorectal fields has occurred in the last 6 to 10 years. — The host summarizing a resource [Ep 19 · 1:07](https://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, telling the world what they are doing, and having a vision of being able to do a better job than others. — The host summarizing a resource [Ep 19 · 1:16](https://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. — The host summarizing a resource [Ep 19 · 1:38](https://library.globalcastmd.com/watch/tell-me-a-story-pediatric-surgeons-putting-colorectal-center-on-the-map-13829?t=98)

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