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Based on 30 years of experience as a surgeon working in the field of pediatric colorectal and pelvic reconstructive surgery, author Marc Levitt shares the tips and tricks that he has developed to make operations and patient management easier and reproducible. This book teaches these skills to achieve positive results. Patients with anorectal malformations (ARMs), Hirschsprung disease (HD), fecal incontinence from a variety of conditions, colonic motility disorders, and a myriad of other conditions comprise the field of pediatric colorectal and pelvic reconstruction. Such patients require care throughout their lives from specialists across numerous fields, which may include colorectal surgery, urology, gynecology, and GI motility, as well as specialized nursing, orthopedics, neurosurgery, anesthesia, pathology, radiology, psychology, social work, and nutrition. Sometimes the field can seem chaotic and unpredictable. Reconstruction requires creativity and at times it feels that artwork is being created during the actual operation with no pre-plan in mind. Marc Levitt and his colleagues have worked very hard to counter that feeling, to be fully prepared, and to develop protocols, techniques, and processes that can be adopted by other clinicians, so that optimal results for patients can be achieved. This book reflects both this experience and this approach.
Anorectal and Cloacal Malformations
Newborn Anorectal Malformations
Predictors of Continence
Operative Decision Making
Operative Techniques
Anal Stenosis, Rectal Atresia, and Presacral Mass
Cloaca
Postoperative Care of a PSARP Incision
Rare Cases
Anorectal Malformation Myths
Hirschsprung Disease
Diagnosis
The Pull-Through
Total Colonic Hirschsprung Disease
Late Diagnosis Hirschsprung Disease
Hirschsprung Disease Myths
Functional Constipation and Fecal Incontinence
Bowel Management
Evaluation of Constipation and Surgical Adjuncts
Malone Appendicostomy (Antegrade) or Enemas (Retrograde) for Colonic Cleaning
Malone Complications and Troubleshooting
Laxatives
Thickening the Stool with Fiber
Bacterial Overgrowth
Sharing Tissues
Functional Constipation and Fecal Incontinence Myths
Post-PSARP and Post-HD Pull-Through Problems
Problems after PSARP
Deciding When to Do a Redo Procedure in ARM
Problems after an HD Pull-Through
Deciding When to Do a Redo Procedure in HD
Miscellaneous Colorectal Topics and Techniques
Operating Room Setup and Positioning
Stomas
Ischiorectal Fat Pad
Miscellaneous Colorectal Conditions