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Ulcerative Colitis
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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At this point, the Duhamel is really only appropriate for an ileoduhamel, although Levitt would still do an ileoanal. — Marc Levitt, The Colorectal Quiz Episode 21: The History of Hirschsprung Disease · 4:22
The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
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The treatment for Hirschsprung disease has undergone tremendous evolution over the past century. Here, Dr. Marc Levitt and Dr. Jason Frischer discuss the history of Hirschsprung disease and how the treatment has improved to what we know tod
video15:20 · Jul 2026
The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia. Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018 · 2:58
Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discuss the top ten practice gaps of 2018. Here they discuss type of maintenance fluid, emphasizing use of normotonic fluids to reduce ri
video5:57 · Sep 2018
National anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding. — Matt Kurt, Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016 · 4:00
Ulcerative Colitis and Familial Adenomatous Polyposis: Update Course 2016
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At the 4th Annual Stay Current in Pediatric Surgery Update Course in 2016, Dr. Jason Frischer discusses management techniques of ulcerative colitis and familial adenomatous polyposis. Topics of discussion include nutrition, steroids, thromb
video46:16 · Sep 2018
Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016
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Dr. Kurt Heiss discusses enhanced recovery after surgery programs (ERAS). This presentation includes discussion of enhanced healing mechanisms through means of nutrition, electrolyte consumption, decreasing the length of stay, no narcotics,
video44:22 · Jan 2019
Inflammatory Bowel Disease: Update Course 2015
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Dr. Samir Pandya,Assistant Professor, Department of Surgery, Children's and Women's Physicians of Westchester presents on inflammatory bowel disease. He discusses management of ulcerative colitis, indeterminate colitis, colectomy, and J-pou
video13:49 · Jan 2019
The Duhamel is now really only appropriate for an ilio-Duhamel, although Levitt would still do an ilioanal. — Marc Levitt, The Colorectal Quiz Episode 21: The History of Hirschsprung Disease · 0:26
The Role of Diversion During Ileal Pouch Anal Anastomosis (IPAA) Creation in Pediatric Ulcerative Colitis - JPS
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New article you should know from Journal of Pediatric Surgery by Cecilia Gigena
"The Role of Diversion During Ileal Pouch Anal Anastomosis (IPAA) Creation in Pediatric Ulcerative Colitis"
Authors: Ursula Adams, Chris Agala, Topher Mc
video · Feb 2024
El papel de la ostomía durante la creación del Pouch ileal coon anastomosis anal (IPAA) en la colitis ulcerosa pediátrica - JPS
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Nuevo articulo que tenes que conocer de la revista JPS por la Dra. Cecilia Gigena
"El papel de la ostomía durante la creación del Pouch ileal coon anastomosis anal (IPAA) en la colitis ulcerosa pediátrica"
Autores: Ursula Adams, Chris
video · Feb 2024
The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
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The treatment for Hirschsprung disease has undergone tremendous evolution over the past century. Here, Dr. Marc Levitt and Dr. Jason Frischer discuss the histor
podcast15:56 · Jul 2026
If a patient has received infliximab within the last 6 weeks, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk. Inflammatory Bowel Disease: Update Course 2014 · 28:11
Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014
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Dr. Samir Pandya presents case studies of Crohn's disease of ulcerative colitis.Discussion involved imaging modalities in Crohn's Disease, diagnosis of fibrostenotic and fistulizing Crohn's disease, endorectal advancement flap, permanent di
video28:36 · Nov 2018
Inflammatory Bowel Disease: Update Course 2014
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Dr. Samir Pandya presents case studies of Crohn disease and ulcerative colitis. Discussion involves imaging modalities, diagnosis and management of fibrostenotic and fistulizing Crohn disease, endorectal advancement flap, permanent diversio
video28:36 · Jan 2019
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Expert statements from the recordings in this collection.
The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
Harold Hirschsprung identified that a baby could be sick due to this problem but did not understand the pathology.
clinicalMarc Levitt0:26 ↗
The disease is named Hirschsprung disease, not apostrophe S.
guidelineMarc Levitt0:26 ↗
Orvar Swenson figured out the pathology by going to the pathology lab and defined the fact that there were no ganglion cells.
clinicalMarc Levitt0:26 ↗
Prior to Swenson's work, removal of the dilated colon was the treatment, which was a mistake; it was the distal narrow colon that was the problem.
clinicalMarc Levitt0:26 ↗
Swenson developed the first operation for Hirschsprung disease, a full-thickness rectal dissection.
clinicalMarc Levitt0:26 ↗
Some surgeons still do Suave procedures, but they are becoming more Swenson-like with maybe a one-centimeter cuff; Dan von Allman calls those 'Suavesons with a one-centimeter cuff.'
opinionMarc Levitt0:26 ↗
Dr. Yancey was the first surgeon to describe a submucosal dissection for Hirschsprung disease, but published in a journal not widely read; Dr. Suave published later in a more widely read journal, so the technique is called Suave rather than Yancey.
clinicalMarc Levitt0:26 ↗
The Suave technique was developed because people said the Swenson caused fecal and urinary incontinence or voiding dysfunction; Swenson himself wrote that the operation was good but surgeons were doing it wrong by dissecting too wide.
clinicalMarc Levitt0:26 ↗
Doing a proper Swenson right on the bowel wall, like a PSARP right on the bowel wall, avoids nerve injury; if you see fat you can get closer, as the nerves are in the fatty layer.
clinicalMarc Levitt0:26 ↗
Swenson was 105 when he died and used to write letters to Levitt and Alberto Pena asking them to promote the Swenson operation.
clinicalMarc Levitt0:26 ↗
Duhamel had the idea to leave the original rectum behind and do a pull-through next to it, then mate the two lumens.
clinicalMarc Levitt0:26 ↗
The Duhamel is now really only appropriate for an ilio-Duhamel, although Levitt would still do an ilioanal.
opinionMarc Levitt0:26 ↗
Rabine did a low anterior resection for Hirschsprung disease, leaving about six centimeters behind; some patients did fine as ganglionated bowel pooped through the six centimeters of aganglionated bowel, but that operation has gone to the wayside.
clinicalMarc Levitt0:26 ↗
Dr. Boley was the first to do the primary coloanal anastomosis of a Suave, eliminating the need to leave the bowel hanging out and come back at day seven; the proper description is the Suave technique with the Boley modification, i.e., a Suave-Boley.
clinicalMarc Levitt5:57 ↗
Henry So was a pediatric surgeon in the Philippines and the first to do a primary pull-through (transabdominal) with no preceding stoma, because patients with stomas at home in the Philippines faced such social stigma that babies were basically left to die by their families.
clinicalMarc Levitt5:57 ↗
Dr. Martin was the first surgeon-in-chief and pediatric surgeon at Cincinnati Children's Hospital.
clinicalJason Frischer9:40 ↗
Dr. Martin developed the Martin procedure, an expansion of the Duhamel for long-segment Hirschsprung disease, leaving a longer aganglionated segment of rectum and pulling through ganglionated bowel.
clinicalJason Frischer9:40 ↗
Dr. Martin's biggest contribution was in ulcerative colitis; in 1977, before the J-pouch, he took the endorectal pull-through technique used in Hirschsprung disease and applied it to ulcerative colitis, doing a total proctocolectomy with ilioanal anastomosis.
clinicalMarc Levitt10:34 ↗
The transanal dissection and Suave plane dissection is the same concept as the mucosectomy in ulcerative colitis.
clinicalMarc Levitt10:34 ↗
Helen Noblet figured out the suction rectal biopsy; she is from Melbourne, Australia.
clinicalMarc Levitt11:41 ↗
Keith Jorgensen did the laparoscopic version of the Suave; in his original description (with Tom Inge on the paper), they talked about leaving a five-centimeter cuff, which nowadays would be way too much.
clinicalMarc Levitt11:41 ↗
Jack Langer approached Hirschsprung disease transanally, doing a transanal resection of the rectosigmoid with or without laparoscopy or laparotomy.
clinicalMarc Levitt11:41 ↗
Luis de la Torre also did transanal resection around the same time as Jack Langer; some places around the world are doing transanal only, and Levitt does that in certain circumstances.
clinicalMarc Levitt11:41 ↗
Dan Teitelbaum did an incredible amount of work in Hirschsprung disease, particularly significant research in enterocolitis; he passed away from a brain tumor.
clinicalMarc Levitt11:41 ↗
Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018
Iatrogenic hyponatremia is one of the biggest problems in hospitals, related to ADH physiology and the use of hypotonic fluids rather than normal saline.
clinical1:23 ↗
Children become hyponatremic because they are given half normal saline, and the data on this are clear.
clinical1:23 ↗
The correct maintenance fluid for a 15-year-old post-colectomy patient is D5 normal saline with 20 milliequivalents of potassium.
guideline2:05 ↗
The American Academy of Pediatrics is coming out with a consensus statement on isotonic maintenance fluids (anticipated as of March).
guideline2:31 ↗
Hospitalized children develop hyponatremia because they receive less than isotonic (hypotonic) solutions, leading to cerebral edema and other complications.
clinical2:31 ↗
The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia.
guideline2:58 ↗
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