When Nicklaus Children's Hospital clinicians and administrators surveyed the statewide pediatric medical landscape in 2017, they identified a gap in colorectal care. Specialists were available, but they weren't consolidated within a comprehensive program. In response, they gathered their human and technological resources and developed the Colorectal Center at Nicklaus Children's. The program launched in 2018 and has become a referral center within Florida and beyond, with many patients traveling from Latin America and the Caribbean.

“In the past, these patients traveled to many different hospitals to see all the necessary specialists who only saw a few cases each year,” says Juan Calisto, MD, pediatric surgeon and Director of the Colorectal Center at Nicklaus Children's. “By focusing on colorectal pediatric patients, we see hundreds of these cases annually, which gives us a rare advantage.”

Recognized Colorectal Excellence

This advantage yields significant benefit to pediatric patients and their families. Most importantly, Dr. Calisto states that the focused team translates to positive outcomes for this pediatric population. At the Colorectal Center, gastroenterologists, urologists and surgeons work alongside nurses, assistants, nutritionists, child life specialists, case managers and others. Each has experience and intimate familiarity with pediatric colorectal conditions.

“Optimizing care for pediatric colorectal patients requires a team approach involving diverse specialties,” Dr. Calisto says. “Our collaborative approach to care planning and treatment makes our process seamless.”

Thanks to this approach, the Colorectal Center quickly became a trusted referral center. Six years after its opening, the Colorectal Center now cares for more than 1,000 pediatric patients on an annual basis. Each patient receives a comprehensive diagnostic work-up, an individualized treatment plan and appropriate ongoing management.

Conditions commonly treated at the Colorectal Center include:

• Anorectal malformation “imperforate anus”
• Hirschsprung disease
• Ulcerative colitis
• Crohn's disease
• Uterine and vaginal anomalies
• Rectal prolapse
• Severe constipation
• Fecal incontinence
• Reoperative surgery

Unique Offerings and an Open-Door Policy

As a comprehensive program, the Colorectal Center provides care for the full spectrum of colorectal needs. The team of experts uses state-of-the-art diagnostic tools, such as molecular diagnosis, 3D radiological imaging and the latest techniques for colorectal issues. The surgeons perform between 120 and 150 complex procedures annually. Additionally, Nicklaus Children's is one of only a few facilities in the United States offering robotic pediatric colorectal surgery, uniquely positioning these specialists to provide exceptional care.

The team also performs revisional surgery on behalf of referring surgeons, correcting surgical attempts that do not yield the intended results. Such offerings realize immediate, tangible benefits that change children's lives. Children achieve healthy bowel function, have daily bowel movements, experience no pain and return to life without needing absorbent briefs.

Because all children cannot access Nicklaus Children's, Colorectal Center surgeons want to duplicate their success and help others achieve the same outcome for their patients. When patients come to the Colorectal Center via referral, the Colorectal Center does more than keep the referring provider in the loop.

“We invite referring physicians to be involved at whatever level they desire,” Dr. Calisto says. “Some surgeons are even involved in the operation, so they can see the technique we use.”

Once surgeons understand the techniques, they take their newfound knowledge wherever they serve children. Dr. Calisto sees this as a positive net outcome, as it allows children to undergo life-changing surgery without leaving their home city or country.

Improving Colorectal Care Through Partnerships

The quality of care offered at the Colorectal Center is evidenced by its lower-than-national-average infection and complication rates. Center clinicians continuously seek opportunities for enhancement, reviewing infection and complication data on a quarterly basis to identify ways to improve care.

The team also aims to improve care for pediatric colorectal patients worldwide. A series of strategic partnerships helps them achieve this goal.

• Children's National in Washington, D.C. Clinicians share protocols and techniques, and surgeons from each facility operate at partner facilities once or twice a year to foster deeper collaboration.
• Cleveland Clinic Florida. Clinicians share protocols and techniques and model advanced colorectal techniques for inflammatory bowel disease, particularly among the 18- to 21-year-old patient population.
• Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). As members of the national consortium of colorectal surgeons, Nicklaus Children's clinicians enter patient outcomes and other information into the organization's database. Clinicians also participate in trials and perform research through the partnership.

The future holds much promise, as the Colorectal Center offers excellent results and is pushing the field forward through innovative research. One area of particular interest is same-day surgery. Now common for many adult procedures, Dr. Calisto hopes this development will spread to the pediatric realm. With the increasing footprint of robotic assistance and other minimally invasive techniques, it may be a reality soon.

“That's the next step in the future of pediatric surgery,” Dr. Calisto says. “That's what we're striving for.”