Baby being changed on a bed. Pediatric Colorectal Surgery

Pediatric Colorectal Surgery: Conditions We Treat And What Families Can Expect

Colorectal problems in children can be stressful for the entire family, especially when they affect nutrition, growth, toileting, and day-to-day comfort. You want straight answers, a clear plan, and a team that understands how children heal. At Pacific Coast Pediatric Surgery, Dr. Philip K. Frykman provides specialized evaluation and treatment for newborns, infants, children, and adolescents, with continuity into early adulthood when congenital conditions require long-term follow up. This guide explains the conditions we treat, how we diagnose and plan care, what surgery and recovery look like, and how we support your child’s continence and quality of life over time.

Conditions We Treat

Anorectal malformations (a.k.a. Imperforate anus)
These conditions involve an anus that is either missing or positioned incorrectly. They may be identified at birth or soon after. We carefully evaluate the anorectal anatomy, associated anomalies, and functional considerations, and create a tailored plan that focuses on proper reconstruction and long-term continence.

Hirschsprung disease
In Hirschsprung disease, a section of bowel (most commonly the rectum and colon) lacks specialized nerve cells (ganglion cells) that coordinate movement, leading to severe constipation, abdominal distention, vomiting, or delayed passage of meconium in newborns. Diagnosis is confirmed by rectal biopsy. Treatment removes the non-functioning segment of bowel and restores continuity.

Fecal incontinence and complex constipation
Some children struggle with continence after pull-through surgery for anorectal malformations, Hirschsprung disease, or due to motility problems. Others have constipation related to functional or structural issues that have not responded to standard therapies. We design bowel management programs that may include dietary changes, medications, pelvic floor strategies, timed toileting routines, enemas, or advanced options for continence support.

Rectal prolapse
When the rectum protrudes from the anus, it can cause bleeding, discomfort, and hygiene challenges. We begin with nonoperative measures and move to procedures such as laparoscopic rectopexy when needed.

Constipation related structural problems
Anal stenosis, strictures, and other structural concerns can contribute to difficult stools, pain, and soiling. Evaluation defines the cause so we can offer targeted interventions that relieve symptoms and protect function.

How We Evaluate Your Child

History and physical examination
We start with careful listening to understand feeding patterns, stooling history, growth, prior surgery, and daily challenges at home and school, then a focused examination is performed in a child sensitive manner.

Imaging and diagnostic tests
Ultrasound, contrast enema, or MRI may refine anatomy. Anorectal manometry and examination under anesthesia can help assess sphincter tone and pelvic floor function. For suspected Hirschsprung disease, rectal biopsy confirms the diagnosis.

Multidisciplinary collaboration
We coordinate with pediatric gastroenterology, pediatric urology, radiology, anesthesia, and child life specialists. Many children with anorectal malformations have urinary or spinal considerations; integrated care enhances safety and long-term outcomes.

Clear discussion and written plans
You receive plain language explanations of findings, timing and options, anesthesia plans tailored to children, pain control, and how to reach us with questions. We outline feeding progression, activity guidance, and school return expectations.

Surgical Options We Offer

Pull-through operations
For Hirschsprung disease, we remove the aganglionic segment and connect healthy bowel to the anus. When appropriate, we use minimally invasive techniques that aim to reduce pain, scarring, and hospital stay while protecting function.

Posterior sagittal anorectoplasty (PSARP also referred to as the “Pena Procedure”) and minimally invasive Laparoscopic-assisted anorectal pull-through (LAARP)
For anorectal malformations, PSARP and LAARP precisely positions the rectum within the sphincter complex. The approach is individualized to your child’s anatomy and associated conditions, with early attention to continence training and skin care.

Malone antegrade continence enema (MACE)
Some children benefit from a catheterizable channel that allows antegrade enemas through the abdomen for predictable emptying. MACE can be life changing for children with severe constipation or fecal incontinence who have not found success with other methods.

Laparoscopic rectopexy
For recurrent rectal prolapse or prolapse associated with constipation and pelvic floor dysfunction, laparoscopic rectopexy secures the rectum and can reduce symptoms. We combine surgery with bowel management to address the underlying drivers of prolapse.

Minimally invasive focus
Whenever safe and appropriate, we use child specific minimally invasive techniques. Smaller incisions may reduce discomfort and speed recovery, though the choice of approach always follows what is safest for your child and best for long-term function. Families seeking a regional resource can explore laparoscopic pediatric colorectal surgery in Los Angeles and Calabasas on our services page for an overview of techniques and conditions we treat.

Bowel Management Programs

A structured bowel program can transform daily life for your child and family. We customize plans that combine:

  • Diet and hydration adjustments that match your child’s age and growth needs
  • Medications that regulate stool consistency and frequency
  • Timed toileting and school plans that support privacy and success
  • Rectal enemas or transanal irrigations when needed
  • MACE protocols for predictable emptying in children who need more dependable control

We teach you how to implement the plan at home, adjust doses safely, and recognize when to call. Regular follow up helps refine the program as your child grows.

What to Expect Before, During, and After Surgery

Preoperative planning
You receive a checklist covering preoperative fasting, medication adjustments, and what to bring. Our pediatric anesthesia team plans child specific strategies for comfort and safety, and we discuss pain control methods, including local anesthetics, acetaminophen or ibuprofen when appropriate, and strategies that limit opioids.

Day of surgery
Most procedures use small incisions and are completed under general anesthesia. You meet the operating team and can stay updated during the operation. Many procedures are outpatient; for hospital stays, we keep them as short as safety allows and include you in every decision.

Recovery at home
We provide written instructions for incision care, bathing, diet, activity, and signs that warrant a call. We give direct contact information and schedule follow up to monitor healing, stooling patterns, and continence. School and sports timing is reviewed with you so you can plan life around recovery and milestones.

Long-term follow up
Children grow, and continence evolves with growth and learning. We reassess regularly, adjusting bowel plans and providing support for school accommodations, skin care, and social confidence. Our goal is stable continence, comfortable stools, and full participation in daily life.

Answers to Common Questions

Is colorectal surgery considered general surgery
Pediatric colorectal surgery builds on the training foundation of general surgery, yet it is a distinct subspecialty. Children’s anatomy, physiology, and long-term functional goals differ from adults, and pediatric surgeons complete additional fellowship training focused on child specific techniques, instruments, and recovery strategies.

What age is pediatric surgery for
Pediatric surgery serves newborns, infants, children, and adolescents. For congenital conditions such as anorectal malformations or Hirschsprung disease, follow up can extend into early adulthood to maintain continuity and protect outcomes.

What is the most common pediatric surgical problem
In general pediatric surgical practice, hernias and appendicitis are among the most common conditions. In a specialized colorectal clinic, constipation related disorders and anorectal concerns are frequent reasons for consultation, including functional and structural causes that affect continence and comfort.

What is the most common pediatric surgery
Across pediatrics, common operations include hernia repair and appendectomy. In a colorectal focused setting, procedures such as pull-through operations for Hirschsprung disease, PSARP and LAARP for anorectal malformations, and MACE placement are commonly performed to improve continence and quality of life.

Why Families Choose Dr. Frykman

  • Emphasis on minimally invasive approaches when appropriate, with child specific instruments and anesthesia strategies
  • Multidisciplinary coordination with gastroenterology, urology, radiology, genetics, and child life services
  • Clear, compassionate communication that respects your questions and your child’s comfort
  • Structured programs for bowel management and long-term follow up that support continence, nutrition, and growth

If you are seeking a thoughtful second opinion or ready to move forward with evaluation, you can learn more about Dr. Philip Frykman, pediatric surgeon in Calabasas and how our practice supports families from first visit through recovery.

Summary and Next Steps

Pediatric colorectal care is about more than a single operation. It is a pathway that starts with careful diagnosis, continues with individualized surgical and nonoperative plans, and extends into long-term support for continence, comfort, and confidence at home and at school. Whether your child needs a pull-through for Hirschsprung disease, PSARP or LAARP for an anorectal malformation, a MACE to achieve reliable bowel emptying, or laparoscopic rectopexy for rectal prolapse, our team will guide you through each step with clear expectations and compassionate care. Call our Calabasas office at (805) 372-8500 with questions or to schedule an appointment, and let us help your child move from symptoms to stability with a plan that fits your family.