The team of pediatric surgeons at Shriners Hospitals for Children — Northern California understands the physical and emotional impacts of colon and rectal diseases. They lead a multidisciplinary team that manages the entire spectrum of care for kids of all ages – from infants to adolescents. Whether it be complex surgery, medical management or psychosocial support, our team addresses the individual needs of each patient. In all cases, the goal is to put patients on the path to independence by freeing them from the social stigmas that may leave them feeling ashamed, depressed and alone.
Conditions treated
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- Anorectal malformations
- Bladder extrophy
- Caudal regression syndrome/sacral agenesis
- Chronic constipation
- Cloaca/cloacal anomaly
- Cloacal extrophy
- Encopresis
- Fecal incontinence
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- Idiopathic constipation
- Megacolon
- Neurogenic bladder
- Neurogenic bowel
- Rectal prolapse
- Rectal trauma
- Spina bifida
- VATER/VACTERL association
Nonsurgical treatment options
Bowel management program
Our bowel management program is a one-week outpatient program for children who are unable to anticipate or control their bowel activity. After children participate in this intensive program, many of them are in normal underwear by the end of the week. By maintaining bowel management after the program ends, these patients can avoid bowel accidents, bed-wetting, permanent colostomy and dependence on diapers. The improvement in self-esteem and quality of life is often remarkable. This program is designed primarily for children age 3 and up.
Patients with Hirschsprung disease or severe idiopathic constipation can benefit from colonic irrigation. This option can alleviate immobile stool in the colon, preventing bacterial overgrowth and colitis. Our team teaches parents to perform colonic irrigation effectively at home.
Even young patients with constipation can be taught to use the Peristeen® system, which comfortably and predictably enables them to empty their bowels at home. Children gain independence and confidence to go to school and take part in social activities and sports.
Injecting Botox into the anal sphincter can be an effective treatment for idiopathic constipation, Hirschsprung disease and anal fissures in children. It reduces hard and painful stool, the number of days between stooling, and leads to fewer soiling accidents. Many parents are interested in this newer treatment option.
Surgical treatment options
The pediatric surgery team is devoted to the development of innovative and minimally invasive surgical techniques for colorectal conditions. The following surgical options are offered at Shriners Hospitals for Children — Northern California:
Surgeons at the Northern California Shriners Hospital strive to avoid ostomy and are skilled in surgical techniques that make this possible for some patients after surgical correction for Hirschsprung disease and anorectal malformation. While a stoma may be medically necessary, families are reassured that the care team will avoid stoma whenever possible.
The Northern California Shriners Hospital offers solutions that enable children to manage their care by themselves and reduce the bowel routine to an hour or less. Most children do not have accidents between flushes. Patients with Hirschsprung disease, anorectal malformation, spina bifida and spinal injuries may benefit from these procedures, which allow them to swim, play sports and establish a predictable bowel routine.
- Appendicostomy (Malone procedure)
- Neo-appendicostomy (Neo-Malone Procedure)
- Cecostomy/Chait
When patients require an ostomy, and when it’s time for ostomies to be closed, medical staff are experienced in helping families manage surgeries and ostomy care effectively. Ostomies are typically closed two to three months after anorectal malformation repair. Following closure, families receive post-surgery recovery plans to ensure successful, ongoing bowel management at home.
To repair the cloaca, Shriners Hospitals for Children offers posterior sagittal anorectoplasty vaginal urethral plasty (PSARPVUP). This reconstructive surgery brings together multiple specialties, including colorectal surgery and urology.
With a depth of techniques available and expertise with a variety of issues, surgeons correct problems, minimize complications and achieve improved results.
Shriners Hospitals for Children — Northern California surgeons are skilled and experienced in both primary and revision pull-through surgery. In most cases, this procedure can be done with minimally invasive techniques in a single operation. Medical and dietary management continue following surgery to minimize constipation.
The medical team
Medical staff
Diana L. Farmer, M.D., FACS, FRCS, Surgeon-in-Chief
Shinjiro Hirose, M.D., Director, Pediatric Surgery
Payam Saadai, M.D., Director of the Pediatric Colorectal Center, Pediatric Surgeon
Erin G. Brown, M.D., Pediatric Surgeon
Alana Beres, MDCM, MPH, Pediatric Surgeon
Arthur de Lorimier, M.D., CPE, Pediatric Gastroenterologist
Advance practice providers
Jennifer Miranda, MSN, NP-C
Kat Swartz, MSN, CPANP
Nurse case manager
Carolyn Wilson, BSN, RN
Registered dietician
Sarah McCallum, RD
Child life specialists
Kat Davis, MS, MFT, CCLS
Sarah Ferrin, CCLS
Licensed clinical social worker
Courtney Krackie, LCSW
Medical assistant and patient scheduler
Aime Andrade
Pediatric anesthesiologists
The team of subspecialty board-certified pediatric anesthesiologists at Shriners Hospitals for Children — Northern California provides exceptional care for children before, during and after surgery or procedures that require anesthesia. Keeping children comfortable and safe are top priorities.
Pediatric intensivists
The pediatric itensivists at Shriners Hospitals for Children oversee the care of each patient admitted to the intensive care unit (ICU), which may occur following surgery. Medically complex and compromised patients receive exceptional care. Patients traveling to the Northern California Shriners Hospital from areas where pediatric ICUs are not available benefit from the resources and expertise the hospital offers.