Newswise — Surgical expertise and advances in technology have combined to allow physicians to provide minimally invasive treatment for many congenital anomalies, says Philip K. Frykman, MD, PhD, associate director of pediatric surgery at Cedars-Sinai Medical Center.
"It's being shown that most patients " including children " recover more quickly and have less pain from laparoscopic-assisted surgery than from traditional open operations," says Frykman, who joined the Cedars-Sinai staff in July 2004. "We're now able to do more neonatal types of procedures with laparoscopic techniques because of advances in technology and greater experience on the part of surgeons."
One of the most significant advances in neonatal surgery over the past five years, he says, has been the ability to perform high imperforate anus repair as a laparoscopic-assisted procedure. "Babies with imperforate anus are born without a normal anal opening," Frykman explains. "The condition occurs in about one in 5,000 births and its cause is unknown." The surgery involves creating an opening for the passage of stool."
Imperforate anus has several variations including high-type and low-type. The traditional operation for children born with high imperforate anus (where the rectum ends above the pelvic muscle structures) is an open procedure that requires making a very large incision in the anal region. The new surgery is done with a combination of techniques, doing some of it from inside the abdomen under laparoscopy, and making a very small incision where the anus should be normally. According to Frykman, Cedars-Sinai is just one of a few medical centers in Southern California that offers this surgery.
He has performed this particular laparoscopic surgery twice since joining the Cedars-Sinai staff. "It's a relatively new advancement and we can perform this operation with good results. The goal is to try to decrease the morbidity and improve the long-term continence of these patients, enabling them to have a more normal life."
Surgeons decide whether to perform a surgery laparoscopically, Frykman says, based on the size of the patient, the complexity of the problem and whether or not the patient is medically-stable. Minimally invasive surgery, also called laparoscopic-assisted surgery, is performed by making several small incisions (usually less than a half-inch in length) to enter the body. Aided by a miniature video camera placed inside the abdomen, the surgeon uses tiny instruments to repair damaged tissues or remove diseased organs.
Pediatric surgeons at Cedars-Sinai perform minimally-invasive surgeries for other congenital conditions including Hirschsprung's disease which occurs when the nerve cells in the muscles that line the large intestine are missing, allowing stool to build up and create a blockage.
"One of the things I'm working on is developing a research program to look at both the diagnosis and treatment of Hirschsprung's disease. We already do a minimally invasive operation but I'd like to see how we can improve the way we deal with some of the more complicated patients," says Frykman.
The condition occurs before a child is born but, in milder cases, may not be diagnosed until a later age, even into adulthood. Statistics collected by The National Institutes of Health show that Hirschsprung's disease occurs in one of every 5,000 births in the United States.
Cedars-Sinai's prenatal diagnosis and consultation pediatric surgery program allows surgeons to intervene quickly if a baby needs surgery. "If a condition is diagnosed prenatally and the child is delivered at Cedars-Sinai," Frykman says, "we can make sure that the delivery goes smoothly, and we can begin handling the baby's surgical problems in a very timely fashion."
Frykman received his bachelor's degree from Pitzer College with honors and his medical degree from the University of Texas Southwestern Medical School in Dallas. He earned a master's degree from Peter F. Drucker Graduate Management Center in Claremont, California, and a doctorate in molecular genetics (working with Nobel laureates Dr. Michael S. Brown and Dr. Joseph L. Goldstein) at the University of Texas Southwestern Graduate School of Biomedical Sciences. Frykman completed residencies in general surgery at the University of Cincinnati Medical Center and in pediatric surgery at the University of Alabama at Birmingham and The Children's Hospital of Alabama.
For more information about Cedars-Sinai's Department of Pediatric Surgery, call (310) 423-3221.
One of only four hospitals in California whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 17 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and was recently fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu.
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