The article from the Journal of Pediatric Surgery outlines a protocolized approach for evaluating and managing children with functional constipation refractory to medical management. This protocol involves a series of diagnostic tests, including contrast enemas and anorectal manometry, to exclude conditions like Hirschsprung disease and identify sphincter issues before proceeding to colonic manometry (CMAN) for motility assessment. The key finding is that performing a Malone appendicostomy for antegrade continence enemas (ACE) was highly successful in 86% of the 22 patients identified with a colonic motility problem, suggesting this surgical intervention can effectively treat refractory constipation and avoid the need for colonic resection in the majority of cases. The authors propose this collaborative framework to standardize care and improve outcomes for these challenging pediatric patients.