Laparoscopic seromuscular colonic biopsies: a surgeon's experience
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Sebastian K King1, Jonathan R Sutcliffe, John M Hutson
1Department of General Surgery, Royal Children's Hospital, Melbourne, Victoria 3052, Australia.
Insights
Laparoscopic colonic biopsies are effective for diagnosing chronic constipation in children when other methods fail. This minimally invasive technique identifies neuropeptide anomalies with low complication rates.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Colonic dysmotility is a key cause of chronic constipation in children.
- Rectal biopsies have limited diagnostic yield for colonic dysmotility.
- Laparoscopic colonic muscle biopsies offer a direct examination of the affected area.
Purpose of the Study:
- To evaluate the utility of laparoscopic colonic muscle biopsies in diagnosing intractable constipation in pediatric patients.
- To assess the safety and outcomes of this surgical technique.
Main Methods:
- A retrospective review of 197 pediatric patients undergoing laparoscopic seromuscular colonic biopsies over 10 years.
- Biopsies were taken from multiple colonic segments (hepatic flexure, mid-transverse, splenic flexure, sigmoid).
- Analysis included perforation frequency, postoperative recovery, and immunohistochemical findings.
Main Results:
- 44% of patients (86/197) showed specific neuropeptide anomalies (reduced Substance P or Vasoactive Intestinal Peptide).
- The procedure had a low rate of mucosal perforation (3% recognized, 1% unrecognized), managed conservatively.
- Most patients (81%) were discharged the day after surgery, with a mean recovery time of 28.7 hours.
Conclusions:
- Laparoscopic colonic biopsy is a valuable diagnostic tool for pediatric chronic constipation.
- The technique allows for pathological diagnosis, identifying underlying causes of dysmotility.
- Complications associated with laparoscopic biopsy are acceptably low.
Background:
Colonic dysmotility is a recognised cause of chronic constipation in children. Colonic dysmotility is better analysed by examination of the colonic muscle than rectal biopsy, which does not examine the defective area and has a low yield. We explored the role of laparoscopic colonic muscle biopsies to investigate children with intractable constipation. The authors describe the technique, its application, and results from a large series.
Methods:
A retrospective review was conducted of all patients undergoing laparoscopic seromuscular colonic biopsies (hepatic flexure, mid-transverse colon, splenic flexure, and sigmoid colon) by a single surgeon for the investigation of chronic constipation over a 10-year period. Patient records were reviewed to determine the perforation frequency and management, postoperative recovery time and the frequency of an immunohistochemical abnormality.
Results:
One hundred ninety-seven patients (118 boys) were investigated by laparoscopic biopsy during the period. The mean age was 8.0 +/- 4.0 years (range, 1.4-22.4). The patients took 28.7 +/- 13.6 hours (range, 8-120) to recover, with 37 (19%) having nausea and/or vomiting requiring antiemetics. Most patients (160/197, 81%) were discharged the following day. Six patients (3%) had a mucosal perforation recognised at operation (treated by an Endoloop) with no change in postoperative outcome. Two patients (1%) had an unrecognised mucosal perforation requiring laparoscopic reoperation and Endoloop closure (laparotomy/colostomy not required), with no further sequelae. Eight-six patients (44%) had a specific immunohistochemical neuropeptide anomaly (reduced substance P [84], reduced vasoactive intestinal peptide [2]).
Conclusions:
Laparoscopic biopsy is a valuable tool to investigate chronic constipation in children, allowing a pathological diagnosis to be made in many cases. The complications of the procedure are acceptably low with this technique.
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