Transanal rectosigmoid resection for severe intractable idiopathic constipation

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Colorectal Surgery

Background:

• Idiopathic constipation significantly impacts children's quality of life.
• A portion of pediatric patients with constipation do not respond to medical treatments.
• Surgical intervention is necessary for refractory cases of idiopathic constipation.

Purpose of the Study:

• To introduce and evaluate a novel transanal surgical technique for managing medically intractable idiopathic constipation in children.
• To assess the efficacy of transanal rectosigmoid resection in reducing symptoms and medication reliance.

Main Methods:

• Retrospective review of 288 patients with severe idiopathic constipation and soiling.
• Surgical intervention involved transanal full-thickness rectosigmoid resection with colo-anal anastomosis for patients refractory to medical management and with megarectosigmoid.
• Analysis of preoperative and postoperative laxative use and continence status.

Main Results:

• Fifteen patients underwent transanal rectosigmoid resection, with an average of 43 cm of rectosigmoid resected.
• Postoperative laxative requirements decreased significantly from 68 mg senna/day to 8.6 mg/day (P < .001).
• Nine patients achieved complete continence, one experienced manageable diarrhea, and two had occasional soiling due to noncompliance.

Conclusions:

• Transanal rectosigmoid resection is an effective surgical option for children with intractable idiopathic constipation.
• The procedure leads to substantial reduction or elimination of laxative use while maintaining or improving continence.
• This technique presents a valuable alternative to more invasive surgeries like colonic resections or stomas.