Surgical options for the management of severe functional constipation in children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Evidence Review

Background:

• Constipation is a prevalent pediatric issue with varied severity and management strategies.
• Most pediatric functional constipation cases resolve with conservative treatment, avoiding specialized testing or surgery.
• Intractable constipation, particularly with fecal soiling, necessitates specialized evaluation, including motility testing, for medical and surgical planning.

Purpose of the Study:

• To review existing literature on surgical interventions for severe pediatric constipation.
• To assess the quality and evidence levels of studies on surgical approaches.
• To evaluate the use of objective outcome measures in surgical treatment studies.

Main Methods:

• Literature review of publications concerning surgical approaches for severe constipation in children.
• Assessment of the quality and levels of evidence within the reviewed studies.
• Analysis of the application of objective measures for determining treatment outcomes.

Main Results:

• Limited recent studies evaluate surgical indications or treatments for functional constipation.
• Existing systematic reviews predominantly analyze older studies, with most evidence being Level 4 or 5.
• A standardized definition for 'failed medical management,' a common surgical indication, is lacking.
• Many proposed surgical procedures lack robust outcome data.

Conclusions:

• There is a critical need for protocolized, prospective studies on surgical evaluation and treatment of pediatric constipation.
• Validated outcome measures are essential for advancing the evidence base in this field.
• The described center's protocol for surgical evaluation and treatment is presented.