Surgical decision-making in the management of children with intractable functional constipation: What are we doing...

Area of Science:

• Pediatric Surgery
• Pediatric Gastroenterology
• Clinical Practice Guidelines

Background:

• Intractable functional constipation (FC) in children may necessitate surgical intervention.
• Current surgical management lacks evidence-based guidelines, particularly concerning motility testing.
• Motility testing is often used to guide surgical decisions in pediatric FC.

Purpose of the Study:

• To evaluate the diagnostic and surgical strategies employed by pediatric surgeons and gastroenterologists for intractable FC in children.
• To identify current practices and variations in the management of pediatric intractable FC.

Main Methods:

• A survey was distributed to physicians at an international conference.
• The survey included case-based questions focusing on anorectal and colonic manometry results.
• Physicians' responses regarding diagnostic and surgical approaches were collected.

Main Results:

• 74 physicians responded to the survey.
• Anorectal manometry was utilized by 70% of respondents; 52% considered botulinum toxin for anal achalasia and 21% for dyssynergia.
• Colonic manometry was used by 38%, with 57% using it to guide surgical decisions. Surgical approaches varied, with antegrade continence enemas and anal botulinum injections being most common.

Conclusions:

• Significant variability exists in surgical decision-making for pediatric intractable FC.
• There is a clear need for clinical guidelines on utilizing anorectal and colonic manometry in surgical planning for pediatric intractable FC.