Primary sigmoidectomy and appendicostomy for chronic idiopathic constipation.

Area of Science:

• Pediatric Surgery
• Colorectal Surgery
• Gastroenterology

Background:

• Chronic idiopathic constipation (CIC) in children can lead to significant social and medical complications.
• Megarectosigmoid and fecal incontinence are challenging aspects of CIC that often resist conservative management.

Purpose of the Study:

• To evaluate the efficacy of primary sigmoidectomy and appendicostomy in pediatric patients with CIC complicated by megarectosigmoid and fecal incontinence.
• To present surgical outcomes and patient benefits from this intervention.

Main Methods:

• Retrospective review of eight pediatric patients (age 5-19 years) with CIC, megarectosigmoid, and fecal incontinence treated between 2014 and 2016.
• Analysis of prior medical treatments (including polyethylene glycol), surgical indications, and post-operative outcomes.

Main Results:

• All patients experienced prolonged constipation (4-15 years) and severe social issues, with four having autism.
• Surgical indications included failed laxative therapy, enema non-compliance, and social distress from incontinence.
• Post-operatively, all patients achieved daily bowel movements and complete resolution of fecal incontinence.

Conclusions:

• Primary sigmoidectomy and appendicostomy represent a highly effective treatment for selected pediatric patients with severe CIC, megarectosigmoid, and fecal incontinence.
• This surgical strategy can significantly improve quality of life by resolving debilitating symptoms and social challenges.