Outcomes of colonic resection for chronic idiopathic constipation in childhood

Area of Science:

• Pediatric surgery
• Gastroenterology
• Colorectal surgery

Background:

• Severe constipation in children can be refractory to medical management.
• Surgical intervention, including colonic resection, is considered for select cases.
• Different surgical techniques exist, each with potential outcomes and complications.

Purpose of the Study:

• To evaluate the outcomes of various colonic resection procedures for intractable constipation in pediatric patients.
• To compare the effectiveness of pan-proctocolectomy with ileoanal pouch anastomosis (IPAA), total colectomy with ileorectal anastomosis (IR), and segmental resections (SR).

Main Methods:

• Prospective data collection of colonic resections performed over 20 years.
• Classification of outcomes as Good (anal defecation, no soiling), Intermediate (anal defecation with soiling or need for antegrade continence enema [ACE]), or Poor (permanent stoma).
• Recording of all complications associated with each procedure.

Main Results:

• 22 children underwent colonic resection; mean follow-up was 40 months.
• Outcomes were: Good in 45%, Intermediate in 18%, and Poor (permanent stoma) in 36%.
• Surgical resection restored anal defecation in 75% of children who previously had a stoma; no procedure demonstrated superior outcomes or complication rates.

Conclusions:

• Colonic resection may be a viable option for carefully selected pediatric patients with severe constipation.
• Parents must be counseled regarding the substantial risk (approximately 40%) of requiring a permanent stoma post-surgery.
• The choice of resection technique did not significantly influence the overall success or complication profile.