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Surgically treated intractable constipation in children evaluated with colonic manometry.

Alisha Gupta1, Sonia Basson1, Osvaldo Borrelli2

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Surgical management for intractable constipation (IC) in children, guided by colonic manometry (CM), shows varied success rates. Procedures like antegrade colonic enema (ACE) and ostomy can improve bowel evacuation, but some patients require ongoing treatment or further surgery.

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Colonic dysmotilityIntractable constipationManometry

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Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Colorectal surgery

Background:

  • Intractable constipation (IC) is defined as constipation unresponsive to optimal conventional treatment for at least three months.
  • Colonic manometry (CM) is a recommended diagnostic tool for evaluating pediatric IC.
  • Surgical intervention is considered for children with IC who do not respond to conservative measures.

Purpose of the Study:

  • To review the surgical outcomes of children diagnosed with intractable constipation (IC).
  • To evaluate the effectiveness of different surgical procedures, including antegrade colonic enema (ACE), colostomy, and ileostomy, in managing pediatric IC.
  • To assess the role of colonic manometry (CM) in guiding surgical decisions for IC.

Main Methods:

  • A retrospective review of medical records of children with IC treated surgically between 2006 and 2018.
  • Surgical interventions included antegrade colonic enema (ACE), colostomy, or ileostomy.
  • Success was defined as adequate bowel evacuation without the need for further unplanned surgery.

Main Results:

  • Sixty-seven children underwent surgery, with 56 included based on preoperative CM.
  • Success rates varied by surgical approach and colonic dysfunction pattern: ACE (75% for normal, 61% for left-sided, 60% for pancolonic), colostomy (70% for left-sided), and ileostomy (100% for left-sided, 100% for pancolonic).
  • At long-term follow-up, 10 patients were off all treatment and doing well, while others remained on ACE washouts or had ostomies.

Conclusions:

  • Surgical management can be effective for intractable constipation (IC) in children.
  • Colonic manometry (CM) plays a crucial role in guiding the selection of appropriate surgical interventions for pediatric IC.
  • A significant proportion of patients achieve adequate bowel evacuation and improved quality of life following surgical treatment.