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Scientific solution to a complex problem: physiology and multidisciplinary team improve understanding and outcome in

Eleni Athanasakos1, Sally Dalton2, Susan McDowell2

  • 1Department of Paediatric Surgery, The Royal London Hospital, Paediatrics Level 7, Ward 7D, Whitechapel Rd, London, E1 1BB, UK. Eleni.Athanasakos@bartshealth.nhs.uk.

Pediatric Surgery International
|December 18, 2019
PubMed

Insights

A new Children's Anorectal Physiology Service (CAPS) improved patient satisfaction for children with chronic constipation and fecal incontinence. This multidisciplinary approach offers a scientific solution for complex pediatric bowel conditions.

Area of Science:

  • Pediatric Gastroenterology
  • Colorectal Surgery
  • Pediatric Surgery

Background:

  • Chronic constipation (CC) and fecal incontinence (FI) in children lack diagnostic clarity, hindering effective management.
  • A multidisciplinary approach is crucial for addressing complex pediatric bowel conditions.

Purpose of the Study:

  • To evaluate the impact of an innovative Children's Anorectal Physiology Service (CAPS) on outcomes for children with CC/FI.
  • To assess if a specialized service improves diagnostic credibility and patient management.

Main Methods:

  • Prospective study of 112 children with CC/FI.
  • Utilized awake high-resolution anorectal manometry (AHRAM), endoanal ultrasound, and transit marker studies (TMS).
  • Assessed quality of life (QoL) and risk of distress using validated questionnaires.

Main Results:

  • 81% had abnormal St Marks Incontinence scores (SMIS), and 90% had abnormal Cleveland Constipation Scores (CCS).
  • AHRAM revealed sphincter dysfunction in 32% and altered rectal sensation in 20-22%.
  • Patient and parent satisfaction significantly improved post-intervention (p < 0.05).

Conclusions:

  • Scientific investigations integrated with a multidisciplinary team enhance patient satisfaction.
  • This specialized service effectively reduces self-reported illness severity in pediatric patients.
  • A scientific, multidisciplinary solution is essential for managing complex pediatric anorectal disorders.
Abstract

Keywords:
Anorectal physiologyChronic constipationFaecal incontinenceHigh-resolution anorectal manometry (HRAM)Multidisciplinary team (MDT)Pathophysiology

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