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Diverting Ileostomy in Children With Functional Constipation: A Study Evaluating the Utility of Colon Manometry
Leonel Rodriguez1,2, Kitzia Colliard1, Samuel Nurko1
1From the Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Diverting ostomy (DO) helps children with severe constipation. Colon manometry (CM) can guide ostomy closure, improving outcomes when an algorithm is used. Further research is needed.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Pediatric functional constipation (FC) can be refractory to medical management, necessitating invasive evaluations like colon manometry (CM) and surgical interventions such as diverting ostomy (DO).
- The role of CM in optimizing surgical outcomes after DO for FC remains to be fully elucidated.
Purpose of the Study:
- To evaluate the utility of colon manometry (CM) in guiding surgical interventions, specifically diverting ostomy (DO) closure, in pediatric patients with functional constipation (FC).
- To assess the association between CM findings, patient demographics, ostomy indications, and the success of ostomy closure.
Main Methods:
- A retrospective study included 60 children with medically refractory FC who underwent DO.
- Colon manometry (CM) data, including high amplitude propagating contractions (HAPCs), were analyzed. Ostomy closure success was defined by the absence of further surgical need.
- A CM-guided ostomy closure algorithm was developed and its predictive role in response to closure was evaluated.
Main Results:
- Of 30 patients who underwent ostomy closure, 23 (76.7%) had a successful outcome.
- No significant association was found between ostomy outcome and patient demographics, time with ostomy, or CM variables like HAPCs or overall CM improvement.
- Failed response to ostomy closure was associated with a history of antegrade colonic enemas (ACE) failure (P=0.026), while successful response was linked to ostomy closure guided by the CM algorithm (P=0.03).
Conclusions:
- Diverting ostomy (DO) is an effective intervention for selected pediatric patients with medically refractory functional constipation (FC), often improving colonic motility.
- Colon manometry (CM) can effectively guide the timing and type of ostomy closure in this population.
- Larger prospective studies are warranted to validate the findings and the utility of the CM-guided algorithm for ostomy closure.
Objectives:
Pediatric functional constipation (FC) may require invasive evaluations [like colon manometry (CM)] and surgical interventions [including diverting ostomy (DO)]. We evaluated the utility of CM in guiding surgery after DO.
Methods:
Children with medically refractory FC undergoing an ostomy were included. Institutional Review Board approval was obtained for this retrospective study. Demographics and CM variables [high amplitude propagating contractions (HAPCs)] were recorded. Outcome measures: response to ostomy closure defined as successful if no need for further surgery after ostomy closure, and improvement on baseline CM after ostomy. A CM-guided ostomy closure algorithm was developed based on previous studies. We evaluated the association between response to ostomy closure and demographics, ostomy indication and CM improvement, and evaluated the role of CM predicting response using algorithm.
Results:
A total of 60 children underwent ostomy for FC (median age: 7.1 years, range 0.15-23.6 years, 50% female). Ostomy was closed in 30 patients and deemed successful in 23 of 30. CM was performed in 42 of 60 patients before ostomy and in 29 of 30 before ostomy closure. We found no association between ostomy outcome and age, gender, weight, imaging studies, follow-up time, time with ostomy, HAPCs, and CM improvement. We found an association between failed response and ostomy indication of antegrade colonic enemas (ACE) failure ( P = 0.026) and successful response when ostomy closure was guided by algorithm ( P = 0.03).
Conclusions:
DO is a useful intervention in selected children with medically refractory FC, improving colon motility in most. CM can successfully guide the timing and type of ostomy closure. Larger studies are needed to further validate our findings.
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