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[Surgical treatment of chronic constipation with megarectum in children]
Insights
A novel surgical technique, sphinctero-myectomy and-plasty, offers a promising solution for chronic constipation associated with megarectum. This procedure successfully treated 70% of patients, with others showing significant improvement.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Pediatric Surgery
Context:
- Chronic constipation is a prevalent condition, often associated with megarectum, significantly impacting quality of life.
- Idiopathic chronic constipation and short-segment aganglionosis are key indications for surgical intervention when conservative measures fail.
Purpose:
- To present a new operative procedure, termed sphinctero-myectomy and-plasty, for patients suffering from chronic constipation and megarectum.
- To evaluate the efficacy and outcomes of this surgical technique in a cohort of patients.
Summary:
- The procedure involves an incision along the dentate line, division of sphincter muscles, and rectal wall anastomosis to the dentate line, effectively replacing the posterior anus with rectal tissue.
- Ten patients, including nine with idiopathic chronic constipation and one with short-segment aganglionosis, underwent the operation.
- Post-operative evaluation at 1-3 years revealed a complete cure in 70% of cases, with the remaining 30% experiencing improvement requiring occasional suppository use.
Impact:
- Sphinctero-myectomy and-plasty demonstrates significant potential as a primary surgical option for managing complex cases of chronic constipation with megarectum.
- This innovative approach may offer a durable solution, improving bowel function and patient outcomes in a challenging patient population.
Abstract:
In this paper, a new operative procedure for patients with chronic constipation with megarectum and its results are presented. Nine cases of idiopathic chronic constipation and one case of short aganglionosis showing megarectum underwent this operation. An incision was placed on the dentate line at 6 o'clock and the internal sphincter muscle was identified. The incision was extended to this muscle. The blunt division between the internal and external sphincter muscles was orally advanced 5 cm from the dentate line. The all layers of anus and lower part of rectum in length of 5 cm were clamped by 2 forceps in width of 1 cm. The mucosal and muscular layers were bilaterally cut in the outer side of the forceps. The rectum on the top of the forceps was pulled through to the dentate line and was anastomosed there; i.e. the posterior part of the anus was replaced by the rectal wall. Bowel habits of operated patients were evaluated at 1 to 3 years after the operation. Complete cure was obtained in 7 cases (including 1 case with aganglionosis). Three cases improved but needed sometimes suppositories. This procedure, sphinctero-myectomy and-plasty may be an operation of choice for chronic constipation with megarectum.