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Published on: November 9, 2016
Pediatric Bowel Management Options and Organizational Aspects
Elizaveta Bokova1, Wendy Jo Svetanoff2, Marc Aaron Levitt3
1Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
A bowel management program (BMP) improves outcomes for children with fecal incontinence and constipation. This multidisciplinary approach enhances quality of life and reduces hospital visits.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Bowel management programs (BMPs) are essential for managing fecal incontinence and severe constipation in pediatric patients.
- These programs address conditions like anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation.
- BMPs aim to decrease emergency department visits and hospital admissions.
Purpose of the Study:
- To review updates in antegrade flushes for bowel management.
- To discuss organizational aspects, collaborative care, telemedicine, and family education within BMPs.
- To present one-year outcomes of a comprehensive bowel management program.
Main Methods:
- Implementation of a multidisciplinary BMP involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers.
- Focus on family education for postoperative outcomes and complication prevention (e.g., Hirschsprung-associated enterocolitis).
- Utilization of telemedicine for defined patient anatomies, assessing parent satisfaction and patient stress.
Main Results:
- BMPs demonstrated effectiveness across all colorectal patient groups at 1- and 2-year follow-ups.
- Social continence was achieved in 70-72% at 1 year and 78% at 2 years.
- Significant improvements in patients' quality of life were observed.
Conclusions:
- Multidisciplinary BMPs are effective in improving continence and quality of life for pediatric colorectal patients.
- Family education and telemedicine are key components for successful outcomes.
- Transitional care to adult programs is vital for long-term continuity and desired outcomes.
Abstract:
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70-72% and 78% of patients, respectively, and an improvement in the patients' quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.
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