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Surgery for chronic idiopathic constipation: pediatric and adult patients - a systematic review
Kerry A Swanson1, Hannah M Phelps1, William C Chapman1
1Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States.
Insights
Surgical management for chronic idiopathic constipation (CIC) differs between children and adults. While both surgical approaches improve symptoms, antegrade continence enema (ACE) procedures in pediatric patients have higher complication rates than adult resections.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Colorectal Surgery
Background:
- Chronic idiopathic constipation (CIC) presents similar challenges in pediatric and adult patients, yet surgical interventions vary significantly.
- This systematic review compares surgical management trends and outcomes for CIC across different age groups.
Approach:
- A comprehensive literature search was conducted across major databases (MEDLINE, Embase, Scopus, Cochrane) from 1995 to 2020.
- Included studies focused on surgical resection or antegrade continence enema (ACE) procedures for CIC, analyzing outcomes like bowel movement frequency, pain, laxative use, and complications.
Key Points:
- Adults predominantly undergo surgical resection (94%) for CIC, while pediatric patients primarily receive ACE procedures (96%).
- Both ACE procedures and resections demonstrate efficacy in improving CIC symptoms.
- ACE procedures are linked to increased rates of complications and reinterventions compared to resections.
Conclusions:
- Surgical strategies for CIC diverge, with ACE procedures favored in pediatrics and resections in adults.
- Further research on long-term outcomes of resections and ACE procedures in pediatric CIC is warranted to guide optimal surgical choices.
Background:
Chronic idiopathic constipation (CIC) is a substantial problem in pediatric and adult patients with similar symptoms and workup; however, surgical management of these populations differs. We systematically reviewed the trends and outcomes in the surgical management of CIC in pediatric and adult populations.
Methods:
A literature search was performed using Ovid MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov between January 1, 1995 and June 26, 2020. Clinical trials and retrospective and prospective studies of patients of any age with a diagnosis of CIC with data of at least 1 outcome of interest were selected. The interventions included surgical resection for constipation or antegrade continence enema (ACE) procedures. The outcome measures included bowel movement frequency, abdominal pain, laxative use, satisfaction, complications, and reinterventions.
Results:
Adult patients were most likely to undergo resection (94%), whereas pediatric patients were more likely to undergo ACE procedures (96%) as their primary surgery. Both ACE procedures and resections were noted to improve symptoms of CIC; however, ACE procedures were associated with higher complication and reintervention rates.
Conclusion:
Surgical management of CIC in pediatric and adult patients differs with pediatric patients receiving ACE procedures and adults undergoing resections. The evaluation of resections and long-term ACE data in pediatric patients should be performed to inform patients and physicians whether an ACE is an appropriate procedure despite high complication and reintervention rates or whether resections should be considered as an initial approach for CIC.
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