Chronic constipation. Manometric patterns and surgical considerations

Area of Science:

• Pediatric Gastroenterology
• Colorectal Surgery

Background:

• Severe chronic constipation refractory to standard treatments affects children.
• Diagnostic challenges exist in identifying underlying causes beyond Hirschsprung's disease.

Purpose of the Study:

• To investigate the efficacy of internal sphincter myectomies in children with severe chronic constipation.
• To differentiate subtypes of constipation based on manometric findings.

Main Methods:

• Barium enemas, rectal biopsies, and anorectal manometry were used.
• Internal sphincter myectomies were performed on selected patients.
• Patients were categorized based on internal sphincter pressure and relaxation response.

Main Results:

• 49 of 73 patients with dilated anorectums had normal ganglion cells on biopsy.
• Manometry identified distinct groups: elevated pressure with relaxation (Group A), normal pressure without relaxation (Group B).
• Myectomy improved bowel function in 19 of 25 patients, normalizing pressures in Group A and improving relaxation in Group B.

Conclusions:

• Internal sphincter abnormalities contribute to refractory constipation in children.
• Internal sphincter myectomy can be an effective treatment for specific manometric subtypes.
• Further research is needed to optimize surgical outcomes and patient selection.