AAP PaperTransanal rectosigmoid resection for severe intractable idiopathic constipation
Section snippets
Materials and methods
We reviewed the records of all patients who were referred to us with severe idiopathic constipation and soiling over a 20-year period. All patients were previously seen by a pediatrician or a pediatric gastroenterologist and were considered unmanageable. The vast majority were referred for surgical consultation to evaluate for Hirschsprung's disease, and no patient turned out to have Hirschsprung's. Patients first received a thorough history and physical examination and then were subjected to
Results
Two hundred eighty-eight patents were referred to our care with severe idiopathic constipation over a 20-year period. Two hundred fifty-six (89%) patients were medically managed and did not require operative intervention. No referred patient in this group had Hirschsprung's disease. In all patients, soiling was eliminated after the laxative regimen was implemented. The intractable patients (32 patients, 11%) were offered surgery (Table 1). Seventeen received a sigmoid resection only (previously
Discussion
A subset of patients with severe idiopathic constipation, refractory to medical therapy, will benefit from surgical intervention. In this study we present our experience with a transanal full-thickness rectosigmoid resection and a primary colo-anal anastomosis. Patients had a significant reduction or elimination in laxative requirement, were continent postoperatively, and had an improved quality of life. We believe this approach is a novel minimally invasive alternative to treat this patient
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Intermediate and long-term outcomes of a bowel management program for children with severe constipation or fecal incontinence
2020, Journal of Pediatric SurgeryOutcomes of colonic resection for chronic idiopathic constipation in childhood
2020, Journal of Pediatric SurgeryCitation Excerpt :Among children left with a permanent stoma, 82% were deemed to have had successful treatment [17]; by our criteria all these children would be categorized as failed treatments. Levitt reported 60% of 15 children who underwent transanal rectosigmoid resection to be clean on follow up, broadly similar to our success rate of 64% [15]. The same authors subsequently reported a series of 31 children who underwent a combination of segmental resection and ACE surgery as definitive treatment [18].
Functional Constipation and Fecal Incontinence
2020, Pediatric Gastrointestinal and Liver Disease, Sixth EditionTransanal proximal rectosigmoidectomy. A new operation for severe chronic idiopathic constipation associated with megarectosigmoid
2019, Journal of Pediatric SurgerySurgical treatment of idiopathic megarectum in constipated children
2019, Journal of Pediatric SurgeryCitation Excerpt :The data obtained with ultrasound examination correlate with morphological findings. A previous study reported that idiopathic megarectum occurs infrequently and was present in only 11% of patients referred to a pediatric colorectal center for surgical treatment of chronic constipation [11]. This low prevalence may explain the lag in acceptance of idiopathic megarectum as an indication for transanal rectosigmoid resection.
Functional constipation in children: Is there a place for surgical treatment
2019, Journal of Pediatric Surgery