Role of ano rectal myomectomy in children with chronic refractory constipation

Abstract

Background:Chronic refractory constipation (CRC) is an uncommon type of constipation. These children have persistent symptoms even after treatment with high dose laxatives, which may cause abdominal distension, vomiting, cramping and bloating. We conducted this study to assess the diagnostic and therapeutic role of anorectal myomectomy in children with CRC.Materials and Methods:This study includes 107 patients who fit the criteria of CRC. Complete bowel preparation with polyethylene glycol solution, enemas and antibiotics was carried out before surgery in all patients. The anorectal myomectomy was carried out under general anaesthesia with the patient in the high lithotomy position. The patients were followed up from 6 months to 13 years postoperatively. The success of myomectomy was based on the daily and complete passage of stools without the need for medication or enemas.Results:A total of 99 patients were included in the study, of which, 86 (86.86%) patients showed a good response to anorectal myomectomy. Of these, 32 patients had normal histology, 14 had histology suggestive of Hirschsprung's disease, 8 had hypoganglionosis, 10 had ultra-short segment Hirschsprung's disease and 22 had hypertrophic nerves with immature ganglia. Poor response was seen in 13 (13.13%) patients of whom 5 had normal histology, 5 had Hirschsprung's disease, 2 had hypoganglionosis and 1 had ultra-short segment Hirschsprung's disease.Conclusion:Anorectal myomectomy is an effective and technically simple procedure in selected patients with CRC for both diagnostic and therapeutic purposes.

How do we define therapy-resistant constipation in children aged 4–18 years old? A systematic review with meta-narrative synthesis

“…Among them, duration of medical treatment was the most frequently used component in defining therapy-resistant constipation. Of the 47 studies which included duration of treatment as part of the definition, 2 studies considered no responsiveness of 2 years or more to treatment, 18 53 3 considered unresponsiveness to treatment more than 12 months, 21 48 59 2 studies considered no responsiveness of 6 months to treatment, 42 43 10 studies used duration of treatment more than 3 months 10 17 24 25 39 40 44 47 52 60 and 1 study defined therapy-resistant constipation as having bowel movement less than 3 per week for at least 2 months prior to diagnosis 36 ( figure 2 ).…”

“… 47 2 Hynes et al , 53 Rawat et al , 48 RBR-7mry33, Kajbafzadeh et al , 43 Ng et al , 42 Gupta et al , 39 Puoti et al , 25 Monjaraz et al , 52 Kuizenga-Wessel et al , 40 Koppen et al , 51 Wessel et al , 44 Campos et al , 24 Nurko et al , 10 RBR-344jq8, Redkar et al , 19 Redkar et al . 36 3 Bonilla et al , 16 Heitmann et al , 23 Gomez-Suarez et al , 37 van Wunnik et al , 35 Haddad et al , 46 Gonzalez et al . 28 4 Baalem et al , 41 Omar et al , 22 Arbizu et al , 26 van der Wilt et al , 27 van der Wilt et al , 61 Christison Lagay et al , 38 Levitt et al , 45 Tang et al , 20 Youssef et al , 54 IRCT20111229008554N4.…”

“… 29 *At least 2 years: Yik et al , 18 Hynes et al ; 53 at least 12 months: Bellomo-Brandao et al , 21 Arruda et al , 59 Rawat et al , 48 RBR-7mry33; at least 6 months: Kajbafzad et al ; 43 at least 3 months: Noviello et al , 60 Gupta et al , 39 Puoti et al , 25 Monjaraz et al , 52 Kuizenga-Wessel et al , 40 Koppen et al , 17 Wessel et al , 44 Mousavi et al , 47 Campos et al , 24 Nurko et al , 10 RBR-344jq8; at least 1 month: Redkar et al , 19 Redkar et al . 36 …”

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

“…Four studies [222][223][224][225] provide some very-low-quality evidence that suggests anorectal myectomy may be effective at treating CFC, in children who have not responded to medical treatment. However, due to methodological limitations and low number of studies, the evidence is insufficient to support generalisable conclusions.…”

“…Reasons for exclusion and details of ongoing studies which are summarised in Report Supplementary Material 15. All of the studies were conducted in high-income countries: the USA (n = 10), 276,280,282,284,287,289,290,292,293,298 UK (n = 9), 1,261,274,275,277,278,287,288,296 the Netherlands (n = 2) 224,294 and Australia (n = 1). 279 Six studies presented limited economic evidence from more than one country; 17,273,276,281,285,291 none of the cost data reported within these studies were gathered in low-middle-income countries (LMICs).…”