Surgical Management of Idiopathic Constipation in Pediatric Patients

Abstract

Constipation is a common childhood problem, but an anatomic or physiologic cause is identified in fewer than 5% of children. By definition, idiopathic constipation is a diagnosis of exclusion. Careful clinical evaluation and thoughtful use of imaging and other testing can help exclude specific causes of constipation and guide therapy. Medical management with laxatives is effective for the majority of constipated children. For those patients unresponsive to medications, however, several surgical options can be employed, including anal procedures, antegrade colonic enemas, colorectal resection, and intestinal diversion. Judicious use of these procedures in properly selected patients and based on appropriate preoperative testing can lead to excellent outcomes. This review summarizes the surgical options available for managing refractory constipation in children and provides guidance on how to choose the best procedure for a given patient.

Tratamiento del estreñimiento funcional en pediatría

“…Los procedimientos aplicados son miectomía, apendicostomía, cecostomía, colectomía y colostomía. Siminas, et al publicaron una revisión sistemática sobre las diferentes intervenciones quirúrgicas actuales 67,68 .…”

Surgical Interventions for Functional Constipation: An Update

“…32 The literature provides information on several surgical procedures with segmental resection including proctocolectomy with reservoir and ileoanal anastomosis, Duhamel's operation, transanal Soave's and Swenson's operation, Soave-Georgeson laparoscopic surgery, and laparoscopic/open sigmoidectomy with and without ACE. [33][34][35][36] In the pediatric population, partial colon resection (open or laparoscopic) with colocolonic anastomosis is the most common intervention. 4 We prefer a laparoscopic low-anterior resection, with a transection of the upper rectum below the peritoneal reflection after a laparoscopic pelvic dissection and resection of the entire sigmoid, with anastomosis of the upper sigmoid to the upper rectum.…”

“…34,35,[37][38][39] On the other hand, others propose always using an ACE procedure as a first step and these authors only perform more aggressive interventions in those with failure of management with ACE. 33 It is likely that with more uniform motility testing and use of antegrade flushes only, fewer colonic resections will be needed.…”

“…It can have a role in those patients with failure to thrive related to diffuse colonic dysmotility in whom motility does not improve after a temporary diversion with ileostomy. 33 In general, morbidity is estimated in 15% of patients with a reoperation rate at approximately 10% in surgical procedures for FC. 4,33 Given the difficulties involved in decision making and the high impact of surgical interventions, there is a great need for consensus guidelines for surgical interventions in children with FC.…”

“…33 In general, morbidity is estimated in 15% of patients with a reoperation rate at approximately 10% in surgical procedures for FC. 4,33 Given the difficulties involved in decision making and the high impact of surgical interventions, there is a great need for consensus guidelines for surgical interventions in children with FC. First, there is no consensus on whether surgery which could include a colonic resection should be done only in patients who have been under a mechanical emptying bowel program for a certain time, and second, it is not known if only patients with a proven motility problem should be having an intestinal resection.…”