Is There a Role for Colectomy in Children with Constipation?
Abstracts
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BACKGROUND: Surgical options for childhood constipation have been considered to be unnecessarily aggressive and often meet resistance by both parents and care providers. Thus, surgery has been traditionally reserved for children with constipation secondary to colonic aganglionosis and anorectal malformations. METHODS: A retrospective chart review of 137 children referred to a tertiary care motility center, identified 19 children (10 female, age 7.6 + 3.9 yrs) who between 1996-2001 underwent surgery of their diseased colon. Surgery was performed after colonic and anorectal manometry had identified abnormal motility. Colonic manometry was performed with an endoscopically placed water perfused catheter whose tip was located in the proximal colon. Aganglionosis and spinal defects had been ruled out in all patients. Indications for manometry evaluation included persistent constipation (28%), abdominal pain and constipation (11%), constipation with encopresis (50%) and evaluation of a diverted colon prior to reanastamosis (11%). All children had failed aggressive medical and behavioral treatment. We utilized a questionnaire to interview caregivers, a mean of 25.4 + 14.9 mo from the time of manometry evaluation. RESULTS: Proximal abnormalities were seen in 2 patients, abnormalities involving the distal colon and rectosigmoid region in 13 patients, pancolonic abnormalities in 2 patients, and abnormalities limited to the anus in 2 patients. The 2 patients with anal dysfunction had incomplete relaxation of the internal anal sphincter consistent with a diagnosis of anal achalasia. Seven patients underwent resection of the diseased colon with a pull through procedure, 5 patients had a partial colectomy with primary reanastamosis, 3 patients underwent diverting ostomy procedures, and 4 patients had a total colectomy. Adverse events related to surgery include skin breakdown at site of ostomy in 2 patients, fecal incontinence after pull-through procedure in 3 patients, and persistent constipation in one patient. Parents of 17 of 19 patients (89%) felt that the symptoms after surgery were improved. CONCLUSION: Our data suggest that surgery may have a role in the treatment of children with constipation and with documented abnormalities in motility. Manometry may guide the surgical approach, demonstrating the length of the abnormal colonic segment. Parents and patients appear satisfied with outcomes of surgical treatment. In a subset of patients, surgery leads to normalization of the defecatory problem. |
