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DIFFERENCES IN SURGICAL MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION
Prisca C. Obidike
*1, Alison Jung
1, Zoë Hemmer
1, Austin D. Williams
2, Remy Fenrich
2, Michael Gyimah
3, Kristy L. Rialon
4, Lily S. Cheng
11Surgery, University of Virginia, Charlottesville, VA; 2Baylor College of Medicine, Houston, TX; 3HCA Florida Lawnwood Hospital, Fort Pierce, FL; 4Texas Children's Hospital, Houston, TX
PurposeChronic Idiopathic Constipation (CIC) is a common gastrointestinal disorder affecting 10-14% of children and adults. Although most patients are successfully treated with medical therapies, surgical intervention is often needed when these therapies fail. We hypothesized that surgical management of CIC differs between adults and children and between children presenting to a non-stand-alone children’s hospital (CH) within an adult hospital compared to a stand-alone CH.
MethodsA retrospective chart review identified patients presenting with a chief complaint of CIC between March 1, 2017, and August 31, 2022 to (1) a general pediatric surgery practice at a non-stand-alone CH (n=68); (2) a pediatric colorectal surgery practice at a stand-alone CH (n=92); and (3) an adult colorectal surgery practice (n=642) within the same geographical region in the United States. Patients with Hirschsprung Disease, anorectal malformations, congenital colorectal disease, spina bifida, gastrointestinal cancers, inflammatory bowel disease, and other known causes of constipation were excluded. A Chi-squared test was performed for statistical analysis and a p-value of <0.05 was considered significant.
ResultsAdults were significantly less likely than children to undergo surgery for CIC (8.6% vs. 29%, p < 0.05). Children were more likely to receive antegrade continence enema (ACE) procedures whereas adults were more likely to receive intestinal diversion or resection (Figure 1). Children who had surgery for CIC were more likely to have a neurodiverse disorder compared to adults (47% vs. 4%, p<0.05). Children who had surgery at a non-stand-alone or stand-alone CH were similar in age (mean 9.6 ± 1.3 vs. 9.5 ± 3.4 years), and there was no significant difference in the rate of surgical intervention between hospitals (24% vs. 21%). However, children at the stand-alone CH were more likely to have intestinal resection or diversion than those who presented to a non-stand-alone CH (60% vs. 0% p<0.05). Ninety-two percent of children who had intestinal resection or diversion had an abnormal contrast enema, colonic or anorectal manometry.
ConclusionSurgical management of CIC differs among adults and children and among children who present to different pediatric surgical practices. Better communication and collaboration between pediatric and adult surgeons, and amongst pediatric surgeons, may help improve and standardize surgical management of CIC.
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