title: Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?
abstract: OBJECTIVE
  The aim of this study was to assess benefit of surgery in the treatment of childhood constipation in children without aganglionosis or anorectal malformations.
  
  
  METHODS
  Retrospective chart review and follow-up questionnaire of 19 children (10 girls, age 7.6 +/- 3.9 years) who underwent surgery after colonic and anorectal manometry had documented abnormal motility. Children at the time of manometric evaluation had symptoms of intractable constipation a mean of 5.1 +/- 2.5 years. Follow-up questionnaires were administered to caregivers a mean of 11.4 +/- 9.3 months after surgical intervention.
  
  
  RESULTS
  Proximal colonic abnormalities were seen in 2 patients, abnormalities involving the distal colon and rectosigmoid region in 13 patients, pancolonic abnormalities in 2 patients, and incomplete relaxation of the internal anal sphincter in 2 patients. Surgery led to increase in frequency of bowel movements per week (8.1 v 1.9; P <.005), decrease in soiling episodes per week (2.20 v 4.7; P <.01), and decrease in daily use of medications for constipation (0.8 v 2.3; P <.05). Adverse events included skin breakdown at site of ostomy (9%), fecal incontinence after pull-through procedure (13%), and persistent constipation (4.5%). Parents felt that the symptoms after surgery were completely resolved in 89% of patients.
  
  
  CONCLUSIONS
  Surgery may be beneficial in the management children with chronic intractable constipation and documented abnormalities in motility.
authors.affiliation: Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nader N
authors.initials: NN
authors.lastname: Youssef
authors.forename: Licia
authors.initials: L
authors.lastname: Pensabene
authors.forename: Edward
authors.initials: E
authors.lastname: Barksdale
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
mesh_terms: D000714:Anastomosis, Surgical; D002648:Child; D002908:Chronic Disease; D003082:Colectomy; D003106:Colon / Q000502:physiology / Q000601:surgery*; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006627:Hirschsprung Disease; D006801:Humans; D008297:Male; D008365:Manometry; D012007:Rectum / Q000002:abnormalities; D012189:Retrospective Studies; D017211:Treatment Failure