title: Transanal rectosigmoid resection for severe intractable idiopathic constipation.
abstract: BACKGROUND
  Idiopathic constipation is a source of significant morbidity in children. A subset of patients is refractory to medical therapy and requires surgical intervention. We present a novel surgical technique for the management of these patients.
  
  
  METHODS
  We reviewed the records of 288 patients with severe idiopathic constipation and soiling. Patients who were refractory to medical management and had a megarectosigmoid underwent a transanal full-thickness rectosigmoid resection with a primary colo-anal anastomosis.
  
  
  RESULTS
  Fifteen patients underwent a transanal rectosigmoid resection. The preoperative contrast enema demonstrated an enormously dilated rectosigmoid in 14. An average of 43 cm (range, 8-98 cm) of rectosigmoid was resected. Of 14 patients with more than 3 months of follow-up, the preoperative laxative dose was 68 mg of senna/d (range, 52-95 mg), which decreased to 8.6 mg postoperatively (P < .001). Nine patients are clean without soiling, 1 is more prone to diarrhea, but is clean. Two patients soil occasionally, but are noncompliant, and 2 were lost to follow-up.
  
  
  CONCLUSIONS
  Transanal rectosigmoid resection for medically intractable idiopathic constipation resulted in a dramatic reduction or elimination in laxatives use while preserving continence. It is a useful alternative to surgical options such as other colonic resections, antegrade enemas, and stomas.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. marc.levitt@cchmc.org
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.forename: Colin A
authors.initials: CA
authors.lastname: Martin
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D003248:Constipation / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D008531:Megacolon / Q000601:surgery; D012007:Rectum / Q000601:surgery