Intractable chronic constipation in children: outcome after anorectal myectomy.
BACKGROUND
Many children with constipation fail to respond with conventional medical therapy. Surgery can produce a good result in dysfunction of the colon secondary to aganglionosis. However, its role in treating idiopathic constipation is more controversial.


METHODS
A consecutive series of 44 patients with chronic idiopathic intractable constipation were included in this study. All children were investigated by barium enema and anorectal manometry. Due to inadequate response to medical therapy, all of these patients were selected for internal sphincter myomectomy. Patients were followed-up from 3 to 12 months.


RESULTS
Short-term (3 months) and long-term (6 months) follow-up was available for all patients. The histology examinations showed normal ganglion cells in 32, hypoganglionosis in eight and aganglionosis in four patients. In short-term, regular bowel habits, without the need for laxatives or low dose drugs were recorded in 35 patients (79.5%). Overall there was an improvement in 68.2% of the children after 6 months follow-up. There was not any correlation between histopathological findings, duration of symptoms, age and sex of operation and response to myectomy.


CONCLUSIONS
anorectal myectomy is an effective procedure in patients with intractable idiopathic constipation. It relieves symptoms in 68.2% of patients with chronic refractory constipation.
Department of Pediatric Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran.
Seyed Abdollah
SA
Mousavi
Hasan
H
Karami
Ahmad Ali
AA
Rajabpoor
D000367:Age Factors; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003248:Constipation / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D003906:Developing Countries; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007492:Iran; D008297:Male; D009130:Muscle, Smooth / Q000601:surgery; D061214:Patient Safety; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome