title: Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?
abstract: BACKGROUND
  Children with intractable functional constipation (FC) may eventually require surgery, often guided by motility testing. However, there are no evidence-based guidelines for the surgical management of intractable FC in children.
  
  
  OBJECTIVE
  To assess the diagnostic and surgical approach of pediatric surgeons and pediatric gastroenterologists towards children with intractable FC.
  
  
  METHODS
  A survey was administered to physicians attending an international conference held simultaneously in Columbus (Ohio, USA) and Nijmegen (the Netherlands). The survey included 4 questions based on cases with anorectal and colonic manometry results.
  
  
  RESULTS
  74 physicians completed the questionnaire. Anorectal manometry was used by 70%; 52% of them would consider anal sphincter botulinum toxin injections for anal achalasia and 21% would use this to treat dyssynergia. Colonic manometry was used by 38%; 57% of them reported to use this to guide surgical decision-making. The surgical approach varied considerably among responders answering the case questions based on motility test results; the most commonly chosen treatments were antegrade continence enemas and anal botulinum injections.
  
  
  CONCLUSIONS
  Surgical decision-making for children with intractable FC differs among physicians. There is a need for clinical guidelines regarding the role of anorectal and colonic manometry in surgical decision-making in children with intractable FC.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands. Electronic address: i.j.koppen@amc.nl.
authors.forename: Ilan J N
authors.initials: IJ
authors.lastname: Koppen
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Sophie
authors.initials: S
authors.lastname: Kuizenga-Wessel
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lu
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Lane
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wood
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Center for Colorectal and Pelvic Reconstruction, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Desale
authors.initials: D
authors.lastname: Yacob
mesh_terms: D001003:Anal Canal / Q000503:physiopathology; D001291:Attitude of Health Personnel; D002648:Child; D000066491:Clinical Decision-Making / Q000379:methods*; D003106:Colon / Q000503:physiopathology; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D000072102:Gastroenterologists; D005769:Gastrointestinal Motility; D006801:Humans; D008365:Manometry; D009426:Netherlands; D009820:Ohio; D012007:Rectum / Q000503:physiopathology; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Children; Constipation; Manometry; Motility; Surgery; Treatment