title: [Outcome of posterior anorectal myectomy for the treatment of idiopathic chronic constipation].
abstract: OBJECTIVE
  The aim of this study is to assess the outcome of surgery (Lynn's myectomy) in patients with chronic persistent constipation and failure of medical treatment.
  
  
  METHODS
  Descriptive study of patients with severe chronic constipation treated by posterior anorectal myectomy (Lynn's technique). We report data from the last 15 years, with a minimum postoperative follow-up of one year. Patients included in the study suffered from a long-term constipation refractory to medical management. Data regarding contrast enema, anorectal manometry and rectal biopsy were recorded. The procedure's outcome is classified following clinical criteria: Asymptomatic: >3 bowel movements per week, with no soiling/incontinence and with no medical treatment; Improvement: >3 bowel movements per week, with no soiling/incontinence but using laxatives occasionally.
  
  
  RESULTS
  Nineteen myectomies were performed (median age of 8.47 years). Median time of constipation before surgery was 7.89 years. Rectal biopsy findings: 10 with ganglion cells, 4 without ganglion cells and other abnormalities in 5. Anorectal manometry was performed in 6 patients, 4 presented rectoanal inhibitory reflex. Four patients were diagnosed of Hirschsprung's disease (1 was asymptomatic after myectomy, 2 needed further surgery and 1 was lost in follow-up). Of the remaining 15 patients, 8 were asymptomatic (53.3%), 4 experienced improvement (26.6%) and 1 without clinical changes is on pelvic floor physiotherapy. Two were lost in follow-up. There were no other postoperative complications after long term follow-up.
  
  
  CONCLUSIONS
  Lynn's myectomy is an effective and safe procedure in patients suffering from persistent chronic constipation despite of medical treatment. It is also the definitive treatment for patients with ultrashort-segment Hirschsprung's disease.
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: M
authors: M
authors: Ortega Escudero
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: J M
authors: JM
authors: Gutiérrez Dueñas
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: C
authors: C
authors: Hernández Díaz
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: C
authors: C
authors: Ruiz Hierro
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: R
authors: R
authors: Chamorro Juárez
authors: Servicio de Cirugía Pediátrica. Hospital Universitario de Burgos. Burgos.
authors: E
authors: E
authors: Ardela Díaz
keywords: Constipation; Internal anal sphincter myectomy; Ultrashort-segment Hirschsprung’s disease