title: Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital.
abstract: Children with intractable functional constipation (FC) may eventually require surgery. However, guidelines regarding the surgical management of children with intractable FC are lacking. The aim of this study was to describe the surgical management of FC in children.
  
  
  
  A retrospective chart review was performed of children with FC (according to the Rome III criteria) who underwent ileostomy, colostomy or (sub)total colectomy at a tertiary hospital. Treatment success was defined as no longer fulfilling the Rome III-FC-criteria or having a functional ostomy. In addition, a self-developed questionnaire was administered to parents by telephone to assess postsurgical satisfaction (yes-no question and rated on a scale of 1-10).
  
  
  
  Thirty-seven patients (68% female) were included; median age at first surgery was 12 years (range 1.6-17.6). The initial surgical procedure consisted of ileostomy (n=21), colostomy (n=10), sigmoid resection (n=5) and subtotal colectomy (n=1). Success criteria were fulfilled by 85% of the patients. Postsurgical satisfaction of parents was 91% with a median postoperative satisfaction score of 8 (range 2-10), and 97% would opt for the same procedure(s) if necessary. Thirty patients (81%) experienced stoma problems, with 12 patients (32%) requiring stoma-revisions. Other complications occurred in 16 patients (43%).
  
  
  
  Surgery can improve symptoms in children with intractable FC. Despite morbidity and complications, parental satisfaction is high. Prospective, high-quality research is necessary to develop guidelines for the diagnostic work-up and surgical management in children with intractable FC.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Kuizenga-Wessel
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.|Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: I J N
authors.initials: IJN
authors.lastname: Koppen
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: L W
authors.initials: LW
authors.lastname: Zwager
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Department of Pediatric Surgery, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: de Jong
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000592:standards; D003125:Colostomy / Q000592:standards; D003248:Constipation / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000592:standards; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011183:Postoperative Complications; D057234:Preoperative Period; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: children; functional constipation; surgery; treatment