Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?

Effect of Octreotide on Colonic Motility in Pediatric Patients With Chronic Recalcitrant Constipation

“…Patients with intractable constipation and normal colonic motility are often offered surgical treatment (MACE/cecostomy) if all medical therapy has failed. 6 Patients with true dysmotility may need MACE/cecostomy or total or segmental colonic resection depending on severity of colonic dysmotility. There is a need to identify newer medical therapies to treat patients with intractable constipation and colonic dysmotility as treatments options are very limited.…”

Targeting the Causes of Intractable Chronic Constipation in Children: The Nuclear Transit Study (NTS)

“…However, rectal mucosal biopsy can be useful for the diagnosis of food intolerance/allergy if eosinophilia and mast cells are demonstrated (Carroccio et al 2000;Daher et al 2001;Carroccio & Iacono 2006;Scaillon & Cadranel 2006). Some centres advocate the identification of "the site of slowing in the colon" to decide on the part/segment of the colon to be resected in patients with intractable symptoms, desperate for a cure (Youssef et al 2004). This has important implications because patients with pancolonic slow transit will not benefit from a segmental resection as the risk of relapse of symptoms is much higher.…”

Analysis of the commonest causes and symptoms of chronic constipation in children

“…Wydaje się, że w przypadku dzieci koszty terapii mogą być jeszcze wyższe. Co więcej, wykazano, iż zaparcia przewlekłe u dzieci preZ tego względu uważa się, iż zabieg chirurgiczny powinien być brany pod uwagę jedynie w przypadku braku jakichkolwiek efektów leczenia zachowawczego [27][28][29]. W trakcie kwalifikacji pacjenta do leczenia zabiegowego należy bardzo dokładnie ocenić ewentualne korzyści z zabiegu chirurgicznego oraz ryzyko wystąpienia poważnych działań niepożądanych [1].…”