Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?

Koppen, Ilan J.N.; Kuizenga-Wessel, Sophie; Lu, Peter L.; Benninga, Marc A.; Lorenzo, Carlo Di; Lane, Victoria A.; Levitt, Marc A.; Wood, Richard J.; Yacob, Desale

doi:10.1016/j.jpedsurg.2016.05.023

Cited by 46 publications

(49 citation statements)

References 39 publications

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“…In severe cases of intractable FC, surgical treatment is sometimes considered as a treatment of last resort [61•]. A survey study showed that physicians differ in surgical decisionmaking for children with intractable FC [62]. Given the difficulties involved in decision-making and the high impact of surgical interventions, there is a great need for consensus guidelines for surgical interventions in childhood FC [62].…”

Section: Surgical Interventionsmentioning

confidence: 99%

“…A survey study showed that physicians differ in surgical decisionmaking for children with intractable FC [62]. Given the difficulties involved in decision-making and the high impact of surgical interventions, there is a great need for consensus guidelines for surgical interventions in childhood FC [62]. Two publications have currently attempted to provide such a protocol based on literature review and clinical experience [61•, 63].…”

Section: Surgical Interventionsmentioning

confidence: 99%

“…Anal myectomy and anal dilation have been largely abandoned by surgeons due to the risk of complications. The major risk of these two procedures is that the basal pressure of the anal sphincter can be weakened to the point of causing fecal incontinence [62].…”

Section: Surgical Interventionsmentioning

confidence: 99%

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Controversies in the Management of Functional Constipation in Children

Mill

Koppen

Benninga

2019

Curr Gastroenterol Rep

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Purpose of review Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre-and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. Recent findings Pre-and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Summary Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.

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Section: Surgical Interventionsmentioning

confidence: 99%

Section: Surgical Interventionsmentioning

confidence: 99%

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Controversies in the Management of Functional Constipation in Children

Mill

Koppen

Benninga

2019

Curr Gastroenterol Rep

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“…Surgery is generally performed in a step‐up approach, beginning with the least invasive procedure and proceeding to more invasive treatment options only after failure of the previous step. Since there are no guidelines for surgery in children with intractable FC, the choice of surgical intervention is challenging and the approach differs among centers . Surgical options include botulinum toxin injections into the anal sphincter complex, anal sphincter myectomy, sacral nerve stimulation (SNS), creation of an access for administration of antegrade enemas, segmental or total colonic resection, and temporary/permanent diverting ileostomy, and colostomy .…”

Section: Introductionmentioning

confidence: 99%

“…Since there are no guidelines for surgery in children with intractable FC, the choice of surgical intervention is challenging and the approach differs among centers. 13 Surgical options include botulinum toxin injections into the anal sphincter complex, anal sphincter myectomy, sacral nerve stimulation (SNS), creation of an access for administration of antegrade enemas, segmental or total colonic resection, and temporary/ permanent diverting ileostomy, and colostomy. 11,14 The rationale for diversion via an ostomy is to relieve symptoms and to decompress the colon, giving the diverted colonic segment time to recover.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital

Kuizenga-Wessel

Koppen

Zwager

et al. 2016

Neurogastroenterology Motil

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Current practice in the care of children with functional constipation: What is the hold up?

van der Zande,

Koppen,

Yacob

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesFor children with intractable functional constipation (FC), there are no evidence‐based guidelines for subsequent evaluation and treatment. Our objective was to assess the practice patterns of a large, international cohort of pediatric gastroenterologists.MethodsWe administered a survey to physicians who attended the 2nd World Congress of Pediatric Neurogastroenterology and Motility held in Columbus, Ohio (USA) in September 2023. The survey included 29 questions on diagnostic testing, nonpharmacological and pharmacological treatment, and surgical options for children with intractable FC.ResultsNinety physicians from 18 countries completed the survey. For children with intractable FC, anorectal manometry was the most commonly used diagnostic test. North American responders were more likely than Europeans to use stimulant laxatives (97% vs. 77%, p = 0.032), prosecretory medications (69% vs. 8%, p < 0.001), and antegrade continence enemas (ACE; 83% vs. 46%, p = 0.009) for management. Europeans were more likely than North Americans to require colonic transit testing before surgery (85% vs. 30%, p < 0.001). We found major differences in management practices between Americans and the rest of the world, including use of prosecretory drugs (73% vs. 7%, p < 0.001), anal botulinum toxin injections (81% vs. 58%, p = 0.018), ACE (81% vs. 58% p = 0.018), diverting ileostomies (56% vs. 26%, p = 0.006), and colonic resections (42% vs. 16%, p = 0.012). No differences were found when respondents were compared by years of experience.ConclusionsPractice patterns in the evaluation and treatment of children with intractable FC differ widely among pediatric gastroenterologists from around the world. A clinical guideline regarding diagnostic testing and surgical decision‐making is needed.

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Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?

Cited by 46 publications

References 39 publications

Controversies in the Management of Functional Constipation in Children

Controversies in the Management of Functional Constipation in Children

Surgical management of children with intractable functional constipation; experience of a single tertiary children's hospital

Current practice in the care of children with functional constipation: What is the hold up?

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