Surgical management of functional constipation: An intermediate report of a new approach using a laparoscopic sigmoid resection combined with malone appendicostomy
| Autor: | Alessandra C. Gasior, Richard J. Wood, Carlo Di Lorenzo, Karen A. Diefenbach, Peter L. Lu, Carlos A. Reck, Marc A. Levitt, Desalegn Yacob, Karla Vaz, Alejandra Vilanova-Sanchez |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Laxative Bowel management Appendix Cerebral palsy 03 medical and health sciences 0302 clinical medicine Colon Sigmoid 030225 pediatrics medicine Humans Tethered Cord Child Retrospective Studies business.industry Spina bifida General Medicine medicine.disease Surgery Regimen Cecostomy Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Functional constipation 030211 gastroenterology & hepatology Female Laparoscopy business Constipation Sigmoid resection Follow-Up Studies |
| Zdroj: | Journal of pediatric surgery. 53(6) |
| ISSN: | 1531-5037 |
| Popis: | Introduction We previously reported our surgical technique for functional constipation for patients who have failed medical management using a novel collaborative approach with gastroenterology input, pre-operative contrast enema, colonic manometry, and laxative protocol combined with a laparoscopic colonic resection with Malone appendicostomy. Now we report our intermediate outcomes. Methods Patients who failed bowel management program for functional constipation were reviewed from 3/2014–2/2017. Patients with Hirschsprung disease, anorectal malformation, tethered cord, spina bifida, Trisomy 21, cerebral palsy, mitochondrial disease, or prior colon resection were excluded. Results Of 31 patients (14 females; median age 12years, follow-up 10.3months) with functional constipation and failed medical management, 26 (84%) had preoperative colonic manometry which, in addition to the contrast enema, guided laparoscopic colon resection. Ten patients (32.3%) are clean with no flushes (1 takes no laxatives, 8 are on low dose laxatives only, and 1 patient was clean on laxatives but chose to switch back to flushes). Of the 21 patients that remain on antegrade flushes, 20 (95.2%) are clean, and one patient (4.8%) continues to soil. We define clean as no soiling and no abnormal stool burden on x-ray. Laxative trials are planned for all patients on an antegrade flush regimen. Conclusion Our intermediate results show that laparoscopic colon resection with Malone appendicostomy allows the majority of patients to be clean on antegrade flushes, and some to be on no or minimal laxatives. Type of study Retrospective review. Level of Evidence 3 |
| Databáze: | OpenAIRE |
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