Surgical Interventions for Functional Constipation: An Update
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In brief
In brief
Review of surgical management options for pediatric functional constipation refractory to medical therapy. Covers patient selection criteria based on diagnostic workup (biopsy, transit studies, manometry) and describes interventions including intestinal diversion, antegrade enemas, nerve stimulation, resection, and botulinum toxin injection.
Written by the GCMD Library team from the article.
Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progresses, it can lead to fecal retention and rectal and sigmoid distension, which impairs normal colorectal motility. Surgical interventions are influenced by the results of: a rectal biopsy, transit studies, the presence of megacolon/megarectum on contrast enema, the degree of soiling/incontinence, anorectal manometry findings, and colonic motility evaluation. In this review, we describe the different surgical options available (intestinal diversion, antegrade enemas, sacral nerve stimulation, colonic resections, and Botulinum toxin injection) and provide guidance on how to choose the best procedure for a given patient.