Current Surgical Management of Pediatric Idiopathic Constipation A Systematic Review of Published Studies

被引:64
作者
Siminas, Sotirios [1 ]
Losty, Paul D. [2 ,3 ]
机构
[1] Royal Manchester Childrens Hosp, Dept Paediat Surg, Manchester M27 1HA, Lancs, England
[2] Univ Liverpool, Inst Child Hlth, Dept Acad Paediat Surg, Liverpool L69 3BX, Merseyside, England
[3] Alder Hey Childrens Hosp NHS Fdn Trust, Dept Paediat Surg, Liverpool, Merseyside, England
关键词
idiopathic constipation; outcome(s); pediatrics; surgery; systematic review; botox; ANTEGRADE CONTINENCE ENEMA; TERM-FOLLOW-UP; SEVERE CHILDHOOD CONSTIPATION; SLOW-TRANSIT CONSTIPATION; INTRACTABLE CONSTIPATION; DEFECATION DISORDERS; RESTORATIVE PROCTOCOLECTOMY; FECAL INCONTINENCE; COLONIC MANOMETRY; BOTULINUM TOXIN;
D O I
10.1097/SLA.0000000000001191
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective:Surgery for pediatric idiopathic constipation (IC) is undertaken after failure of bowel management programs. Decisions are influenced by rectal biopsy, transit studies, megacolon/megarectum, degree of soiling/incontinence, and anorectal manometry profile(s). A systematic review of ALL published studies critically evaluates outcomes of surgery for IC.Methods:MEDLINE (PubMed), Google Scholar, and EMBase were searched for English-language articles only. Studies included (1) peer-review publications with 3 or more patients, and (2) clinical outcomes defined by authors.Results:Forty-five reports (1157 patients) met full inclusion criteria. Only 2 papers were randomized controlled trials. Many had small patient numbers (median n=16; range: 3-114). Twenty-three described heterogenous populations with variant pathology. Follow-up was short (median = 1.5 years: range: 3 months-14 years). The antegrade continence enema operation (ACE)[open/laparoscopic assisted, cecostomy, or left sided ACE]was judged as successful in 82% of cases, although high morbidity and reoperations were reported. Colon resection and pull through operations had good outcome(s) in 79% of children with 17% reporting significant morbidity and a 10% incidence of revisional surgery. Anal dilatation did not improve outcome(s). Botulinum toxin injection scored equally effective compared to internal sphincter myectomy in short-term follow-up. Permanent colostomy was considered successful in 86% of refractory IC cases.Conclusions:Surgical management and outcome(s) for pediatric IC are based on low-quality evidence. No single operation was considered best practice. This study crucially highlights that surgeons must develop better care strategies.
引用
收藏
页码:925 / 933
页数:9
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