Transanal rectosigmoid resection for severe intractable idiopathic constipation

J Pediatr Surg. 2009 Jun;44(6):1285-90; discussion 1290-1. doi: 10.1016/j.jpedsurg.2009.02.049.

Abstract

Introduction: Idiopathic constipation is a source of significant morbidity in children. A subset of patients is refractory to medical therapy and requires surgical intervention. We present a novel surgical technique for the management of these patients.

Methods: We reviewed the records of 288 patients with severe idiopathic constipation and soiling. Patients who were refractory to medical management and had a megarectosigmoid underwent a transanal full-thickness rectosigmoid resection with a primary colo-anal anastomosis.

Results: Fifteen patients underwent a transanal rectosigmoid resection. The preoperative contrast enema demonstrated an enormously dilated rectosigmoid in 14. An average of 43 cm (range, 8-98 cm) of rectosigmoid was resected. Of 14 patients with more than 3 months of follow-up, the preoperative laxative dose was 68 mg of senna/d (range, 52-95 mg), which decreased to 8.6 mg postoperatively (P < .001). Nine patients are clean without soiling, 1 is more prone to diarrhea, but is clean. Two patients soil occasionally, but are noncompliant, and 2 were lost to follow-up.

Conclusion: Transanal rectosigmoid resection for medically intractable idiopathic constipation resulted in a dramatic reduction or elimination in laxatives use while preserving continence. It is a useful alternative to surgical options such as other colonic resections, antegrade enemas, and stomas.

MeSH terms

  • Adolescent
  • Anal Canal / surgery*
  • Anastomosis, Surgical
  • Child
  • Child, Preschool
  • Colon / surgery*
  • Colon, Sigmoid / surgery
  • Constipation / surgery*
  • Digestive System Surgical Procedures / methods
  • Humans
  • Megacolon / surgery
  • Rectum / surgery