Surgical approach to megarectum and/or megasigmoid in children with unremitting constipation.


eMediNexus    29 January 2018

The goal of a new study published in the Annals of Medicine and Surgery was to determine the outcomes of surgery in children with functional constipation (FC), and to contribute to formulating a standard of care for children with megarectum (MR) and/or redundancy of the sigmoid colon (MS) who fail medical management. This study utilized mucosal proctectomy and endorectal pull-through (MP) or sigmoidectomy (SE) with colorectal anastomosis at the peritoneal reflection. Overall, 30/43 patients had MP while 13/43 underwent SE; follow-up was obtained in 83% MP and 70% SE patients. It was noted that 60% of MP and 78% of SE patients reported regular evacuations and no soiling. On the other hand, 20% MP patients had occasional urgency or soiling or episodic constipation. Whereas, 12% MP and 22% SE patients required antegrade continence enemas (ACE) or scheduled cathartics and/or stool softeners. While 4% MP had no appreciable benefit with respect to frequent loose stools and soiling, presumably from encopresis. From the findings, it was inferred that MR is characterized by diminished sensation, poor compliance and defective contractility. It was stated that children with MR show better outcomes with MP compared to SE. Moreover, MP reliably preserves continence; whereas total proctectomy (trans-anal or trans-abdominal) may cause incontinence.

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