From the Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
the Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):578-583. doi: 10.1097/MPG.0000000000003579. Epub 2022 Jul 28.
Pediatric functional constipation (FC) may require invasive evaluations [like colon manometry (CM)] and surgical interventions [including diverting ostomy (DO)]. We evaluated the utility of CM in guiding surgery after DO.
Children with medically refractory FC undergoing an ostomy were included. Institutional Review Board approval was obtained for this retrospective study. Demographics and CM variables [high amplitude propagating contractions (HAPCs)] were recorded. Outcome measures: response to ostomy closure defined as successful if no need for further surgery after ostomy closure, and improvement on baseline CM after ostomy. A CM-guided ostomy closure algorithm was developed based on previous studies. We evaluated the association between response to ostomy closure and demographics, ostomy indication and CM improvement, and evaluated the role of CM predicting response using algorithm.
A total of 60 children underwent ostomy for FC (median age: 7.1 years, range 0.15-23.6 years, 50% female). Ostomy was closed in 30 patients and deemed successful in 23 of 30. CM was performed in 42 of 60 patients before ostomy and in 29 of 30 before ostomy closure. We found no association between ostomy outcome and age, gender, weight, imaging studies, follow-up time, time with ostomy, HAPCs, and CM improvement. We found an association between failed response and ostomy indication of antegrade colonic enemas (ACE) failure ( P = 0.026) and successful response when ostomy closure was guided by algorithm ( P = 0.03).
DO is a useful intervention in selected children with medically refractory FC, improving colon motility in most. CM can successfully guide the timing and type of ostomy closure. Larger studies are needed to further validate our findings.
小儿功能性便秘（FC）可能需要进行侵入性评估[如结肠测压（CM）]和手术干预[包括转流性造口术（DO）]。我们评估了 CM 在 DO 后指导手术的效用。
纳入接受造口术且药物难治性 FC 的儿童。本回顾性研究获得机构审查委员会批准。记录人口统计学和 CM 变量[高振幅传播收缩（HAPCs）]。结果测量：造口关闭的反应定义为造口关闭后无需进一步手术为成功，并且造口后 CM 基线改善。根据先前的研究制定了 CM 指导的造口关闭算法。我们评估了造口关闭反应与人口统计学、造口适应证和 CM 改善之间的关系，并使用算法评估了 CM 预测反应的作用。
共有 60 名儿童因 FC 而行造口术（中位年龄：7.1 岁，范围 0.15-23.6 岁，50%为女性）。30 名患者关闭了造口，其中 23 名成功。60 名患者中有 42 名在造口前和 30 名在造口关闭前进行了 CM 检查。我们未发现造口结果与年龄、性别、体重、影像学研究、随访时间、造口时间、HAPCs 和 CM 改善之间存在关联。我们发现造口反应失败与逆行结肠灌肠（ACE）失败的造口适应证之间存在关联（P=0.026），而当根据算法指导造口关闭时则存在成功反应（P=0.03）。
DO 是一种治疗药物难治性 FC 的有用干预措施，可改善大多数结肠动力。CM 可以成功指导造口关闭的时机和类型。需要更大规模的研究来进一步验证我们的发现。
