Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan-Mar;15(1):31-35.
doi: 10.4103/ajps.AJPS_99_17.

Role of ano rectal myomectomy in children with chronic refractory constipation

Rajeev Gurunath Redkar  1 , Vinod Raj  1 , Anant Bangar  1 , Varun Hathiramani  2 , Swathi Chigicherla  1 , Shruti Tewari  1
Affiliations

Role of ano rectal myomectomy in children with chronic refractory constipation

Rajeev Gurunath Redkar et al. Afr J Paediatr Surg. 2018 Jan-Mar.

Abstract

Background: Chronic refractory constipation (CRC) is an uncommon type of constipation. These children have persistent symptoms even after treatment with high dose laxatives, which may cause abdominal distension, vomiting, cramping and bloating. We conducted this study to assess the diagnostic and therapeutic role of anorectal myomectomy in children with CRC.

Materials and methods: This study includes 107 patients who fit the criteria of CRC. Complete bowel preparation with polyethylene glycol solution, enemas and antibiotics was carried out before surgery in all patients. The anorectal myomectomy was carried out under general anaesthesia with the patient in the high lithotomy position. The patients were followed up from 6 months to 13 years postoperatively. The success of myomectomy was based on the daily and complete passage of stools without the need for medication or enemas.

Results: A total of 99 patients were included in the study, of which, 86 (86.86%) patients showed a good response to anorectal myomectomy. Of these, 32 patients had normal histology, 14 had histology suggestive of Hirschsprung's disease, 8 had hypoganglionosis, 10 had ultra-short segment Hirschsprung's disease and 22 had hypertrophic nerves with immature ganglia. Poor response was seen in 13 (13.13%) patients of whom 5 had normal histology, 5 had Hirschsprung's disease, 2 had hypoganglionosis and 1 had ultra-short segment Hirschsprung's disease.

Conclusion: Anorectal myomectomy is an effective and technically simple procedure in selected patients with CRC for both diagnostic and therapeutic purposes.

Keywords: Anorectal myomectomy; Hirschsprung's disease; chronic refractory constipation.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
The Lone Star Retractor System
Figure 2
Figure 2
The posterior muscle strip being excised
See this image and copyright information in PMC

References

    1. Levitt MA, Martin CA, Falcone RA, Jr, Peña A. Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg. 2009;44:1285–90. - PubMed
    1. Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1–13. - PubMed
    1. Staiano A, Andreotti MR, Greco L, Basile P, Auricchio S. Long-term follow-up of children with chronic idiopathic constipation. Dig Dis Sci. 1994;39:561–4. - PubMed
    1. Keshtgar AS, Ward HC, Clayden GS, Sanei A. Thickening of the internal anal sphincter in idiopathic constipation in children. Pediatr Surg Int. 2004;20:817–23. - PubMed
    1. Bustorff-Silva JM, Costa-Pinto EA, Fukushima E. Role of anorectal manometry in the differential diagnosis of chronic constipation in children. J Pediatr (Rio J) 2000;76:227–32. - PubMed