Rectal Myectomy in Treatment of Chronic Idiopathic Constipation among Children

Chronic intractable childhood constipation is a debilitating disease that need multidisciplinary approach care of these patients, typically consists of diet modification, cathartic agents, enema, biofeedback training, psychotherapy and the last surgical intervention. Rectal myectomy is one of the them. In our hospital, we have investigated more than 540 children (aged between 2 and 12 years, M/F=298/242) with chronic constipation that have not responded to current treatment by pediatricians and pediatric gastroenterologists. We excluded all children with known neurological, hormonal, drug, diet and anatomical causes of constipation. All cases had barium enema study and half of them underwent anorectal manometry. The number of bowel movements was one every 3 to 15 day. 65 patients with typical findings of Hirschsprung's that were proved by rectal biopsy were excluded. Posterior rectal myectomy (3 cm. length×1 cm. width) was done in 475 of causes and the spicemens sent for histological study. NID and Hirschsprung's was reported in 75 of them that deleted from our study and finally, 400 (M/F, 212/188) children were followed. Constipation resolved in 65% (260) patients in whom there were intermittent or no application of cathartic agents and their bowel movements increase eight or more over a 15 day period. 35% of children did not experience any significant changes in their defecation pattern, in whom other methods of management were applied (e.g. Daily enema, biofeedback, colon resection, Melon procedure). Children with chronic idiopathic refractory constipation may be subsided to rectal myectomy in approximately 65% of them. There were no significant complications through in this procedure.