Management of Surgical Constipation in Children

Background: Constipation is a common pediatric concern, affecting up to 30% of children and often resulting in significant healthcare visits. Chronic constipation can be functional or surgical, with conditions like Hirschsprung disease, anorectal malformations, and dolichocolon (DC) contributing to the surgical subset. This study aims to distinguish chronic surgical constipation from habitual constipation and to assess the management approaches.Methods: A prospective interventional study was conducted at Benha University Hospital from August 2023 to September 2024, including 60 pediatric patients diagnosed with surgical constipation (Hirschsprung disease, DC, or anorectal malformation). Comprehensive evaluations included clinical history, physical examinations, laboratory tests, radiological imaging, and pathological assessments. Surgical management involved various techniques, and postoperative outcomes were monitored. Results: The cohort's median age at diagnosis was 7 years, with a predominance of females (60%). Hirschsprung disease was the most common surgical cause (60%). Surgical interventions included anoplasty (26.7%), sigmoidectomy (13.3%), and Swenson procedure (40%). The mean operative time was 3 hours. Postoperatively, the mean length of hospital stay was 9 days, with a 20% readmission rate. Notably, 20% experienced anastomosis dehiscence. Recurrence was observed in 13.3%, with 33.3% requiring long-term laxatives. Significant differences in outcomes, such as surgical procedure type and operative time, were found between patients requiring additional interventions and those without.Conclusion: Chronic surgical constipation in children presents with varied symptoms and requires tailored surgical interventions. Timely diagnosis and appropriate surgical management can improve outcomes, but recurrence remains a concern. Further investigation into long-term management strategies is warranted.