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Technique for surgical management of intractable functional constipation
Background: Intractable functional constipation (IFC) in children poses a significant clinical challenge when standard medical interventions are unsuccessful. The laparoscopic-assisted transanal proximal rectosigmoidectomy (LATPRS) procedure is a surgical option that combines the precision of laparoscopic techniques with the functional benefits of transanal dissection.
Patients and methods: A prospective trial was conducted at Al-Azhar pediatric surgery departments from January 2022 to January 2025, with a focus on children diagnosed with IFC. Each participant underwent LATPRS combined with a Malone Antegrade continence enema (MACE). The comprehensive data collection process included patient demographics, surgical details, postoperative recovery, complications, and functional outcomes. These data were recorded and subsequently analysed. Furthermore, a validated symptom severity (SS) scoring system and the Pediatric Quality of Life Inventory (PedsQoL) were employed to assess outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| children diagnosed with IFC | Active Comparator | . Each participant underwent LATPRS combined with a Malone Antegrade continence enema (MACE) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| laparoscopic assisted transanal proximal rectosigmoidectomy | Procedure | using laparoscopy for such procedure in children is unique for this study |
|
| Measure | Description | Time Frame |
|---|---|---|
| soiling | Number of soiling episodes in pre-operative and post-operative period. Soiling refers to the inadvertent passage of fecal material into inappropriate places, such as underwear or other clothing. | 3 years |
| Measure | Description | Time Frame |
|---|---|---|
| symptoms severity score | The total symptoms severity score ranged from 0, indicating the best outcome, to 65, indicating the worst outcome. These scores comprised individual assessments in the following areas: soiling problems (range = 0--10); delay in defecation (range = 0--10); difficulty and pain associated with stool passage (range = 0--5); intensity of laxative treatment (range = 0--10); child's general health (range = 0--5); behavior related to bowel problems (range = 0--5); overall improvement of symptoms (range = 0--12); and amount of stool detected during abdominal examination (range = 0--8). A score range of 0-21 is classified as mild and considered "well." In contrast, a score range of 22-43 is categorized as moderate, indicating noticeable bowel dysfunction that requires ongoing management. A score ranging from 44-65 is classified as severe, with significant debilitating symptoms indicative of intractable cases |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mohamed Abdelmaboud, assistant professor | Faculty of medicine- Al-Azhar University Hospitals | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| pediatric surgery departments- Al-Azhar University Hospitals | Cairo | Egypt |
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| 3 years |
| The Pediatric Quality of Life Inventory (The PedsQoL™ questionnaires) | The tool initially created by James W. Varni and colleagues [16], which has received prior validation from the World Health Organization, was employed to evaluate QoL. This is a practical and validated modular tool for assessing health-related quality of life (HRQOL) in children aged 4-18 years (10). The scale evaluates the fundamental aspects of physical, emotional, social, and school functioning in children. The PedsQoL total score ranges from 0 to 92. A score between 0 and 30 is regarded as having a mild impact, indicating good quality of life. In contrast, a score between 31 and 61 suggests a moderate impact with some limitations in physical, emotional, or social functioning. A score from 62 to 92 is considered to have a severe impact, reflecting a significant compromise in quality of life, with notable distress or disability | 3 years |