Slow transit constipation with dolichosigmoid in children – possibilities of surgical treatment

Abstract

Introduction. Chronic constipations in children occupy one of the leading places in pediatric gastroenterological practice. Conservative treatment if effective in 90-92%. Although, children with refractory slow transit constipations caused by dolichosigmoid in case of ineffective medical treatment require other ways to solve the problem, surgery may be one of them. Aim of the Study. To elaborate effective methods of surgical treatment of dolichosigmoid in children. Methods. The results of surgical treatment of 61 children with dolichosigmoid aged from 6 to 18 have been analyzed. The children were divided into two groups: I group (n = 32 children) – surgical treatment by means of resection of the sigmoid colon was analyzed; ІІ group (n = 29 children) – the efficacy of the suggested surgery was analyzed, long-term functional results were studied, clinical efficacy of the applied methods was evaluated. Rectal biopsy was performed, irrigoradiographic examinations were estimated, the indices of anosphincterometry were studied. Results. According to the findings of radiologic examinations dolichosigmoid in children should be classified into isolated and combined with dilation of the rectum. In case of dolichosigmoid with dilated rectum hypogangliosis is found histologically. Conclusions. During surgical treatment of dolichosigmoid in children with dilation of the rectum the operation of Soave-Boley endorectal pull-through is recommended to be performed. In case of isolated dolichosigmoid in children the operation of sigmoidectomy is indicated with descendorectal end-to-end anastomosis with formation of distal colon ligament.