A Prospective Study of Posterior Anorectal Myectomy As A Therapeutic Approach for Refractory Idiopathic Constipation in Children- Outcomes and Efficacy
Iranian Journal of Pediatric Surgery,
Vol. 11 No. 2 (2025),
26 October 2025
,
Page 179 - 192
https://doi.org/10.22037/irjps.v11i2.46982
Abstract
Introduction: A subgroup of children with chronic idiopathic constipation continues to have persistent symptoms after treatment with high-dose laxatives, suppositories, and enemas. This study aims to determine the surgical outcome of anorectal myectomy as a treatment for these patients.
Materials and methods: The study included 46 children with refractory constipation who were not responsive to diet, laxatives, or enemas. Children with Hirschsprung disease, documented metabolic disease, diabetes, and hypothyroidism were excluded from the study. Posterior anorectal myectomy was performed in every included case. Children were followed up for 1 to 3 years after the surgery, and their frequency of fecal evacuations, fecal consistency, straining during defecation, and fecal diameter were monitored using the Bristol Stool Scoring system.
Results: Out of 46 cases that underwent surgery, 29 were boys, with an average age of 5.4 ± 2.5 years (range, 3 to 12 years). The mean duration of constipation was 13.7 ± 4.1 months (6 to 17 months). The duration of medical treatment for constipation was 13.9 ± 8.3 months (6 to 22 months). There was an overall improvement in 84% of the children, and the results were statistically significant (P<0.0005). Three (6.52%) of the patients continued to experience severe constipation 6 months postoperatively. Ganglion cells were found in 34 children, hypoganglionosis in 9, and absent in 2.
Conclusion: Improvement is observed in fecal consistency, fecal diameter, the number of bowel movements per day, and straining before and during defecation after anorectal myectomy.
- Idiopathic constipation
- anorectal myectomy
- histology
- children
How to Cite
References
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