Management of severe functional constipation with failed medical management

quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"When medical management fails to resolve constipation, patients with neurogenic or neuromuscular causes of chronic constipation, anorectal malformations, and patients with idiopathic CIC utilize daily enemas to achieve evacuation. Adherence to a regular bowel management program can achieve social continence for many of these patients, but as they grow older, it becomes more convenient for them to be able to manage enema administration independently. In these patients, ACE administration has been demonstrated to improve quality of life [9, 10]."

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"Patients who have not demonstrated some degree of success with rectal enemas are unlikely to have additional benefit from antegrade enemas. A careful assessment and preparation of the patients is crucial for the success of an antegrade enema operation. At least a 3-month course of retrograde enemas to prove responsiveness and compliance should be completed prior to consideration of enteral access ACE administration. Moreover, ACE delivery may require a lifelong commitment from the patient."

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"For patients with irreversible megarectosigmoid due to unaddressed constipation after anorectal malformation repair, Hirschsprung disease, or idiopathic CIC, segmental resection of the dilated sigmoid with a colo-colonic anastomosis is indicated before evaluating enteral access for ACE administration. Sigmoidectomy can be performed in a conventional open operation, laparoscopically, transanally, or in a hybrid technique [8]. In general, a great proportion of the rectum should be preserved in patients with prior repair of anorectal malformations to allow for a reservoir for stool to produce a feeling of fullness. Patients with idiopathic CIC may undergo more complete rectal resection, as sphincter function and proprioception tend to be intact. Patients who have true fecal incontinence are not well served with sigmoidal resection, as it may convert a tendency toward constipation to one toward softer stools, exacerbated by laxative therapy. Thus patients with CIC and true fecal incontinence are better served with enteral access for ACE administration."

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"Enteral access for ACE administration is indicated for patients with CIC who have failed other medical treatments but who are responsive/compliant to regular administration of retrograde enemas."