Refractory functional constipation: clinical management or appendicostomy?,

Detalhes bibliográficos
Autor(a) principal: Arruda,Vanesca P.A. de
Data de Publicação: 2020
Outros Autores: Bellomo-Brandão,Maria A., Bustorff-Silva,Joaquim M., Lomazi,Elizete Aparecida
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Jornal de Pediatria (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572020000200210
Resumo: Abstract Objective: To compare the clinical evolution in patients with refractory functional constipation undergoing different therapeutic regimens: oral laxatives and antegrade enemas via appendicostomy or clinical treatment with oral laxatives and rectal enemas. Methods: Analysis of a series of 28 patients with a mean age of 7.9 years (2.4-11), followed-up in a tertiary outpatient clinic. Refractory functional constipation was defined as continuous retentive fecal incontinence after at least a 12-month period of consensus therapy. After the diagnosis of refractory condition, appendicostomy was proposed and performed in 17 patients. Outcomes: (1) persistence of retentive fecal incontinence despite the use of enemas, (2) control of retentive fecal incontinence with enemas, and (3) control of retentive fecal incontinence, spontaneous evacuations, with no need for enemas. Results: Six and 12 months after the therapeutic option, control of retentive fecal incontinence was observed only in patients who underwent surgery, 11/17 and 14/17, p = 0.001 and p = 0.001, respectively. At 24 months, control of retentive fecal incontinence was also more frequent in operated patients: 13/17 versus 3/11 with clinical treatment, p = 0.005. In the final evaluation, the median follow-up times were 2.6 and 3 years (operated vs. clinical treatment, p = 0.40); one patient in each group was lost to follow-up and 9/16 operated patients had spontaneous bowel movements vs. 3/10 in the clinical treatment group, p = 0.043. Surgical complications, totaling 42 episodes, were observed 14/17 patients. Conclusion: Appendicostomy, although associated with a high frequency of complications, controlled retentive fecal incontinence earlier and more frequently than clinical treatment. The choice of one of the methods should be made by the family, after adequate information about the risks and benefits of each alternative.
id SBPE-1_da9537a5e3fb5b76636f94b641efdece
oai_identifier_str oai:scielo:S0021-75572020000200210
network_acronym_str SBPE-1
network_name_str Jornal de Pediatria (Online)
repository_id_str
spelling Refractory functional constipation: clinical management or appendicostomy?,Functional constipationEnemaChildAdolescentFecal incontinenceAbstract Objective: To compare the clinical evolution in patients with refractory functional constipation undergoing different therapeutic regimens: oral laxatives and antegrade enemas via appendicostomy or clinical treatment with oral laxatives and rectal enemas. Methods: Analysis of a series of 28 patients with a mean age of 7.9 years (2.4-11), followed-up in a tertiary outpatient clinic. Refractory functional constipation was defined as continuous retentive fecal incontinence after at least a 12-month period of consensus therapy. After the diagnosis of refractory condition, appendicostomy was proposed and performed in 17 patients. Outcomes: (1) persistence of retentive fecal incontinence despite the use of enemas, (2) control of retentive fecal incontinence with enemas, and (3) control of retentive fecal incontinence, spontaneous evacuations, with no need for enemas. Results: Six and 12 months after the therapeutic option, control of retentive fecal incontinence was observed only in patients who underwent surgery, 11/17 and 14/17, p = 0.001 and p = 0.001, respectively. At 24 months, control of retentive fecal incontinence was also more frequent in operated patients: 13/17 versus 3/11 with clinical treatment, p = 0.005. In the final evaluation, the median follow-up times were 2.6 and 3 years (operated vs. clinical treatment, p = 0.40); one patient in each group was lost to follow-up and 9/16 operated patients had spontaneous bowel movements vs. 3/10 in the clinical treatment group, p = 0.043. Surgical complications, totaling 42 episodes, were observed 14/17 patients. Conclusion: Appendicostomy, although associated with a high frequency of complications, controlled retentive fecal incontinence earlier and more frequently than clinical treatment. The choice of one of the methods should be made by the family, after adequate information about the risks and benefits of each alternative.Sociedade Brasileira de Pediatria2020-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572020000200210Jornal de Pediatria v.96 n.2 2020reponame:Jornal de Pediatria (Online)instname:Sociedade Brasileira de Pediatria (SBP)instacron:SBPE10.1016/j.jped.2018.09.001info:eu-repo/semantics/openAccessArruda,Vanesca P.A. deBellomo-Brandão,Maria A.Bustorff-Silva,Joaquim M.Lomazi,Elizete Aparecidaeng2020-05-06T00:00:00Zoai:scielo:S0021-75572020000200210Revistahttp://www.jped.com.br/https://old.scielo.br/oai/scielo-oai.php||jped@jped.com.br1678-47820021-7557opendoar:2020-05-06T00:00Jornal de Pediatria (Online) - Sociedade Brasileira de Pediatria (SBP)false
dc.title.none.fl_str_mv Refractory functional constipation: clinical management or appendicostomy?,
title Refractory functional constipation: clinical management or appendicostomy?,
spellingShingle Refractory functional constipation: clinical management or appendicostomy?,
Arruda,Vanesca P.A. de
Functional constipation
Enema
Child
Adolescent
Fecal incontinence
title_short Refractory functional constipation: clinical management or appendicostomy?,
title_full Refractory functional constipation: clinical management or appendicostomy?,
title_fullStr Refractory functional constipation: clinical management or appendicostomy?,
title_full_unstemmed Refractory functional constipation: clinical management or appendicostomy?,
title_sort Refractory functional constipation: clinical management or appendicostomy?,
author Arruda,Vanesca P.A. de
author_facet Arruda,Vanesca P.A. de
Bellomo-Brandão,Maria A.
Bustorff-Silva,Joaquim M.
Lomazi,Elizete Aparecida
author_role author
author2 Bellomo-Brandão,Maria A.
Bustorff-Silva,Joaquim M.
Lomazi,Elizete Aparecida
author2_role author
author
author
dc.contributor.author.fl_str_mv Arruda,Vanesca P.A. de
Bellomo-Brandão,Maria A.
Bustorff-Silva,Joaquim M.
Lomazi,Elizete Aparecida
dc.subject.por.fl_str_mv Functional constipation
Enema
Child
Adolescent
Fecal incontinence
topic Functional constipation
Enema
Child
Adolescent
Fecal incontinence
description Abstract Objective: To compare the clinical evolution in patients with refractory functional constipation undergoing different therapeutic regimens: oral laxatives and antegrade enemas via appendicostomy or clinical treatment with oral laxatives and rectal enemas. Methods: Analysis of a series of 28 patients with a mean age of 7.9 years (2.4-11), followed-up in a tertiary outpatient clinic. Refractory functional constipation was defined as continuous retentive fecal incontinence after at least a 12-month period of consensus therapy. After the diagnosis of refractory condition, appendicostomy was proposed and performed in 17 patients. Outcomes: (1) persistence of retentive fecal incontinence despite the use of enemas, (2) control of retentive fecal incontinence with enemas, and (3) control of retentive fecal incontinence, spontaneous evacuations, with no need for enemas. Results: Six and 12 months after the therapeutic option, control of retentive fecal incontinence was observed only in patients who underwent surgery, 11/17 and 14/17, p = 0.001 and p = 0.001, respectively. At 24 months, control of retentive fecal incontinence was also more frequent in operated patients: 13/17 versus 3/11 with clinical treatment, p = 0.005. In the final evaluation, the median follow-up times were 2.6 and 3 years (operated vs. clinical treatment, p = 0.40); one patient in each group was lost to follow-up and 9/16 operated patients had spontaneous bowel movements vs. 3/10 in the clinical treatment group, p = 0.043. Surgical complications, totaling 42 episodes, were observed 14/17 patients. Conclusion: Appendicostomy, although associated with a high frequency of complications, controlled retentive fecal incontinence earlier and more frequently than clinical treatment. The choice of one of the methods should be made by the family, after adequate information about the risks and benefits of each alternative.
publishDate 2020
dc.date.none.fl_str_mv 2020-04-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572020000200210
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572020000200210
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1016/j.jped.2018.09.001
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Sociedade Brasileira de Pediatria
publisher.none.fl_str_mv Sociedade Brasileira de Pediatria
dc.source.none.fl_str_mv Jornal de Pediatria v.96 n.2 2020
reponame:Jornal de Pediatria (Online)
instname:Sociedade Brasileira de Pediatria (SBP)
instacron:SBPE
instname_str Sociedade Brasileira de Pediatria (SBP)
instacron_str SBPE
institution SBPE
reponame_str Jornal de Pediatria (Online)
collection Jornal de Pediatria (Online)
repository.name.fl_str_mv Jornal de Pediatria (Online) - Sociedade Brasileira de Pediatria (SBP)
repository.mail.fl_str_mv ||jped@jped.com.br
_version_ 1752122322263736320