Refractory functional constipation: clinical management or appendicostomy?,
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , |
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. |
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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 |
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1752122322263736320 |