789 results on '"Bowel management"'
Search Results
2. Is the Transrectal Diameter (TRD) Suitable for Assessing Faecal Loads and Monitoring Bowel Management in Children with Hirschsprung Disease—ReKiSo Study: Prospective Study.
- Author
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Lindert, Judith, Erkel, Daniel, Schulze, Felix, Hofer, Meike, Rzepka, Edyta, and Märzheuser, Stefanie
- Subjects
FECES ,OUTPATIENT medical care ,DESCRIPTIVE statistics ,BOWEL & bladder training ,LONGITUDINAL method ,HIRSCHSPRUNG'S disease ,RECTUM ,CONSTIPATION ,SYMPTOMS ,CHILDREN - Abstract
Background: Constipation and outlet obstruction may persist after successful pull-through in Hirschsprung Disease (HD). The radiographic assessment of the faecal load is widely used but exposes the child to radiation. This study aims to evaluate whether the transrectal diameter (TRD) assessed with ultrasound correlates with symptoms of faecal load and whether the TRD normalises when symptoms disappear. Method: Children with HD after pullthrough and functional constipation presenting to our colorectal clinic between 4/23 and 4/24 were assessed for symptoms of constipation, smearing and outlet obstruction, as well as healthy controls. Ultrasound measurement of the TRD was conducted. Bowel management was initiated according to our institutional pathway using Peristeen© irrigation after an orthograde disimpaction regime. Results: A total of 193 children underwent TRD assessment. Of 60 children with HD, 26 (43.3%) presented with obstructive symptoms, and 34 (56.7%) were asymptomatic. In asymptomatic patients with HD, the mean TRD of 2.26 cm (SD 0.61) was significantly (p < 0.001) lower than in HD with symptoms, with a mean TRD of 3.35 cm (SD 1.03). Individuals without colorectal pathology had a mean TRD of 2.04 cm (SD 0.37), and children with functional constipation and symptoms showed a mean TRD of 4.36 cm (SD 1.32). The mean TRD after symptom resolution was 2.37 cm. Conclusions: Children with HD without obstructive symptoms have a TRD < 3 cm, as do controls. The transrectal diameter allows the clinician to sonographically assess the faecal load in children with HD at the bedside without radiation. The TRD is useful for monitoring a bowel management program in children with HD. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Surgical Strategies in Total Colonic Aganglionosis: Primary Pullthrough-Pathway of Care.
- Author
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Märzheuser, Stefanie, Schulze, Felix, and Lindert, Judith
- Subjects
MEDICAL protocols ,POSTOPERATIVE care ,INTESTINES ,CROSS-sectional method ,BIOPSY ,PARENTERAL feeding ,PREHABILITATION ,SURGICAL stomas ,TREATMENT effectiveness ,PREOPERATIVE care ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,BOWEL & bladder training ,LONGITUDINAL method ,ENHANCED recovery after surgery protocol ,HIRSCHSPRUNG'S disease ,NUTRITIONAL status ,MEDICAL records ,ACQUISITION of data ,PLASTIC surgery ,PERIOPERATIVE care - Abstract
Background: Total colonic aganglionosis, as a rare variant of Hirschsprung Disease, still poses challenges to surgeons in terms of diagnosis and management. The optimal preparation for pullthrough is crucial for reconstructive surgery. This study aims to explore our surgical pathway for children with total colonic aganglionosis (TCA) and to describe the prehabilitation necessary to prepare for successful reconstructive pullthrough surgery. Methods: A prospective review of children with TCA receiving an abdominal surgical intervention between 1/22 and 4/24. The cohort included children receiving mapping +/− primary ileoanal pullthrough. An analysis of preoperative, perioperative, and postoperative data, and a short-term follow-up were performed. Results: A total of 18 children with TCA and no prior pullthrough received an abdominal intervention during the 29-month study period, and 5/18 (27.8%) were female. The children had a median of 4 (range 2–7) prior external surgeries; all had a stoma; 6 (33%) children received parental nutrition; 12 children underwent a mapping of the ganglia distribution and bowel length at a median age of 11 months (range 3–54), and in 10 of them, we relocated the stoma. There was a mean involvement of 15 (5–93) cm small bowel aganglionosis, with the remaining mean ganglionic small bowel having a length of 178 cm (110–254). A total of 11 children underwent straight primary ileoanal pullthrough of the stoma site at a median age of 16.7 months (10–133). Conclusions: The timely diagnosis of TCA still challenges the care team, and most children have a rough journey involving several surgeries until their diagnosis is established. The ensure bowel function with an adequate working stoma is the key to enabling enteral nutrition and growth, which are the baseline requirements to undertake a successful pullthrough procedure and restore continuity. Careful perioperative bowel management and parents' active involvement supports children with Hirschsprung Disease achieving the best possible quality of life. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study.
- Author
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Erkel, Daniel, Märzheuser, Stefanie, and Lindert, Judith
- Subjects
- *
HIRSCHSPRUNG'S disease , *ULTRASONIC imaging , *ASYMPTOMATIC patients , *PATHOLOGY , *NEUROLOGICAL disorders - Abstract
Purpose: To evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU). Methods: Prospective case–control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986–1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data. Results: p value for TRD in all groups significant with p < 0.05 and in grouped follow-up. Conclusion: Ultrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. A Systematic Review of Telehealth Utilization for Bowel Management Programs in Pediatric Colorectal Surgery.
- Author
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Bokova, Elizaveta, Elhalaby, Ismael, Saylors, Seth, Lim, Irene Isabel P., and Rentea, Rebecca M.
- Subjects
COLON surgery ,TREATMENT of fecal incontinence ,RECTAL surgery ,PEDIATRIC surgery ,MEDICAL information storage & retrieval systems ,HEALTH services accessibility ,SURGERY ,PATIENTS ,RECTUM abnormalities ,MEDICAL care ,TOILET training ,DESCRIPTIVE statistics ,TELEMEDICINE ,BOWEL & bladder training ,DIGESTIVE organ surgery ,SYSTEMATIC reviews ,MEDLINE ,CAREGIVERS ,MEDICAL databases ,QUALITY of life ,HIRSCHSPRUNG'S disease ,ONLINE information services ,CONSTIPATION ,CHILDREN - Abstract
Recent advancements in pediatric surgery have embraced telehealth (TH) modalities, transitioning from traditional in-person consultations to virtual care. This shift has broadened access to healthcare, potentially enhancing affordability, patient and caregiver satisfaction, and clinical outcomes. In pediatric colorectal surgery, telehealth has been effectively utilized to support Bowel Management Programs (BMPs) for children suffering from constipation and fecal incontinence. A systematic review was conducted to assess the effectiveness of virtual BMPs, analyzing studies from January 2010 to December 2023, sourced from MEDLINE (via PubMed), Embase, and the Cochrane Library, with five studies included. Remote BMPs, implemented through video or telephone consultations, reported satisfaction rates exceeding 75% among families, indicating a strong preference for virtual interactions over traditional visits. Significant findings from the studies include improvements in Vancouver and Baylor scores, reductions in the duration of multidisciplinary consultations, enhancements in pediatric quality of life and Cleveland scores, and decreased frequency of laxative treatments. The implementation of TH has facilitated patient-led care, enabling timely adjustments in treatment and efficient distribution of medical supplies. The findings suggest that virtual BMPs are a viable and effective alternative to conventional approaches, yielding high caregiver satisfaction and superior clinical outcomes while promoting patient independence. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
6. Bowel Management in Hirschsprung Disease—Pre-, Peri- and Postoperative Care for Primary Pull-Through.
- Author
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Lindert, Judith, Schulze, Felix, and Märzheuser, Stefanie
- Subjects
POSTOPERATIVE care ,CROSS-sectional method ,BIOPSY ,LAPAROSCOPY ,T-test (Statistics) ,RESEARCH funding ,FISHER exact test ,PATIENT care ,PREOPERATIVE care ,URINARY catheters ,DESCRIPTIVE statistics ,CHI-squared test ,BOWEL & bladder training ,COLON (Anatomy) ,ENHANCED recovery after surgery protocol ,HIRSCHSPRUNG'S disease ,CONVALESCENCE ,RESEARCH methodology ,MEDICAL records ,ACQUISITION of data ,ELECTRONIC health records ,OSTOMY ,IRRIGATION (Medicine) ,DATA analysis software ,CLINICS ,PERIOPERATIVE care ,RECTUM ,HISTOLOGY ,PATIENT aftercare - Abstract
(1) Background: Bowel management contributes throughout the pathway of care for children with Hirschsprung. Preoperative bowel management prepares the child and family for the pull-through surgery. Perioperative bowel management supports early recovery and tailored bowel management in the follow-up supports the achievement of social continence. (2) Methods: We conducted a cross-sectional assessment of our institutional bowel management program to illustrate the pre-, peri- and postoperative bowel management strategies. (3) Results: A total of 31 children underwent primary pull-through, 23 without a stoma and 8 with a stoma, at a median age of 9 months. All children without a stoma were prepared for surgery by using rectal irrigations. Children with a stoma were prepared for surgery with a transfer of stoma effluent. Transanal irrigation supported early recovery. (4) Conclusions: Bowel management is a key pillar of the management of children with Hirschsprung disease. Incorporating bowel management in the pathway of care facilitates primary pull-through and supports perioperative recovery. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
7. Digital technologies for bowel management: A scoping review.
- Author
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Iyawa, Gloria, Henton, Sally, Maltinsky, Wendy, Casson, Alex, Taylor, Andrea, Lake, Dylan, Medina-Lombardero, Sara, Saleh, Mahdi, and Crichton, Michael
- Subjects
DIGITAL technology ,ARTIFICIAL sphincters ,ARTIFICIAL intelligence ,ANUS - Abstract
The use of digital technologies in managing bowel conditions has been a topic of interest among healthcare practitioners. The objectives of this paper were to provide information about the types of digital technologies that have been used for bowel management and the context of the studies; identify the gaps and challenges in digital technologies for bowel management and propose new methods and techniques for the application of digital technologies in bowel management. A scoping review was conducted following the principles of Preferred Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search was conducted on six academic databases. 1891 papers were retrieved from the initial search; however, 6 papers were included based on the inclusion and exclusion criteria. The findings suggest that published work focused mainly on a research context and with a narrow focus targeting sub-categories of bowel conditions and not implemented in the context of everyday use. The findings also illustrate the variety of early-stage developments focused on increasing support for severe bowel dysfunction, for example, through biofeedback to aid muscle control training, or the placement of artificial anal sphincters to increase rectal perception. However, technology to support bowel management for broader populations with less severe or variable symptoms appears limited. Future work would be to conduct empirical research in the application of advanced technologies such as on-organ sensors in managing bowel conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
8. 经典型先天性巨结肠手术时机与术前肠道管理的研究进展.
- Author
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路航, 唐杰, and 唐维兵
- Abstract
As one of the most common defecation disorders in children, Hirschsprung disease (HSCR) is characterized by an absence of intestinal ganglion cells. Its major treatment is surgical removal of involved intestine. With rapid advancement of medical technology and evolving concepts of diagnosis and therapy in recent years, about 80-90% of patients may be diagnosed during neonatal period. However, timing of pull-through surgery after a definite diagnosis has remained controversial and it is often delayed after neonatal period. Time from diagnosis to pull-through surgery and standardized bowel management are required to relieve distal intestinal obstruction, maintain bowel movements, improve nutrition and prevent an onset of Hirschsprung disease-associated enterocolitis (HAEC). This review focused upon timing of HSCR pull-through surgery, proper preoperative intestinal management and selecting protocols. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
9. Surgical Strategies in Total Colonic Aganglionosis: Primary Pullthrough-Pathway of Care
- Author
-
Stefanie Märzheuser, Felix Schulze, and Judith Lindert
- Subjects
total colonic aganglionosis ,surgical preparation ,colonic pullthrough ,ileoanal anastomosis ,bowel management ,Hirschsprung Disease ,Pediatrics ,RJ1-570 - Abstract
Background: Total colonic aganglionosis, as a rare variant of Hirschsprung Disease, still poses challenges to surgeons in terms of diagnosis and management. The optimal preparation for pullthrough is crucial for reconstructive surgery. This study aims to explore our surgical pathway for children with total colonic aganglionosis (TCA) and to describe the prehabilitation necessary to prepare for successful reconstructive pullthrough surgery. Methods: A prospective review of children with TCA receiving an abdominal surgical intervention between 1/22 and 4/24. The cohort included children receiving mapping +/− primary ileoanal pullthrough. An analysis of preoperative, perioperative, and postoperative data, and a short-term follow-up were performed. Results: A total of 18 children with TCA and no prior pullthrough received an abdominal intervention during the 29-month study period, and 5/18 (27.8%) were female. The children had a median of 4 (range 2–7) prior external surgeries; all had a stoma; 6 (33%) children received parental nutrition; 12 children underwent a mapping of the ganglia distribution and bowel length at a median age of 11 months (range 3–54), and in 10 of them, we relocated the stoma. There was a mean involvement of 15 (5–93) cm small bowel aganglionosis, with the remaining mean ganglionic small bowel having a length of 178 cm (110–254). A total of 11 children underwent straight primary ileoanal pullthrough of the stoma site at a median age of 16.7 months (10–133). Conclusions: The timely diagnosis of TCA still challenges the care team, and most children have a rough journey involving several surgeries until their diagnosis is established. The ensure bowel function with an adequate working stoma is the key to enabling enteral nutrition and growth, which are the baseline requirements to undertake a successful pullthrough procedure and restore continuity. Careful perioperative bowel management and parents’ active involvement supports children with Hirschsprung Disease achieving the best possible quality of life.
- Published
- 2024
- Full Text
- View/download PDF
10. Is the Transrectal Diameter (TRD) Suitable for Assessing Faecal Loads and Monitoring Bowel Management in Children with Hirschsprung Disease—ReKiSo Study: Prospective Study
- Author
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Judith Lindert, Daniel Erkel, Felix Schulze, Meike Hofer, Edyta Rzepka, and Stefanie Märzheuser
- Subjects
Hirschsprung Disease ,bowel management ,rectal ultrasound ,clinician ultrasound ,Pediatrics ,RJ1-570 - Abstract
Background: Constipation and outlet obstruction may persist after successful pull-through in Hirschsprung Disease (HD). The radiographic assessment of the faecal load is widely used but exposes the child to radiation. This study aims to evaluate whether the transrectal diameter (TRD) assessed with ultrasound correlates with symptoms of faecal load and whether the TRD normalises when symptoms disappear. Method: Children with HD after pullthrough and functional constipation presenting to our colorectal clinic between 4/23 and 4/24 were assessed for symptoms of constipation, smearing and outlet obstruction, as well as healthy controls. Ultrasound measurement of the TRD was conducted. Bowel management was initiated according to our institutional pathway using Peristeen© irrigation after an orthograde disimpaction regime. Results: A total of 193 children underwent TRD assessment. Of 60 children with HD, 26 (43.3%) presented with obstructive symptoms, and 34 (56.7%) were asymptomatic. In asymptomatic patients with HD, the mean TRD of 2.26 cm (SD 0.61) was significantly (p < 0.001) lower than in HD with symptoms, with a mean TRD of 3.35 cm (SD 1.03). Individuals without colorectal pathology had a mean TRD of 2.04 cm (SD 0.37), and children with functional constipation and symptoms showed a mean TRD of 4.36 cm (SD 1.32). The mean TRD after symptom resolution was 2.37 cm. Conclusions: Children with HD without obstructive symptoms have a TRD < 3 cm, as do controls. The transrectal diameter allows the clinician to sonographically assess the faecal load in children with HD at the bedside without radiation. The TRD is useful for monitoring a bowel management program in children with HD.
- Published
- 2024
- Full Text
- View/download PDF
11. Quality Assessment of YouTube Videos as an Information Source for Bowel Management in Children.
- Author
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Anadolulu, Ali İhsan, Gerçel, Gonca, and Durakbaşa, Çiğdem Ulukaya
- Abstract
This study aims to evaluate the quality and reliability of YouTube videos about bowel management in children. On April 6th, 2023, the search results for "bowel management in children" on YouTube were rated independently by two authors. JAMA Benchmark Criteria (score 0–4) and a modified DISCERN tool (score 16–80) used for quality and reliability assessment. Data was analyzed by Chi-square test and one-way analysis of variance (ANOVA). Out of 48 videos included, 15 (31.2%) videos were intended for professionals and 33 (68.8%) for the public. The mean number of views was 144.806 and duration was 22 ± 28.4 min. The respective mean duration of videos for professionals 57.7 ± 21.4 min and median number of views was 404.5 (17–8.840) and those for public was 5.7 ± 10.7 min and 8400 (8–5.175.975) (both, p < 0.005). The respective mean DISCERN and JAMA scores of the videos for the public was 45.30 ± 13.18 and 2.93 ± 1.07, and for professionals 75.73 ± 6.52 and 3.8 ± 1.06 (both, p < 0.05). Although the reliability of the videos uploaded for the professionals about pediatric bowel management was higher than for public, duration of the videos was longer and the viewing rates were lower. Shorter but comprehensive and easy-to-understand guidance videos for the public may be of help. Descriptive study. IV. • Due to the widespread use of technology, many patients refer to the internet as an initial stage to access the health information or during the course of their treatment. • Bowel management is used by patients with bowel disabilities to manage fecal incontinence or constipation. • It is more difficult to obtain accurate and quality information from social media on topics where awareness is relatively limited and less popular with the general public. • This study aims to evaluate the quality, reliability and adequacy of the videos presented on YouTube on bowel management program. • YouTube videos about bowel management in children are at a quality level that can be improved. • Shorter but comprehensive and easy-to-understand guidance videos for the public are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
12. Anorectal Malformations and Late-Term Problems.
- Author
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Hakalmaz, Ali Ekber and Tekant, Gonca Topuzlu
- Subjects
- *
CONSTIPATION , *KIDNEY failure , *URINARY incontinence , *RECTUM abnormalities , *FECAL incontinence - Abstract
Anorectal malformation is a disease with different subtypes and anatomical and functional multisystemic involvement that requires a unique approach in each age group. Anomalies associated with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association require detailed investigation and management. Beginning from the neonatal period, treatment is carried out with different surgical procedures. The clinical course of these patients may be associated with medical problems, accompanying congenital anomalies, perioperative management, or late sequelae. Constipation and fecal–urinary incontinence are the most common problems encountered in long-term follow-up. Renal failure is the most important cause of long-term mortality. In addition, these patients need to be under control until adulthood due to cardiological, spinal, genital, gynecological, and endocrine problems. In this follow-up, many pediatric disciplines such as neonatal intensive care, cardiology, nephrology, gastroenterology, and endocrinology cooperate with pediatric surgeons and pediatric urologists. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
13. Anorectal Anomalies
- Author
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Peña, Alberto, Bischoff, Andrea, De la Torre, Luis, Puri, Prem, editor, and Höllwarth, Michael E., editor
- Published
- 2023
- Full Text
- View/download PDF
14. A Systematic Review of Telehealth Utilization for Bowel Management Programs in Pediatric Colorectal Surgery
- Author
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Elizaveta Bokova, Ismael Elhalaby, Seth Saylors, Irene Isabel P. Lim, and Rebecca M. Rentea
- Subjects
telehealth ,telemedicine ,virtual ,bowel management ,Hirschsprung ,anorectal malformation ,Pediatrics ,RJ1-570 - Abstract
Recent advancements in pediatric surgery have embraced telehealth (TH) modalities, transitioning from traditional in-person consultations to virtual care. This shift has broadened access to healthcare, potentially enhancing affordability, patient and caregiver satisfaction, and clinical outcomes. In pediatric colorectal surgery, telehealth has been effectively utilized to support Bowel Management Programs (BMPs) for children suffering from constipation and fecal incontinence. A systematic review was conducted to assess the effectiveness of virtual BMPs, analyzing studies from January 2010 to December 2023, sourced from MEDLINE (via PubMed), Embase, and the Cochrane Library, with five studies included. Remote BMPs, implemented through video or telephone consultations, reported satisfaction rates exceeding 75% among families, indicating a strong preference for virtual interactions over traditional visits. Significant findings from the studies include improvements in Vancouver and Baylor scores, reductions in the duration of multidisciplinary consultations, enhancements in pediatric quality of life and Cleveland scores, and decreased frequency of laxative treatments. The implementation of TH has facilitated patient-led care, enabling timely adjustments in treatment and efficient distribution of medical supplies. The findings suggest that virtual BMPs are a viable and effective alternative to conventional approaches, yielding high caregiver satisfaction and superior clinical outcomes while promoting patient independence.
- Published
- 2024
- Full Text
- View/download PDF
15. Bowel Management in Hirschsprung Disease—Pre-, Peri- and Postoperative Care for Primary Pull-Through
- Author
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Judith Lindert, Felix Schulze, and Stefanie Märzheuser
- Subjects
bowel management ,Hirschsprung disease ,rectal washout ,transanal irrigation ,preparation for surgery ,distal outlet obstruction ,Pediatrics ,RJ1-570 - Abstract
(1) Background: Bowel management contributes throughout the pathway of care for children with Hirschsprung. Preoperative bowel management prepares the child and family for the pull-through surgery. Perioperative bowel management supports early recovery and tailored bowel management in the follow-up supports the achievement of social continence. (2) Methods: We conducted a cross-sectional assessment of our institutional bowel management program to illustrate the pre-, peri- and postoperative bowel management strategies. (3) Results: A total of 31 children underwent primary pull-through, 23 without a stoma and 8 with a stoma, at a median age of 9 months. All children without a stoma were prepared for surgery by using rectal irrigations. Children with a stoma were prepared for surgery with a transfer of stoma effluent. Transanal irrigation supported early recovery. (4) Conclusions: Bowel management is a key pillar of the management of children with Hirschsprung disease. Incorporating bowel management in the pathway of care facilitates primary pull-through and supports perioperative recovery.
- Published
- 2024
- Full Text
- View/download PDF
16. Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury
- Author
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Fater A. Khadour, Younes A. Khadour, Jiang Xu, Ling Meng, Lixin Cui, and Tao Xu
- Subjects
Spinal cord injury ,Bowel dysfunction ,Quality of life ,Bowel management ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Neurogenic bowel dysfunction (NBD) is a common problem among people with spinal injury; management of bowel dysfunction and related problems are considered significant factors in daily life after injury. But despite the critical relevance of bowel dysfunction in the daily life of SCI survivors, there have been few published studies on the management of NBD. So, this study aimed to describe the bowel programmers utilized by people with SCI in China and the impact of bowel dysfunction on the quality of life (QoL). Design A cross-sectional online survey. Setting Rehabilitation Medicine Department of Wuhan’s Tongji Hospital. Participants SCI patients who had been diagnosed with neurogenic bowel dysfunction and who were receiving regular medical monitoring at the rehabilitation medicine department were invited to participate in our study. Outcome measures A neurogenic bowel dysfunction (NBD) score is a questionnaire developed to evaluate the severity of neurogenic bowel dysfunction. A Short Form-12 (SF-12) was designed to measure the quality of life in people with SCI. Demographic and medical status information was extracted from their medical records. Results The two questionnaires were sent to 413 SCI patients. Two hundred ninety-four subjects (43.1 ± 14.5 years of age; men, 71.8%) responded. Most of the respondents performed their bowel movement daily 153 (52.0%), a defecation time was 31–60 min among 70 (23.8%) of them, 149 (50.7%) used medication (drops or liquid) to treat constipation, and 169 (57.5%) used digital stimulation more than once per week to boost the bowel evacuation. This study found a significant association between the QoL score and the time used for each defecation, autonomic dysreflexia (AD) symptoms, taking medication to treat fecal incontinence, using digital stimulation, having uncontrollable flatus and perianal skin problems. Conclusion Management of bowel dysfunction is complex and associated with QoL in people with SCI. Items of the NBD questionnaire that greatly deteriorated the QoL were time in one defecation > 60 min, symptoms of AD during or before defecation, taking medication (drops or liquid), and using digital stimulation. Dealing with those problems can improve the life quality of spinal cord injury survivors.
- Published
- 2023
- Full Text
- View/download PDF
17. State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies.
- Author
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Bokova, Elizaveta, Prasade, Ninad, Rosen, John M., Lim, Irene Isabel P., Levitt, Marc A., and Rentea, Rebecca M.
- Subjects
TREATMENT of fecal incontinence ,URINARY incontinence treatment ,ONLINE information services ,MEDICAL databases ,SPINE diseases ,MEDICAL information storage & retrieval systems ,SYSTEMATIC reviews ,PEDIATRICS ,MEDLINE ,BOWEL & bladder training - Abstract
Background: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. Methods: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Results: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22–71% of patients achieve social continence dependent on the type and level of the lesion. Conclusion: Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
18. State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease.
- Author
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Bokova, Elizaveta, Prasade, Ninad, Janumpally, Sanjana, Rosen, John M., Lim, Irene Isabel P., Levitt, Marc A., and Rentea, Rebecca M.
- Subjects
ENTEROCOLITIS ,LAXATIVES ,BOTULINUM toxin ,IRRIGATION (Medicine) ,ANUS ,CONSTIPATION ,ANTIDIARRHEALS ,HIRSCHSPRUNG'S disease ,ENEMA ,BOWEL & bladder training ,MEDICAL specialties & specialists ,PEDIATRIC surgery ,ALGORITHMS - Abstract
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
19. Standardization of radiograph readings during bowel management week.
- Author
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Bischoff, A., Hayes, K., Guimaraes, C., Merritt, A., Wickham, M., Schneider, L., Martin, H., Ketzer, J., Rodriguez, V., Peña, A., and De La Torre, L.
- Subjects
- *
RADIOGRAPHS , *HIRSCHSPRUNG'S disease , *STANDARDIZATION , *GROUP reading , *RADIOLOGISTS , *SPINA bifida - Abstract
Introduction: During "bowel management week," abdominal radiographs are used to monitor the amount and location of stool. A radiologist familiar with the treatment plan can provide an improved interpretation. The goal of this paper is to standardize the radiological reports during a bowel management week. Methods: We saw 744 patients during bowel management week from May 2016 until March 2023. Diagnosis included: anorectal malformation (397), idiopathic constipation (180), Hirschsprung disease (89), and spina bifida (78). Laxatives were the treatment for 51% of patients, and 49% received enemas. Characteristic radiographs were selected for each treatment group for a proposed reading standardization. Results: When the stool is visualized, it is crucial to report its location. Having a contrast enema helps with the correct interpretation of the colonic anatomy. It is also essential to always compare the amount of stool with the radiograph from the previous day to determine if there is an increase or decrease in stool. Examples of radiographs are shown to guide the use of the preferred proposed terminology. Conclusion: Providing information regarding which treatment modality the patient is receiving and stating that a patient is on a bowel management week treatment is crucial for the radiologist to provide adequate interpretation. The radiologist must be familiar with the treatment goals and purpose of the daily radiograph. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
20. Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation.
- Author
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Domínguez-Muñoz, Alfredo, Bischoff, Andrea, Wehrli, Lea A., Judd-Glossy, Laura, Schneider, Lauren, Merritt, Anne, Wickham, Maura, Ketzer, Jill, Rodriguez, Víctor, Peña, Alberto, and De La Torre, Luis
- Subjects
- *
ENEMA , *TREATMENT effectiveness , *CONSTIPATION , *CHILDREN'S hospitals - Abstract
Purpose: This study aimed to analyze our radiologically supervised bowel management program (RS-BMP) outcomes in patients with chronic idiopathic constipation (CIC). Methods: A retrospective study was conducted. We included all patients with CIC who participated in our RS-BMP at Children´s Hospital Colorado from July 2016 to October 2022. Results: Eighty patients were included. The average time with constipation was 5.6 years. Before our RS-BMP, 95% had received non-radiologically supervised treatments, and 71% had attempted two or more treatments. Overall, 90% had tried Polyethylene Glycol and 43% Senna. Nine patients had a history of Botox injections. Five underwent anterograde continence procedure, and one a sigmoidectomy. Behavioral disorders (BD) were found in 23%. At the end of the RS-BMP, 96% of patients had successful outcomes, 73% were on Senna, and 27% were on enemas. Megarectum was detected in 93% of patients with successful outcomes and 100% with unsuccessful outcomes (p = 0.210). Of the patients with BD, 89% had successful outcomes, and 11% had unsuccessful. Conclusion: Our RS-BMP has been proven to be effective in treating CIC. The radiologically supervised use of Senna and enemas was the appropriate treatment in 96% of the patients. BD and megarectum were associated with unsuccessful outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
21. Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury.
- Author
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Khadour, Fater A., Khadour, Younes A., Xu, Jiang, Meng, Ling, Cui, Lixin, and Xu, Tao
- Subjects
- *
SPINAL cord injuries , *CROSS-sectional method , *NEUROGENIC bowel , *DEFECATION , *SEVERITY of illness index , *QUALITY of life , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *AUTONOMIC dysreflexia , *FECAL incontinence , *BOWEL & bladder training - Abstract
Background: Neurogenic bowel dysfunction (NBD) is a common problem among people with spinal injury; management of bowel dysfunction and related problems are considered significant factors in daily life after injury. But despite the critical relevance of bowel dysfunction in the daily life of SCI survivors, there have been few published studies on the management of NBD. So, this study aimed to describe the bowel programmers utilized by people with SCI in China and the impact of bowel dysfunction on the quality of life (QoL). Design: A cross-sectional online survey. Setting: Rehabilitation Medicine Department of Wuhan's Tongji Hospital. Participants: SCI patients who had been diagnosed with neurogenic bowel dysfunction and who were receiving regular medical monitoring at the rehabilitation medicine department were invited to participate in our study. Outcome measures: A neurogenic bowel dysfunction (NBD) score is a questionnaire developed to evaluate the severity of neurogenic bowel dysfunction. A Short Form-12 (SF-12) was designed to measure the quality of life in people with SCI. Demographic and medical status information was extracted from their medical records. Results: The two questionnaires were sent to 413 SCI patients. Two hundred ninety-four subjects (43.1 ± 14.5 years of age; men, 71.8%) responded. Most of the respondents performed their bowel movement daily 153 (52.0%), a defecation time was 31–60 min among 70 (23.8%) of them, 149 (50.7%) used medication (drops or liquid) to treat constipation, and 169 (57.5%) used digital stimulation more than once per week to boost the bowel evacuation. This study found a significant association between the QoL score and the time used for each defecation, autonomic dysreflexia (AD) symptoms, taking medication to treat fecal incontinence, using digital stimulation, having uncontrollable flatus and perianal skin problems. Conclusion: Management of bowel dysfunction is complex and associated with QoL in people with SCI. Items of the NBD questionnaire that greatly deteriorated the QoL were time in one defecation > 60 min, symptoms of AD during or before defecation, taking medication (drops or liquid), and using digital stimulation. Dealing with those problems can improve the life quality of spinal cord injury survivors. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
22. State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation.
- Author
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Bokova, Elizaveta, Svetanoff, Wendy Jo, Rosen, John M., Levitt, Marc A., and Rentea, Rebecca M.
- Subjects
LAXATIVES ,CONSERVATIVE treatment ,BIOPSY ,CONSTIPATION ,MANOMETERS ,PEDIATRICS ,FECAL incontinence ,HIRSCHSPRUNG'S disease ,BOWEL & bladder training ,ESOPHAGEAL achalasia - Abstract
Background: Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. Methods: A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5–10 years. Results: The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. Conclusion: Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
23. Evaluation of Anal Sphincter with High Resolution Anorectal Manometry and 3D Reconstruction in Patients with Anorectal Malformation.
- Author
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Caruso, Anna Maria, Bommarito, Denisia, Girgenti, Vincenza, Amato, Glenda, Calabrese, Ugo, Figuccia, Adele, Baldanza, Fabio, Grasso, Francesco, Giglione, Emanuela, Casuccio, Alessandra, Milazzo, Mario Pietro Marcello, and Di Pace, Maria Rita
- Subjects
SPINE abnormalities ,FECAL incontinence -- Risk factors ,STATISTICS ,RESEARCH ,ANUS ,THREE-dimensional imaging ,ANALYSIS of variance ,MANOMETERS ,MULTIPLE regression analysis ,QUANTITATIVE research ,FISHER exact test ,PEARSON correlation (Statistics) ,DESCRIPTIVE statistics ,RECTUM abnormalities ,DATA analysis ,DATA analysis software ,STATISTICAL correlation ,LONGITUDINAL method ,BOWEL & bladder training - Abstract
Background: Patients with anorectal malformation (ARM) need long-term follow-up, in order to evaluate fecal continence; the main predictors of longer-term success are the type of ARM, associated anomalies and sacral integrity. Three-Dimensional High Resolution Anorectal Manometry (3D-HRAM) gives detailed information on pressure on the anal complex profile. Our objective was to analyze anal sphincter activity in ARM patients with 3D-HRAM establishing the correlation between manometric and clinical data. Methods: Forty ARM patients were submitted to 3D-HRAM: manometric, anatomical and clinical scores were correlated with each other and with the bowel management response (BM). Results: A positive correlation between all scores and types of ARM was found: in high ARM and in patients with spinal anomalies (regardless to ARM type) lower scores were reported and even after BM they did not achieve good continence. Conclusions: 3D-HRAM gives detailed data on the functional activity of the anal sphincter complex. Our study revealed a correlation between manometric parameters and clinical outcomes, confirming spinal malformations and ARM type as the most important prognostic risk factors for a bad outcome. Specific sphincteric defects can also be explored with manometry, allowing for tailored bowel management strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
24. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations.
- Author
-
Bokova, Elizaveta, Svetanoff, Wendy Jo, Lopez, Joseph J., Levitt, Marc A., and Rentea, Rebecca M.
- Subjects
LAXATIVES ,IRRIGATION (Medicine) ,DIGESTIVE organ abnormalities ,CONSTIPATION ,PEDIATRICS ,RECTUM abnormalities ,ENEMA ,FECAL incontinence ,HIRSCHSPRUNG'S disease ,BOWEL & bladder training - Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
25. Pediatric Bowel Management Options and Organizational Aspects.
- Author
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Bokova, Elizaveta, Svetanoff, Wendy Jo, Levitt, Marc Aaron, and Rentea, Rebecca Maria
- Subjects
ENTEROSTOMY ,PEDIATRICS ,BOWEL & bladder training ,TELEMEDICINE - Abstract
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients' quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
26. Gastrointestinal Disorders in Spinal Cord Injury
- Author
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Wenzel, Lisa, Draganich, Christina, Abramoff, Benjamin A., editor, Wang, Jing, editor, and Krull, Christine, editor
- Published
- 2022
- Full Text
- View/download PDF
27. Impact of a colon management program on the quality of life of patients with constipation and fecal loss
- Author
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Maria Giovana O. Farias and Joaquim M. Bustorff-Silva
- Subjects
Bowel management ,Constipation ,Fecal incontinence ,Quality of life ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
Objective: To evaluate the impact of colon management on the quality of life of patients with constipation and fecal loss. Methodology: We selected 10 patients with incontinence from 4 to 18 years of age who participated in the colon management program for the treatment of fecal incontinence. They underwent the application of a Questionnaire to assess the quality of life of life related to fecal continence in children and adolescents (QQVCFCA) before and after the application of the program. The same questionnaire was applied to a control group, made up of 10 children without fecal incontinence, in order to carry out a comparative analysis between the groups. Results: There was a statistically significant improvement in quality of life in all participants in the cervical management program (p 95%) The post-program quality of life index reached levels similar to those observed among children in the control group. Conclusion: In this way, we conclude that the well-structured colon management program, with individualized therapeutic proposals and based on clinical history, on the pathophysiology of constipation/fecal leakage and on the anatomical changes observed in the contrast enema, performed when the child is admitted to the program, allows us to classify patients well and establish adequate therapy, minimizing the costs and associated risks, ensuring that they can fulfill their social functions, physical sports and leisure activities without compromising their quality of life.
- Published
- 2023
- Full Text
- View/download PDF
28. Assessing the outcomes of manual physical therapy and conventional treatment for chronic pediatric constipation: A dataset analysis of quality of life
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Maria Blanco-Diaz, Alvaro Manuel Rodriguez-Rodriguez, Marta De la Fuente-Costa, Mario Escalera-de la Riva, Sergio Hernandez-Sanchez, Borja Perez-Dominguez, Jose Casana-Granell, and Isabel Escobio-Prieto
- Subjects
Physical therapy ,Physiotherapy techniques ,Bowel management ,Manipulative treatment ,Manual therapy ,Paediatric constipation ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Science (General) ,Q1-390 - Abstract
The dataset presented in this article was used in a pilot randomized and controlled trial that evaluated the effectiveness of manual physical therapy (MPT) compared to conventional pharmacologic treatment (CPT) for treating chronic pediatric functional constipation (CPC). The pilot trial was carried out at the Central University Hospital of Asturias in Oviedo, Spain, with 47 children between 2 and 12 years old being evaluated by a Pediatric Gastroenterologist. Participants received 9 sessions of MPT which were spaced out weekly for the first two months and bi-weekly for the third month. The Pediatric Quality of Life questionnaire (PedsQLTM) scores were assessed at the start of the trial (Time 1), its end (Time 2), and 5 years later (Time 3). The dataset contains the collected raw data, including participant demographics data and PedsQLTM scores categorized by question group, as well as total scores for each participant at each time point. This dataset can be used to further analyze the results and the study can be potentially replicated.
- Published
- 2023
- Full Text
- View/download PDF
29. Rectal Application of Lidocaine Reduces the Severity of Autonomic Dysreflexia following Experimental Spinal Cord Injury.
- Author
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Sachdeva, Rahul, Kalimullina, Tamila, Pawar, Kiran, and Krassioukov, Andrei
- Subjects
- *
SPINAL cord injuries , *LIDOCAINE , *CARDIOVASCULAR diseases , *BLOOD pressure - Abstract
Spinal cord injury (SCI) results in devastating cardiovascular dysfunction. Noxious stimuli from the rectum during bowel routine often trigger life-threatening blood pressure surges, termed autonomic dysreflexia (AD). Rectal application of anesthetic lidocaine jelly has been recommended during bowel care to reduce AD severity by mitigating sensory input. However, clinical studies have reported contradicting evidence. We performed a pre-clinical study on the efficacy of rectal lidocaine in a standardized rodent T3 transection model. We found that 2% and 10% lidocaine significantly reduced AD severity by 32% and 50%, respectively, compared with control (p < 0.0001). Our pre-clinical experiments support the current recommendation of rectal lidocaine application during bowel care. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
30. Single institution review of Mini-ACE® low-profile appendicostomy button for antegrade continence enema administration.
- Author
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Lopez, Joseph J., Svetanoff, Wendy J., Bruns, Nicholas, Lewis, Wendy E., Warner, Christine N., Fraser, James A., Briggs, Kayla B., Carrasco, Alonso, Gatti, John M., Rosen, John M., and Rentea, Rebecca M.
- Abstract
Malone antegrade continence enemas (MACE) provide a conduit in which the patient can achieve improved continence, be clean of stool, and gain independence in maintaining bowel function. The Mini-ACE® is a low-profile balloon button that is used to facilitate the administration of antegrade enemas. We sought to describe our practice and short-term outcomes. This work is a retrospective review of the Mini-ACE® appendicostomy button from April 2019 to March 2021, with follow-up concluding in October 2021. Patient demographics, colorectal diagnoses, and outcomes were examined. Forty-three patients underwent Mini-ACE® placement; 22 (51%) were male. The average age at Mini-ACE® insertion was 9.2 years (range 3–20 years). The most common diagnoses were functional constipation in 19 (44%), anorectal malformation in 15 (35%), and Hirschsprung disease in 3 (7%), spinal differences 3 (7%). There were no intra-operative complications, but 5 (12%) required prolapse resection. The median length of stay was two days (IQR 1, 4). Patients achieved self-catheterization at 4.5 [3,7] months from MACE creation, with 38 children (88%) reporting excellent success in remaining clean of stool. The Mini-ACE® appears to be a safe and low-profile option for antegrade continence enema access. Further research is needed directly comparing complications and patient satisfaction rates between different MACE devices and overall quality of life. Level IV. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
31. Most children experience resolution of idiopathic pediatric rectal prolapse with bowel management alone.
- Author
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Short, Scott S., Wynne, Elisabeth K., Zobell, Sarah, Gaddis, Katherine, and Rollins, Michael D.
- Abstract
Recent studies in children with idiopathic rectal prolapse report up to 48% require surgical intervention to manage refractory disease. We sought to examine outcomes of our non-surgical approach to managing rectal prolapse using a bowel management program. A retrospective review was performed for all children with the diagnosis of rectal prolapse between 2011 and 2020. Children with a rectal polyp or hemorrhoid were excluded. 47 children with rectal prolapse were identified (median age at diagnosis of 4 years (IQR 3,7.75); age ≤ 4 years n = 30; age > 4 years n = 17). Associated diagnoses included constipation (n = 45, 96%) and psychiatric diagnoses (n = 7, 14%). Children underwent a bowel management program including stimulant laxatives in 44 (94%) and osmotic laxatives in 2 (4%). Median follow-up time was 181 days (IQR 77, 238). Median time to resolution of rectal prolapse was 9 months (IQR 4, 13) with a maximum time to resolution of 31 months. We compared children ≤ 4 years old (Group A) to those > 4 years old (Group B). Psychiatric diagnoses were less common in Group A (3.5 vs. 38.9%, p = 0.003). Median time to spontaneous resolution was 6.5 months (IQR 3.5, 9.5) in Group A versus 13.5 (IQR 4, 16) months in Group B, p = 0.13. No differences in surgical intervention were identified. Three (6.4%) patients required surgery for prolapse. A bowel management program is an effective treatment for most children with rectal prolapse. This data suggests that surgical intervention is unnecessary in most children. III. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
32. Fecal Incontinence
- Author
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Patankar, Sanjiv K., Salehomoum, Negar M., Pitchumoni, C. S., editor, and Dharmarajan, T.S., editor
- Published
- 2021
- Full Text
- View/download PDF
33. Anorectal Malformations
- Author
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Ahmad, Hira, Levitt, Marc A., Lacher, Martin, editor, St. Peter, Shawn D., editor, and Zani, Augusto, editor
- Published
- 2021
- Full Text
- View/download PDF
34. State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies
- Author
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Elizaveta Bokova, Ninad Prasade, John M. Rosen, Irene Isabel P. Lim, Marc A. Levitt, and Rebecca M. Rentea
- Subjects
bowel management ,spina bifida ,meningocele ,spinal anomaly ,tethered cord ,constipation ,Pediatrics ,RJ1-570 - Abstract
Background: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. Methods: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Results: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22–71% of patients achieve social continence dependent on the type and level of the lesion. Conclusion: Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient’s age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.
- Published
- 2023
- Full Text
- View/download PDF
35. State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease
- Author
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Elizaveta Bokova, Ninad Prasade, Sanjana Janumpally, John M. Rosen, Irene Isabel P. Lim, Marc A. Levitt, and Rebecca M. Rentea
- Subjects
bowel management ,Hirschsprung disease ,botox ,enterocolitis ,botulinum toxin ,irrigation ,Pediatrics ,RJ1-570 - Abstract
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.
- Published
- 2023
- Full Text
- View/download PDF
36. The presence of a neurodiverse disorder is associated with increased use of antegrade enema therapy in children with severe constipation: A study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC).
- Author
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Short, Scott S, Reeder, Ron W, Lewis, Katelyn E, Dickie, Belinda, Grabowski, Julia, Sepuha, Taylor, Durham, Megan M, Frischer, Jason, Badillo, Andrea, Calkins, Casey M, Rentea, Rebecca M., Ralls, Matt, Wood, Richard J, Fuller, Megan K, van Leeuwen, Kathleen, Avansino, Jeffrey R, Austin, Kelly, and Rollins, Michael D
- Abstract
Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with laxative or enema therapy remain limited and are often complicated by patient/caregiver compliance. We hypothesized that children with neurodiverse disorders and severe constipation would benefit from a bowel management program (BMP) that includes early use of antegrade enemas. Children requiring BMP in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry with diagnosis of constipation and/or constipation with pseudo-incontinence were reviewed. Those with Hirschsprung disease and/or Anorectal Malformation were excluded. BMP needs in patients with a neurodiverse diagnosis were compared to those without to evaluate differences in BMP's. 372 patients requiring a BMP were identified. 95 patients (58 autism spectrum, 54 developmental delay) were neurodiverse, and 277 patients were not. Neurodiverse patients had a higher prevalence of enema therapy 62.1% (59/95) vs. 54.9% (152/273) and use of antegrade enema therapy 33.7% (32/95) vs. 21.2% (58/273), p = 0.126. Neurodiverse patients were older 37.9% (36/95) > 12 years vs. 23.1% (63/273), p = 0.001 and 47.6% (10/21) were changed from laxative to enema therapy over time. 80% (8/10) of those changed from laxatives to enemas used antegrade therapy. 67.3% (35/52) of neurodiverse patients followed over time were on enema therapy at the most recent visit with 80% (28/35) requiring antegrade therapy. A large portion of patients with a neurodiverse disorder who fail laxative therapy use antegrade enemas to achieve effective bowel management. Early consideration of an antegrade conduit may simplify treatment in this group of children. III. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
37. Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers.
- Author
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Bokova E, Elhalaby I, Svetanoff WJ, Lawal TA, Levitt MA, Lim IIP, and Rentea RM
- Abstract
Background: Anorectal malformations (ARMs) commonly result in constipation and fecal incontinence following primary surgical reconstruction. This study investigates global variations in postoperative care and resources., Methods: A survey was distributed via the International Pediatric Endosurgery Group (IPEG) and snowball sampling. Geographically, respondents were categorized into high-income countries (HICs) and low-or middle-income countries (LMICs)., Results: 233 surveys were received, 64% from LMICs and 36% from HICs. Of these, 51% reported monitoring ARM patients for over a year, while 23% utilized digital technologies. Access to anesthesia for anorectal exams was available to 70% of respondents. Only 29% had established a one-week Bowel Management Program (BMP). Collaboration with urologists and gynecologists was more prevalent in HICs (59%) compared to LMICs (37%, p < 0.01). In HICs, nurses and advanced practice providers were significantly more involved in BMP (71% vs. 39% in LMICs; p < 0.01), and abdominal radiographs for regimen adjustments were used more frequently (80% vs. 69% in LMICs; p = 0.03). Treatment regimens were more varied in HICs, and quality of life tracking was more consistent (19% vs. 9% in LMICs; p = 0.02). LMICs reported significant shortages of medications and equipment (75% vs. 58% in HICs; p = 0.01), inadequate sanitation (48% vs. 24%; p < 0.01), and insufficient insurance coverage (58% vs. 44%; p = 0.04)., Conclusions: There are notable global disparities in the postoperative care of ARM patients, particularly in BMP protocols and treatment regimens, with LMICs facing severe socioeconomic challenges. This emphasizes the urgent need for targeted strategies and resources to enhance outcomes for ARM patients across different regions., Level of Evidence: Level III., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
38. Evaluation of Anal Sphincter with High Resolution Anorectal Manometry and 3D Reconstruction in Patients with Anorectal Malformation
- Author
-
Anna Maria Caruso, Denisia Bommarito, Vincenza Girgenti, Glenda Amato, Ugo Calabrese, Adele Figuccia, Fabio Baldanza, Francesco Grasso, Emanuela Giglione, Alessandra Casuccio, Mario Pietro Marcello Milazzo, and Maria Rita Di Pace
- Subjects
anorectal malformations ,high resolution anorectal manometry ,fecal incontinence ,bowel management ,Pediatrics ,RJ1-570 - Abstract
Background: Patients with anorectal malformation (ARM) need long-term follow-up, in order to evaluate fecal continence; the main predictors of longer-term success are the type of ARM, associated anomalies and sacral integrity. Three-Dimensional High Resolution Anorectal Manometry (3D-HRAM) gives detailed information on pressure on the anal complex profile. Our objective was to analyze anal sphincter activity in ARM patients with 3D-HRAM establishing the correlation between manometric and clinical data. Methods: Forty ARM patients were submitted to 3D-HRAM: manometric, anatomical and clinical scores were correlated with each other and with the bowel management response (BM). Results: A positive correlation between all scores and types of ARM was found: in high ARM and in patients with spinal anomalies (regardless to ARM type) lower scores were reported and even after BM they did not achieve good continence. Conclusions: 3D-HRAM gives detailed data on the functional activity of the anal sphincter complex. Our study revealed a correlation between manometric parameters and clinical outcomes, confirming spinal malformations and ARM type as the most important prognostic risk factors for a bad outcome. Specific sphincteric defects can also be explored with manometry, allowing for tailored bowel management strategies.
- Published
- 2023
- Full Text
- View/download PDF
39. State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation
- Author
-
Elizaveta Bokova, Wendy Jo Svetanoff, John M. Rosen, Marc A. Levitt, and Rebecca M. Rentea
- Subjects
bowel management ,functional constipation ,botox ,botulinum toxin ,fecal incontinence ,enema ,Pediatrics ,RJ1-570 - Abstract
Background: Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. Methods: A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5–10 years. Results: The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer’s procedure) can be guided with a balloon expulsion test. Conclusion: Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.
- Published
- 2023
- Full Text
- View/download PDF
40. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations
- Author
-
Elizaveta Bokova, Wendy Jo Svetanoff, Joseph J. Lopez, Marc A. Levitt, and Rebecca M. Rentea
- Subjects
bowel management ,anorectal malformation ,ARM ,imperforate anus ,antegrade enema ,Malone ,Pediatrics ,RJ1-570 - Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.
- Published
- 2023
- Full Text
- View/download PDF
41. Pediatric Bowel Management Options and Organizational Aspects
- Author
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Elizaveta Bokova, Wendy Jo Svetanoff, Marc Aaron Levitt, and Rebecca Maria Rentea
- Subjects
bowel management ,antegrade flushes ,antegrade continence enema ,Malone ,cecostomy ,bootcamps ,Pediatrics ,RJ1-570 - Abstract
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.
- Published
- 2023
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42. Transanal irrigation at a glance.
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Hill, Barry and Mitchell, Aby
- Subjects
- *
IRRIGATION (Medicine) , *CONSTIPATION , *PATIENT education , *FECAL incontinence , *HEALTH self-care , *BOWEL & bladder training - Abstract
This article provides a brief overview of transanal irrigation (TAI). It covers the rationale behind the procedure, the contraindications, possible complications and considerations for patient education and support. [ABSTRACT FROM AUTHOR]
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- 2022
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43. Bowel Management for the Treatment of Chronic Constipation and Soiling in Patients Operated for Hirschsprung’s Disease
- Author
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Bischoff, Andrea, Peña, Alberto, and Puri, Prem, editor
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- 2019
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44. Early and Late Complications Following Pull-Through Operation for Hirschsprung’s Disease
- Author
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Rentea, Rebecca M., Snyder, Charles L., and Puri, Prem, editor
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- 2019
- Full Text
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45. Commentary- Bridging the Gap: The Impact of Bowel Management Programs on Daily Life in Pediatric Colorectal Disease.
- Author
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Lim IIP and Rentea RM
- Subjects
- Humans, Child, Hirschsprung Disease therapy, Patient Reported Outcome Measures, Fecal Incontinence therapy, Fecal Incontinence psychology, Female, Male, Patient Satisfaction statistics & numerical data, Constipation therapy, Anorectal Malformations surgery, Spinal Dysraphism psychology, Spinal Dysraphism complications
- Abstract
Background: This commentary discusses the social impact of bowel management programs (BMPs) on children with colorectal diseases, including anorectal malformations (ARM), Hirschsprung disease (HD), functional constipation (FC), and spina bifida. Previous studies focused on functional outcomes, but this study bridges the gap to daily life experiences., Methods: The study examined children's experiences in BMPs, focusing on school participation, vacation ability, and overall patient experience. Cleanliness, defined as fewer than one stool soiling episode per week, was achieved by 70% of participants., Results: Positive patient experiences were linked to achieving stool cleanliness, regardless of the management method. Invasive methods like enemas did not negatively affect experiences if cleanliness was maintained. Validated patient-reported experience measures (PREMs) and patient-reported outcomes measures (PROMs) were used, though the median age of 8.9 years posed limitations., Conclusion: The commentary highlights the significance of stool cleanliness in improving patient experiences and supports the effectiveness of various BMP methods. Future research should include longitudinal follow-ups to assess BMP durability and gather data from older children., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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46. Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury.
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Dietz, Nicholas, Sarpong, Kwadwo, Ugiliweneza, Beatrice, Wang, Dengzhi, Aslan, Sevda S., Castillo, Camilo, Boakye, Maxwell, and Herrity, April N.
- Abstract
Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988–2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
47. Evaluation and Management of Persistent Problems After Surgery for Hirschsprung Disease in a Child.
- Author
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Ahmad, Hira, Levitt, Marc A., Yacob, Desale, Halleran, Devin R., Gasior, Alessandra C., Di Lorenzo, Carlo, Wood, Richard J., and Langer, Jacob C.
- Abstract
Purpose of Review: Ideally, after operative intervention, a child born with Hirschsprung disease (HD) should thrive, achieve fecal continence, and avoid recurrent episodes of abdominal distention and enterocolitis. However, a significant number of patients continue to struggle following their pull-through procedure. The purpose of this review is to present an organized and practical approach to the evaluation and management of the symptomatic patient post pull-through operation for HD. Recent Findings: Children diagnosed with HD who are not doing well after their initial operation can be categorized in three distinct groups: (1) those that have fecal incontinence, (2) those with obstructive symptoms, and (3) those with recurrent episodes of enterocolitis. It is important to have a systematic diagnostic approach for these patients based on a comprehensive protocol. All three of these patient groups can be treated with a combination of either medical management, reoperation when a specific anatomic or pathologic etiology is identified, or botulinum toxin for non-relaxing sphincters contributing to the obstructive symptoms or recurrent enterocolitis. Summary: For patients not doing well after their initial pull-through, a systematic workup should be employed to determine the etiology. Once identified, a multidisciplinary and organized approach to management of the symptomatic patients can alleviate most post pull-through symptoms. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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48. Management of postoperative fecal incontinence by pediatric surgeons in Nigeria: a pilot study
- Author
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Taiwo A. Lawal
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Anorectal malformation ,Bowel management ,Enema ,Fecal incontinence ,Hirschsprung disease ,Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
Abstract Background Fecal incontinence is a challenging problem in pediatric surgical practice as it occurs in 25 to 50% of patients who have undergone surgery for anorectal malformation and in 5 to 23% after transanal pull-through for Hirschsprung disease. Fecal incontinence impacts on the quality of life of patients; hence, it is important that optimum management is instituted. The management of fecal incontinence in children in sub-Saharan Africa is largely unreported. The study, therefore, evaluated the management practices regarding fecal incontinence by pediatric surgeons in Nigeria. Results A total of 37 pediatric surgeons participated in the cross-sectional pilot study. The mean length of practice as specialists was 9.7 (± 7.8) years. The majority, 33 (89.2%), were males; 23 (62.2%) were ≤ 45 years of age, and 14 (37.8%) had practiced as consultant pediatric surgeons for ≥ 10 years. When presented with a patient with anorectal malformation and recto-bladder neck fistula or Hirschsprung disease who developed fecal incontinence after surgery, 25 (67.6%) and 22 (59.5%), respectively, will combine modalities in managing the patient. Bowel management (81.1% and 83.8% respectively) was the most commonly selected option of managing postoperative fecal incontinence. Other options selected for the management of postoperative fecal incontinence were as follows: examination under anesthesia (43.2% and 37.8%), constipating diet (43.2% and 35.1%), re-operation (24.3% and 27.0%), and diverting colostomy (21.6% and 16.2%) for anorectal malformation and Hirschsprung disease respectively. There were no statistically significant associations between the length of practice as specialist pediatric surgeons and the selection of single vs. multiple treatment options for a patient with fecal incontinence after surgery either for anorectal malformation or Hirschsprung disease. Conclusions A combination of modalities will be adopted by at least 60% of pediatric surgeons in Nigeria to manage postoperative pediatric fecal incontinence with bowel management favored by over 80% of specialists surveyed.
- Published
- 2020
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49. FAECAL CONTINENCE AFTER RECONSTRUCTION OF ANORECTAL MALFORMATIONS
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Polona Studen Pauletič
- Subjects
anorectal malformations ,surgical management ,faecal continence ,bowel management ,Medicine ,Pediatrics ,RJ1-570 - Abstract
The aim of the article is to review anorectal malformations. Babies born with anorectal anomalies need surgical treatment to be able to pass meconium and faeces. Surgical management can sometimes be achieved in a single stage. A two-stage procedure is required for more complex anomalies, with the first stage being the formation of a diverting colostomy. Children born with less complex anorectal malformations have a better prognosis for faecal continence, but, unfortunately, also a higher tendency for constipation. Those with more complex anomalies have poorer muscle development, altered intestinal motility and sensation, and a worse prognosis for complete faecal continence. It is of great importance to prevent constipation after surgical reconstruction. The aim of bowel management is to achieve regular bowel movement with dietary adjustments and laxatives if needed. In faecal incontinence, regular enemas can be used. They must be tailored to each patient. Iatrogenic faecal incontinence is a rare postoperative complication.
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- 2020
- Full Text
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50. Outcomes of children with constipation and autism spectrum disorder treated with antegrade continence enemas.
- Author
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Srinivas S, Halaweish I, Knaus ME, Ahmad H, Griffin KL, Stephenson KG, Yossef L, Trimble C, Jimenez ALN, Lu A, Gasior A, Wood RJ, and Williams KC
- Subjects
- Child, Humans, Quality of Life, Constipation therapy, Constipation complications, Cecostomy adverse effects, Enema adverse effects, Retrospective Studies, Treatment Outcome, Autism Spectrum Disorder complications, Autism Spectrum Disorder therapy, Fecal Incontinence etiology, Fecal Incontinence therapy
- Abstract
Background: Treatment of functional constipation (FC) in children with autism spectrum disorder (ASD) is challenging due to sensory and behavioral issues. We aimed to understand whether antegrade continence enemas (ACEs) are successful in the treatment of FC in children with ASD., Methods: A single-institution retrospective review was performed in children diagnosed with ASD and FC who underwent appendicostomy or cecostomy placement from 2007 to 2019. Descriptive statistics regarding soiling and complications were calculated., Results: There were 33 patients included, with a median age of 9.7 years at the time of ACE initiation. The average intelligence quotient was 63.6 (SD = 18.0, n = 12), the average behavioral adaptive score was 59.9 (SD = 11.1, n = 13), and the average total Child Behavioral Checklist score was 72.5 (SD = 7.1, n = 10). Soiling rates were significantly lower following ACE initiation (42.3% vs. 14.8%, p = 0.04). Behavioral issues only prevented 1 patient (3.0%) from proper ACE use. Eleven patients (36.6%) were able to transition to laxatives. There were significant improvements in patient-reported outcomes measures and quality of life., Conclusion: Placement of an appendicostomy or cecostomy for management of FC in children with severe ASD was successful in treating constipation and improving quality of life., (© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)
- Published
- 2024
- Full Text
- View/download PDF
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