Surgery for childhood constipation

Surgery in children

surgery for ulcerative colitis in children

Constipation in children

Constipation is an extremely common symptom in childhood.

For most children, the symptoms are mild and short-lived. Others require treatment with dietary adjustment and perhaps laxative from their family doctor.

A smaller number will require a hospital based paediatrician with an interest in this problem to supervise treatment.

I am interested in the very few children who are not cured by these measures.

I offer the ACE operation for severely constipated children who have failed other therapies.

ACE stands for Antegrade Continent Enema, or sometimes Antegrade Colonic Enema.

For a handful of children, I offer resectional surgery, including ileal pouch surgery for intractable constipation.

I have published a study of the outcomes of the first five children to undergo removal of their entire colon and rectum with reconstruction using an ileal pouch. These children represent the most severely affected group, but they can be salvaged with this major operation. Here is a link to the study

ACE

The ACE procedure was originally described for children who were born with spina bifida and who, as a result, had less than perfect continence. Other children who underwent the operation were those who had undergone surgery for Hirschsprung's disease.

In Newcastle we have a very large experience of performing the operation for constipation. Follow this link for a pie chart showing the underlying diagnosis of all the children whom I have constructed an ACE on.

ACE diagnoses

The National Institute for Clinical Excellence (NICE) have published guidelines for the management of childhood constipation, and have used our published research to support the use of ACE surgery for this condition.

We have published an analysis of what happens to constipated children who receive an ACE. The next link is to the journal web page showing this research

Outcomes of constipated ACES

Our practice is always to have children reviewed by a consultant paediatric gastroenterologist before considering removal of the colon for constipation.

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