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Srinivas S, Shalash B, Knaus M, Bergus KC, Pruitt LC, Brock G, Thomas J, Minneci PC, Deans K, Wood RJ. Patient-Reported Experience in Colorectal Disease is Predicted by Cleanliness. J Pediatr Surg 2024:S0022-3468(24)00303-8. [PMID: 38816305 DOI: 10.1016/j.jpedsurg.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Children with colorectal diseases such as anorectal malformations (ARM), Hirschsprung disease (HD), and functional constipation (FC) undergo bowel management programs (BMPs) to achieve cleanliness. While patient outcomes, such as cleanliness and quality of life, are well understood, patient experience, such as relationships, ability to participate in sports, and independence and self-confidence is less well understood. We aimed to assess the relationship between BMP and patient experience. METHODS A cross-sectional survey was administered to 295 patients ≥3 years old with ARM, HD, and FC completing BMP. The survey contains 22 questions regarding patient-reported experience measures (PREMs) and 11 regarding patient-reported outcomes measures (PROMs). Each was graded on a Likert scale, with higher scores meaning better experience. Scores were compared by demographics and clinical characteristics and logistic regression was performed controlling for clinically significant variables. A p-value of ≤0.05 was significant. RESULTS There were 205 eligible respondents (69.5%) with a median age of 8.9 years [IQR: 6.1-12.4]. ARM was most common (51.2%) and most achieved cleanliness on BMP (69.3%). There were no differences in experience scores by age, diagnosis, or bowel regimen. Patients that were clean had significantly higher PREM scores (67.7 [IQR: 64.0-83.0] vs. 64.8 [IQR: 55.0-70.1], p = 0.0002) and PROM scores (36.8 [IQR: 33.0-41.0] vs. 34.0 [31.0-38.5], p = 0.005). On regression analysis, cleanliness remained a strongly significant predictor of positive experience scores (β 7.37, SE 1.86, p < 0.0001). CONCLUSIONS Achieving cleanliness was associated with positive patient experience of bowel management programs. This finding suggests that achieving cleanliness, regardless of regimen, may allow patients the best functional and experiential outcomes.
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Affiliation(s)
- Shruthi Srinivas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bayan Shalash
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Maria Knaus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine C Bergus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Liese Cc Pruitt
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guy Brock
- Center for Biostatistics, Department of Bioinformatics, The Ohio State University, Columbus, OH, USA
| | - Jessica Thomas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter C Minneci
- Nemours Surgical Outcomes Center and Department of Surgery, Nemours Children's Health - Delaware Valley, Wilmington, DE, USA
| | - Katherine Deans
- Nemours Surgical Outcomes Center and Department of Surgery, Nemours Children's Health - Delaware Valley, Wilmington, DE, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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Trinidad S, Oyania F, Bingana C, Nuwagaba I, Obermeyer M, Odongo C, Kotagal M, Situma M. Pilot bowel management program at Mbarara Hospital, Uganda. Pediatr Surg Int 2023; 39:292. [PMID: 37962686 DOI: 10.1007/s00383-023-05574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Children with Hirschsprung's disease (HD) and anorectal malformations (ARM) may benefit from a bowel management program (BMP) to treat constipation and fecal incontinence. This study describes a pilot BMP in Uganda. METHODS Patients treated for HD or ARM were recruited for the BMP. Local staff underwent training and progressively took over decision-making. The rates of patient involuntary bowel movements (IBMs) and provider confidence were evaluated pre- and post-BMP with questionnaires. The results were compared with Fischer's exact test. RESULTS Ten staff-2 surgeons, 6 nurses and 2 physiotherapists-and 12 patients participated. Patient median age was 4.5 years (IQR 3-6.6) and ten were male. Ten reported at least daily IBMs prior to the BMP. All patients underwent a clean-out. The parents were then taught to perform daily enemas or irrigations. Specific regimens were determined by patient history and imaging and titrated throughout the BMP. There were differences in the rates of both daytime and nighttime IBMs before and after the BMP (p = 0.0001 and 0.002, respectively). All staff reported increased confidence. CONCLUSIONS We describe the first BMP in Uganda. BMPs can successfully treat constipation and fecal incontinence in low-income countries, although there are challenges with resources and follow-up.
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Affiliation(s)
- Stephen Trinidad
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- , 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Felix Oyania
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Maria Obermeyer
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | | | - Meera Kotagal
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Martin Situma
- Mbarara University of Science and Technology, Mbarara, Uganda
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Wehrli LA, Reppucci ML, De La Torre L, Ketzer J, Rieck JM, Cooper EH, Judd-Glossy L, Peña A, Bischoff A. Gastrointestinal quality of life and bowel function in adults born with anorectal malformation and hirschsprung disease. Pediatr Surg Int 2023; 39:234. [PMID: 37464109 DOI: 10.1007/s00383-023-05516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To assess the quality of life and disease-specific functioning of adults with anorectal malformations (ARM) or Hirschsprung disease (HD) compared to healthy reference scores. METHODS Patients with the diagnosis of ARM or HD from the Adult Colorectal Research Registry completed the Short Form 36 Health Survey (SF-36), the Gastrointestinal Quality of Life Index (GIQoLI), and the Bowel Function Score (BFS) between October 2019 and August 2022. One-sample Wilcoxon test compared the results to reported healthy references with a significance level of < 0.05. RESULTS The response rate was 67%. All three surveys were completed by 133 adults with a slight preponderance of males (51%). Median age was 31 years, 117 were born with ARM and 16 with HD. All subgroups had significantly lower BFS than healthy references. ARM patients scored significantly lower than the healthy reference population when assessed for GIQoL. All showed significant impairment with the mental component summary (MCS) of SF-36. Patients with a successful bowel management had significantly higher scores on all three questionnaires than those with fecal accidents. CONCLUSION Our results emphasize the importance of a successful bowel management and its impact on the quality of life and bowel function. Long-term follow-up is recommended with attention to mental health.
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Affiliation(s)
- Lea A Wehrli
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Marina L Reppucci
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Luis De La Torre
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Jared M Rieck
- Research in Outcomes for Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Emily H Cooper
- Research in Outcomes for Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura Judd-Glossy
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Alberto Peña
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
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Trinidad S, Jensen A, Holder M, Elsner A, Rosen N, Garrison A, Rymeski B, Frischer JS. Sacral Nerve Stimulation in Children with Medically Refractory Fecal Incontinence or Severe Constipation. J Pediatr Surg 2023:S0022-3468(23)00249-X. [PMID: 37221127 DOI: 10.1016/j.jpedsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation. METHODS We performed a retrospective cohort study of all patients treated with SNS after failed medical management at a single center between 9/1/2015 and 6/30/2022. Demographic and clinical data was extracted from the electronic medical record. Rates of involuntary bowel movements were evaluated using a bowel severity score questionnaire and compared pre- and post-SNS using McNemar and McNemar-Bowker tests. RESULTS 70 patients underwent SNS placement. The median age was 12.8 years (IQR 8.6-16.0) and 61.4% were male. The most common diagnosis was idiopathic constipation (67.1%), followed by anorectal malformation (15.7%), and others. 43 patients had severity scores recorded both pre- and at least 90 days post-SNS insertion. The rates of daytime and nighttime involuntary bowel movements were significantly different pre-compared to post-SNS placement (p = 0.038 and p = 0.049, respectively). The rate of daytime and nighttime fecal continence increased from 44% to 58.1% and 53.5%-83.7%, respectively. The rate of at least weekly daytime and nighttime fecal incontinence decreased from 48.8% to 18.7% and 34.9%-7.0%, respectively. Minor pain/neurological symptoms occurred in 40% of patients, while 5.7% developed a wound infection. Further surgery for the SNS was required in 40% of patients. CONCLUSIONS SNS placement can be an effective treatment for medically refractory fecal incontinence. Minor complications and the need for further procedures are common, while more serious complications like wound infections are rare. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Stephen Trinidad
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amanda Jensen
- Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN, USA; The Indiana University School of Medicine, Indianapolis, IN, USA
| | - Monica Holder
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Elsner
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nelson Rosen
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aaron Garrison
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Rymeski
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason S Frischer
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Trinh TH, Nguyen NM, Lam KT, Pham TN, Vu NT, Truong LNU, Tran VQ. Anorectal manometry findings in relation with long-term functional outcomes of the patients operated on for Hirschsprung's disease compared to the reference-based population. Pediatr Surg Int 2023; 39:131. [PMID: 36800080 DOI: 10.1007/s00383-023-05402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE This study investigated anorectal manometry (AM) findings and bowel function of patients operated on for Hirschsprung's disease (HD). METHODS A cross-sectional study was conducted at Children's Hospital 2. Patients operated on for HD from January 2015 to January 2020 were reviewed. Their clinical characteristics, bowel function, and manometric findings were investigated and compared with the references. RESULTS Ninety-five patients and 95 references were enrolled. Mean ages were 6.6 ± 2.2 years and 7.2 ± 2.9 years,; fecal incontinence rates were 25.3% and 2.1%, and constipation rates were 12.6% and 4.2 for the patients versus the references, respectively. Anal resting pressures were significantly decreased in the patients compared to the references (53.2 ± 16.1 mmHg versus 62.2 ± 14.0 mmHg; p < 0.05). Among the patients, the anal resting pressure was significantly decreased in the incontinents than in the continents (46.0 ± 10.6 mmHg versus 55.6 ± 16.9 mmHg, p < 0.05). During the sensation test, the value of maximum tolerated volume was significantly decreased in the incontinents than in the continents (135.9 ± 47.9 mL versus 166.6 ± 58.3 mL, p < 0.05). CONCLUSION AM is an objective method providing beneficial information that could guide a more adapted management in HD patients with defecation disorders.
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Affiliation(s)
- Tung Huu Trinh
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam.,Department of Pediatrics, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Ngoc Minh Nguyen
- Department of Pediatrics, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Kim Thien Lam
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Thach Ngoc Pham
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Nhan Truong Vu
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Linh Nguyen Uy Truong
- University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, District 5, Ho Chi Minh City, Vietnam
| | - Viet Quoc Tran
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam.
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Gabr AA, Shalaby A, Elham Fares A, Hussein Bahaaeldin K, Nabhan Kaddah S, El Tagy G, Ahmed Gad M. Medium-term outcomes of antegrade continent enema (ACE): Cairo University Specialized Pediatric Hospital (CUSPH) experience. J Pediatr Surg 2022:S0022-3468(22)00769-2. [PMID: 36628693 DOI: 10.1016/j.jpedsurg.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/29/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
AIM OF THE STUDY To assess the medium-term outcomes of ACE in children with fecal incontinence (FI). METHOD Eligible children were recruited from the colorectal clinic between December 2016 and January 2020 and were followed prospectively for 2-6 years. A series of questionnaires were used to assess QOL, patients and parent satisfaction, and to assess the outcomes of the ACE. RESULT 24 children aged 6-12 years (mean age 8.17 ± 1.95), including 18 males (75%) and 6 females (25% were studied. Cases included anorectal malformations (45.83%)., Hirschsprung disease (25%), neural tube defects (16.66%), sacrococcygeal teratoma (4.16%), and intractable pseudoincontinence (8.33%). QOL improved from (3) [3 -3] to (16) [16-16],p < 0.05. Fecal incontinence index showed significant improvement: 20 [20-20] versus 3 [0-4],p < 0.05. Bowel symptoms demonstrated improvement in the ability to decide when to pass stools and a decrease in soiling. Stooling survey showed lower scores representing better outcome. ACE questionnaire showed that the range of irrigation volumes used by parents is wide, and that all families recommend the ACE for children with similar condition. Postoperative complications were stenosis (16.66%), stomal prolapse (12.5%), leakage (4.16%), and false passage (4.16%). Satisfaction questionnaire showed a median score of 9 (range, 5-10). CONCLUSION ACE is an effective method to keep the child with FI clean, more socially active, and with a better QOL and FII in the medium-term. The reported complications were stenosis, false passage, and leakage. ACE mucosa prolapse is a novel complication picked up on medium-term follow up.
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Affiliation(s)
- Ahmed Adel Gabr
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
| | - Aly Shalaby
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
| | | | | | | | - Gamal El Tagy
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
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Pilot study of an adult bowel management program for fecal incontinence. J Pediatr Surg 2022; 57:1681-1686. [PMID: 35570011 DOI: 10.1016/j.jpedsurg.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bowel management programs are efficacious in pediatric patients with fecal incontinence or intractable constipation unresponsive to standard treatment. No studies have been done examining outcomes in adults. The objective of this study was to assess continence and quality of life outcomes in adults who have underwent bowel management program. METHODS A retrospective review of patients 16 or older at the time they underwent a bowel management program for fecal incontinence or constipation was performed. Data collected included intake and follow-up stool and urinary continence, patient-reported outcomes measures (Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and an age-adjusted health-related quality of life measure. RESULTS The cohort included 38 patients with a median age of 19 years (range: 16-55) when they underwent our program. 50% of patients were female and the majority (33, 87%) were White. The most common diagnosis was anorectal malformation (16, 42%) followed by functional constipation (10, 27%). Stool continence rates improved after undergoing the program (52.7% prior to 87.6% at follow-up, p<0.01). There was significant improvement in the Baylor Continence Scale, Cleveland Clinic Constipation Score, and PedsQL (p<0.05). CONCLUSIONS Adult patients who underwent a bowel management program for severe fecal incontinence or constipation show significant improvement in stool continence rates, patient-reported outcomes measures, and quality of life. A bowel management program (in-person or via telemedicine) is a feasible treatment strategy for adult patients who fail standard management of fecal incontinence or constipation and should be offered when appropriate. LEVEL OF EVIDENCE III.
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Knaus ME, Ahmad H, Metzger GA, Beyene TJ, Thomas JL, Weaver LJ, Gasior AC, Wood RJ, Halaweish I. Outcomes of a telemedicine bowel management program during COVID-19. J Pediatr Surg 2022; 57:80-85. [PMID: 34686377 PMCID: PMC8452355 DOI: 10.1016/j.jpedsurg.2021.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Due to the COVID-19 pandemic, we transitioned from an in-person bowel management program (BMP) to a telemedicine BMP. The telemedicine BMP consisted of video and/or phone call visits (remote) or a single initial in-person visit followed by remote visits (hybrid). We hypothesized that patient/family satisfaction of a telemedicine BMP would be comparable to an in-person BMP and that there would be improvement in quality of life and functional outcomes after the telemedicine BMP. METHODS After IRB approval, demographic and outcomes data were obtained for patients who underwent the telemedicine BMP from May-October 2020. Outcomes included a parent/patient satisfaction survey, Pediatric Quality of Life Inventory (PedsQL), and parent/patient-reported outcome measures (Vancouver, Baylor, and Cleveland scores) at baseline, 1 and 3 month follow-up. Variables were compared using Chi-square or Wilcoxon-Mann-Whitney tests and a generalized mixed model was used to evaluate outcomes scores at follow-up compared to baseline. RESULTS Sixty-seven patients were included in our analysis with an average age of 8.6 years (SD: 3.9). Patients had the following diagnoses anorectal malformation (52.2%), Hirschsprung's disease (20.9%), functional constipation (19.4%), myelomeningocele (6.0%), and spinal injury (1.5%). Forty-eight patients (72%) underwent the remote BMP and 19 (28%) underwent the hybrid BMP. Sixty-two percent of parents completed the satisfaction survey, with a median score of 5 (very satisfied) for all questions. Over 75% of parents said they would prefer a telemedicine program over an in-person program. There was significant improvement in the Baylor and Vancouver scores after the BMP (p < 0.01), but no difference in the PedsQL or Cleveland scores (p > 0.05). There was a significant improvement in stool continence after the BMP (p < 0.01). CONCLUSION A telemedicine BMP can be an acceptable alternative to a traditional in-person program. There was high parental/patient satisfaction and significant improvement in outcomes. Further research is needed to assess long-term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maria E. Knaus
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States,Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Gregory A. Metzger
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Tariku J. Beyene
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jessica L. Thomas
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Laura J. Weaver
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Alessandra C. Gasior
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States,Division of Colon and Rectal Surgery, Department of Surgery, The Ohio State University, Columbus, OH, United States
| | - Richard J. Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States
| | - Ihab Halaweish
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave. FB Suite 6B.1, Columbus, OH 43205, United States.
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Prospective quality of life outcomes in pediatric fecal incontinence following bowel management. J Pediatr Surg 2021; 56:1459-1464. [PMID: 34103148 DOI: 10.1016/j.jpedsurg.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe fecal incontinence (FI) is common in patients both with and without anorectal malformations. Whether a formal bowel management program (BMP) has significant effects on FI, psychosocial development of the child, and caregiver stress is poorly understood. We hypothesize that BMP participation results in long-term clinical and quality of life (QOL) improvements for patients and caregivers. METHODS Using a prospective cohort study over three years, 342 children (age 3-12 years) and caregivers were followed for one year after attending a week-long BMP, during which a regimen was tailored to promote daily stool evacuation.FI QOL was measured with the validated Cincinnati Fecal Incontinence Scale (CINCY-FIS), evaluating multiple subscales, including parental stress. Scores were obtained at multiple timepoints following BMP (baseline, 2 weeks, 3 months, 1 year). RESULTS Within 2 weeks, BMP participation significantly improved FI with increased frequency of daily daytime voluntary bowel movements (20%-70%, p < 0.001) and decreased daily daytime and nighttimeinvoluntary bowel movements (60%-20%, p < 0.001; 30%-10%, p < 0.05). Marked improvements in CINCY-FIS were observed across multiple QOL subscales, with the greatest in parental stress, and sustained through one year. CONCLUSIONS BMP results in significant and sustained improvement in FI and QOL for patients and caregivers.
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Peña A, De La Torre L, Belkind-Gerson J, Lovell M, Ketzer J, Bealer J, Bischoff A. Enema-Induced spastic left colon syndrome: An unintended consequence of chronic enema use. J Pediatr Surg 2021; 56:424-428. [PMID: 33199058 DOI: 10.1016/j.jpedsurg.2020.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE Enemas have become a common practice for treating fecal incontinence and severe constipation. Several patients receiving enemas complained of severe, colicky, abdominal pain during enema administration and complained that the duration for fluid to pass was progressively increasing. Contrast studies showed a startling picture of severe right colon dilatation and a spastic, narrow, left colon. An investigation was started to seek the origin and possible management of this condition. METHODS Medical and radiologic records were reviewed retrospectively, with emphasis on the type and ingredients of enemas used, the duration the patients had been receiving enemas, and their original diagnosis. A literature review was done on previous reports of this condition and publications related to long-term use of enemas. RESULTS This series included 22 patients (average age, 19.6 years; range, 8-54) with fecal incontinence due to anorectal malformations (10 cases), myelomeningocele (5), cloaca (2), severe colonic dysmotility (2), Hirschsprung's disease (2), and sacrococcygeal teratoma (1). The average duration of enema use was 13.7 years (range, 4-45). The composition of the enemas included saline/glycerin (six cases), only saline solution (five), saline/glycerin/soap (four), plain water (three), and one case each of molasses/milk, saline/glycerin/soap/phosphate, saline/phosphate, and only phosphate. The enemas were performed in an antegrade fashion in 21 cases and rectally in 1. All patients had a dilated right colon and a narrow, spastic, left, transverse, and descending colon. Four patients underwent colonoscopy, colonic manometry, and mucosal biopsies, which did not help in explaining the etiology of the problem. In the literature, 43 reports mentioned a "long-term follow-up" for the administration of enemas, but we could not find a description of symptoms, such as in our cases. CONCLUSIONS An intriguing and, to our knowledge, previously unreported complication of chronic enema use is presented. We call attention to an overly concerning complication and report our findings in the hope that they will aid and stimulate more investigations into this condition. Several hypotheses to explain the cause are presented, as well as potential treatment options.
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Affiliation(s)
- Alberto Peña
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States.
| | - Luis De La Torre
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - Jaime Belkind-Gerson
- Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, United States
| | - Mark Lovell
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, United States
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - John Bealer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
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Baxter KJ, Garza JM, Rollins MD, Drake K, Reeder RW, Wood R, Avansino J, Calkins CM, Ralls M, Garvey EM, Durham MM. Multi-institutional review of bowel management strategies in children with anorectal malformations. J Pediatr Surg 2020; 55:2752-2757. [PMID: 32616413 DOI: 10.1016/j.jpedsurg.2020.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/RATIONALE To describe current bowel management program (BMP) strategies in anorectal malformation (ARM) patients based on patient-level predictors using data from a multi-institutional consortium. MATERIALS/METHODS Patient bowel function and BMP were reviewed from Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) data. The PCPLC is comprised of multidisciplinary specialists researching colorectal and pelvic disorders. Seven US institutions submitted de-identified clinical data on ARM patients into a centralized patient registry. RESULTS The primary ARM of 624 patients was categorized into Mild (45.2%), Moderate (40.4%) or Complex (14.2%) anomaly classifications. Patient-specific BMP were examined based on age and on the presence of spinal cord/sacral anomalies. 418 (67%) enrolled patients were prescribed BMP (<5 yo 56.4%; ≥5-<12 yo 86.7%; ≥12 81.5%). Constipation was the primary chief complaint (80.2%). Forty percent of patients on a BMP were toilet trained and approximately one-half (48.5%) reported daytime stool accidents. Secondary surgical interventions for antegrade continence enemas (ACE) were examined; 14.5% of patients employed ACE strategies and utilization increased with age and varied based on anatomic anomalies. CONCLUSIONS This is the first report on BMP strategies for patients with ARM from the Pediatric Colorectal and Pelvic Learning Consortium. Individual patient characteristics are explored for their impact on bowel management strategy utilization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Katherine J Baxter
- Emory University School of Medicine, Office of Surgical Education, H100 Emory University Hospital1364 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Jose M Garza
- Children's Healthcare of Atlanta, 1400 Tullie Road NE 6th Floor, Atlanta, GA 30329, USA
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kaylea Drake
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ron W Reeder
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Richard Wood
- Nationwide Children's Hospital, 700 Children's Drive Columbus, OH 43205, USA
| | - Jeffrey Avansino
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, 999 N. 92(nd) Street, Milwaukee, WI 53226, USA
| | - Matt Ralls
- University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI 48109, USA
| | - Erin M Garvey
- Phoenix Children's Hospital , 1919 E. Thomas Road, Phoenix, AZ 85106, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, 1405 Clifton Road NE, 3rd Floor, Tower 1, Pediatric Surgical Suite, Atlanta, Ga 30322, USA.
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Kilpatrick JA, Zobell S, Leeflang EJ, Cao D, Mammen L, Rollins MD. Intermediate and long-term outcomes of a bowel management program for children with severe constipation or fecal incontinence. J Pediatr Surg 2020; 55:545-548. [PMID: 31837840 DOI: 10.1016/j.jpedsurg.2019.10.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE We sought to examine the long-term clinical success rates of a bowel management program (BMP) for children with severe constipation or fecal incontinence. METHODS A single center review was conducted of children (≤18 years) enrolled in a BMP and followed in a colorectal specialty clinic (2011-2017). All patients who completed an initial week of the BMP were included. Patients enrolled in a BMP after 2018 were excluded. Success was defined as no accidents and <2 stool smears per week. RESULTS A total of 285 patients were reviewed. BMP was initiated at a median age of 7 years (9 months-17 years). Primary diagnoses included functional constipation (112), anorectal malformation (ARM) (104), Hirschsprung Disease (HD) (41), rectal prolapse (14), spina bifida (6), fecal incontinence (3) and other (5; 4 sacral coccygeal teratomas and a GSW to the buttocks). Initial bowel regimen included large volume enema in 54% and high dose stimulant laxative in 46%. The initial Bowel Management Week (BMW) was successful in 233 (87% of adherent patients) patients with 17 (6%) non-adherent. One hundred twenty-two patients had follow-up at 12 months (72% success amongst adherent patients, 7% of patient non-adherent) and 98 patients had follow-up at 24 months (78% success amongst adherent patients, 10% of patients non-adherent). 21/154 (14%) patients started on enemas were later successfully transitioned to laxatives and 13/132 (10%) patients started on laxatives subsequently required enemas in order to stay clean. Clinic phone contact occurred outside of scheduled visits for adjustment to the BMP in 44% of patients. 33% of patients had surgery to aid bowel management (antegrade colonic enema (ACE) = 81, resection + ACE = 13, diverting stoma = 4). Median follow up was 2.5 years (5 weeks-7 years). CONCLUSION Children who follow a structured BMP with readily available personnel to provide outpatient assistance can experience successful treatment of severe constipation or fecal incontinence long-term. A multi-institutional collaboration is necessary to identify factors which predict failure of a BMP and non-adherence. TYPE OF STUDY Single-center retrospective chart review. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Sarah Zobell
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | | | - Duyen Cao
- University of Utah School of Medicine, Salt Lake City, UT
| | - Lija Mammen
- University of Utah School of Medicine, Salt Lake City, UT
| | - Michael D Rollins
- University of Utah School of Medicine, Salt Lake City, UT; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
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13
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Quality of life in children with pseudoincontinence after implementing a bowel management program in Egypt. J Pediatr Surg 2020; 55:261-264. [PMID: 31918852 DOI: 10.1016/j.jpedsurg.2019.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 12/14/2022]
Abstract
AIM OF THE STUDY The aim of this study was to evaluate the impact of implementing a Bowel Management Program (BMP) on the quality of life (QOL) in children with pseudoincontinence. METHOD Children aged 2.5-13 years with pseudoincontinence were included. Evaluations were performed before and after BMP implementation. Perceptions from parents about QOL were assessed by a QOL questionnaire, and the severity of fecal incontinence (FI) was assessed using the fecal incontinence index (FII) of the Wexner scale. RESULTS 115 children (mean age of 7.54 ± 2.48) were studied over a 3-12 month period (mean duration 4.36 months). QOL improved from 2.45 ± 1.57 to 14.36 ± 1.37, P˂0.05. There was a significant improvement of the FII: 18.65 ± 1.25 versus 0.13 ± 0.39, P˂ 0.05. There was a significant inverse correlation between the final scores of QOL (14.36 ± 1.37) and FII (0.13 ± 0.39) after implementation of the BMP (r = -0.53; P ˂ 0.05). CONCLUSION This is the largest case series examining QOL in pseudoincontinent children. It demonstrates that BMP significantly improves the QOL of these children in the short and midterm. In addition, it is feasible to apply the FII in assessing incontinence in children. To our knowledge, this is the first study of its kind in our region. LEVEL OF EVIDENCE Level IV.
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Lawal TA. Influence of workshop attendance on management of pediatric fecal incontinence in Nigeria. ANNALS OF PEDIATRIC SURGERY 2019. [DOI: 10.1186/s43159-019-0004-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The care of children with fecal incontinence is suboptimal with inadequate support and training opportunities. The postgraduate training of pediatric surgeons on the management of fecal incontinence is inadequate since each training center is not likely to see enough number of cases yearly. Supplemental training through workshops on fecal incontinence may help to bridge the gap. The aim of this cross sectional study was to evaluate the impact of previous attendance of a workshop on fecal incontinence management practices among pediatric surgeons.
Results
A total of 41 respondents participated. Eleven (26.8%) respondents had attended a workshop in the past and seven (17.1%) had done a Malone antegrade continent enema (MACE) on patients. A higher proportion of respondents who had practiced for over 15 years had attended a workshop on fecal incontinence compared to those who had not attended one (90.9% vs. 33.3%, p = 0.001). The proportion of respondents who had attended a workshop on fecal incontinence and had performed a MACE (18.2%) was higher than the proportion of those who had not attended a workshop and had performed a similar procedure on patients (3.3%), p = 0.047.
Conclusions
One quarter of pediatric surgeons in the country surveyed had attended a workshop on fecal incontinence. Prior attendance of a workshop on fecal incontinence is significantly related to experience and significantly influenced the performance of a MACE procedure. Supplementation of the training of pediatric surgeons through workshops on fecal incontinence will help to improve capacity in pediatric colorectal surgical care.
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Zheng H, Liu G, Liang Z, Chen Y, Wen Z, Yu J, Xu X, Liang H, Wang Y. Middle-term bowel function and quality of life in low-type anorectal malformation. Ital J Pediatr 2019; 45:98. [PMID: 31409364 PMCID: PMC6693156 DOI: 10.1186/s13052-019-0701-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-type anorectal malformations (ARMs) are considered benign; however, in China, data regarding such conditions are limited. Thus, this study aimed to assess the middle-term bowel functions and quality of life (QOL) among children with low-type ARM. METHODS Children > 3 years of age who underwent treatment for low-type ARM (vestibular fistula [VF] and perineal fistula [PF]) during 2013 and healthy children were included. The children were interviewed during their outpatient visits. The primary outcome measures were bowel function, as assessed using the Baylor Continence Scale (BCS), and QOL, as measured using the Pediatric Quality of Life Inventory (PedsQL 4.0). RESULTS A total of 82 patients responded; mean patient age was 6.8 (range, 3-12) years. Mean BCS score in the control group (7.94 ± 4.74) was significantly lower than that in the VF (18.69 ± 11.11, P < 0.001) and PF (15.47 ± 6.50, P < 0.001) groups. However, there were no differences in PedsQL 4.0 scores among the groups. The patients scored the lowest for emotional function and the highest for physical function. Nearly all measurements of QOL significantly decreased with increased BCS score. CONCLUSIONS Children with low-type ARM can achieve good bowel control and QOL. However, although ARMs are benign, several children with this condition suffer from anal function problems that affect QOL. Redo operations, mislocated anus, and incorrect constipation treatment are the iatrogenic causes of fecal incontinence.
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Affiliation(s)
- Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guangjian Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zijian Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Yunpei Chen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Zhe Wen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Jiakang Yu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Xiaogang Xu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
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Schletker J, Edmonds T, Jacobson R, Ketzer J, Hall J, Trecartin A, Peña A, Bischoff A. Bowel management program in patients with spina bifida. Pediatr Surg Int 2019; 35:243-245. [PMID: 30402681 DOI: 10.1007/s00383-018-4403-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Our center has been successfully implementing a bowel management program (BMP) for fecal incontinence consecutive to anorectal malformation and Hirschsprung disease. Recently, the number of patients with spina bifida requiring management for fecal incontinence has increased. The purpose of this study was to review the results of bowel management in patients with spina bifida and the challenges unique to this population. METHODS A retrospective chart review was performed including all patients with spina bifida who attended our BMP from February 2016 until April 2018. Data collection included: prenatal intervention, gender, age, characteristics of contrast enema, success rateand challenges faced. RESULTS Twenty-two patients met inclusion criteria 13 of which were females. Three patients had their myelomeningocele repaired prenatally, the remaining were repaired postnatally. Patient ages ranged from 2 to 24 years. Only nine patients were referred to BMP at proper toilet training age. Three patients came to BMP status post an antegrade enema procedure with reported "accidents" on their current regimen. The colon in the contrast enema was non-dilated in all patients and two behaved as hypermotile requiring loperamide. Seventeen patients (77%) were clean of stool and considered successful. Solution leakage during enema administration was the most common challenge and was corrected by increasing the Foley balloon fill volume. CONCLUSIONS Our bowel management program with enemas is effective for patients with a history of spina bifida. The data support specific considerations for this population including frequent adjustments, close follow-up and specific administration techniques.
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Affiliation(s)
- Julie Schletker
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA.
| | - Tiffany Edmonds
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Rebecca Jacobson
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Jill Ketzer
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Jennifer Hall
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Andrew Trecartin
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Alberto Peña
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- Department of Pediatric Surgery, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045, USA
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Wang Y, Liang H, Wu Q, Zheng H, Liu G, Wen Z, Lan M, Yu J, Zhu D, Liang J, Zhang J, Xu X, Xia H. Bowel management program for pediatric postoperative fecal incontinence in China: A surgeon's experience. Medicine (Baltimore) 2017; 96:e7078. [PMID: 28562577 PMCID: PMC5459742 DOI: 10.1097/md.0000000000007078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this article is to report the status of the efficacy of and long-term adherence to the Bowel Management Program (BMP) for fecal incontinence (FI) postoperation in China.Children over 3 years of age with FI postoperation referred to our medical center were included in the study. Evaluations were performed before and 2 years after their clinic visit. The cost of bowel care, improvement in incontinence, health-related quality of life, and family functioning with the BMP were analyzed.A total of 48 children with FI were included in our study, of whom 38 were boys. The median treatment fee was 660.1 dollars. The complications included abdominal pain (4 patients, 8%), occasional vomiting (2 patients, 4%), and hypoglycemia (1 patient, 2%). The incontinence status and health-related quality of life improved significantly after the BMP. Despite the good outcome of the BMP, half of the patients discontinued the program.The BMP is an effective approach to manage FI and improve the patients' quality of life. Poor long-term adherence is currently the main challenge affecting the BMP application in China.
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Affiliation(s)
- Yong Wang
- Southern Medical University
- Department of Pediatric Surgery
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guangjian Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhe Wen
- Department of Pediatric Surgery
| | | | | | | | | | | | | | - Huimin Xia
- Southern Medical University
- Department of Pediatric Surgery
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