Patient Reported Outcomes After Subtotal Colectomy in Pediatric Therapy-resistant Constipation: a combined retrospective and cross-sectional study

BACKGROUND: Current literature on outcomes after subtotal colectomy for therapy-resistant constipation (TRC) in the pediatric population is scarce. We aimed to review clinical outcomes, postoperative complications and health-related quality of life (HRQoL) after subtotal colectomy in children with TRC. METHODS: All children <18 years who underwent a subtotal colectomy for TRC from January 2011 till June 2024 were included and data were extracted from their medical files. Follow up by telephone was done in 2024. Clinical outcomes, postoperative complications and HRQoL after subtotal colectomy were evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS). Treatment success was defined as a defecation frequency > 2 times per week and a fecal incontinence frequency < 1 per 2 weeks. RESULTS: Forty children with TRC were included (78% female). Median age at subtotal colectomy was 16 years [IQR 13-17]. Treatment success following subtotal colectomy was achieved in 68% of patients at a median follow-up of 68 months [IQR 27-129]. Despite subtotal colectomy, 47% of patients still reported abdominal pain. Postoperative complications were observed in 63% of the patients, with major complications (Clavien-Madadi grade III-IV) occurring in 48% of them. HRQoL after subtotal colectomy was preserved in all PROMIS domains across all age groups. CONCLUSION: Treatment success after subtotal colectomy was achieved in 68%, however, approximately half of patients still reported postoperative abdominal pain and postoperative complications rates were high. Subtotal colectomy was associated with a favorable HRQoL across PROMIS domains.