Laparoscopic-assisted transanal soave for refractory constipation in children: outcomes and management

PURPOSE: This study evaluates the efficacy and safety of laparoscopic-assisted transanal Soave procedure (LATSP) in children with refractory constipation unrelated to Hirschsprung's disease, addressing the paucity of evidence for surgical management in this population. METHODS: A single-center retrospective cohort of 30 children (median age: 4 years; range: 1-13) underwent LATSP after failing ≥ 6 months of standardized conservative therapy (dual laxatives + biofeedback). Preoperative evaluation excluded structural/neurogenic etiologies via MRI, barium enema, anorectal manometry, and rectal biopsy confirming the presence of ganglion cells. Primary outcomes included Symptom Severity (SS) scores (0-65) and Bristol Stool Form Scale (BSFS) at 6/24/36 months postoperatively. Complications were graded by Clavien-Dindo. RESULTS: SS scores decreased from 29.1 ± 9.1 preoperatively to 9.2 ± 3.3 at 36 months (P < 0.001). Stool normalization (BSFS Types 4-5) increased from 10% to 73.4% (P < 0.001). Four complications occurred (13.3%): fecal incontinence (n = 2, Grade II), anal bleeding (n = 1, Grade I), and presacral infection (n = 1, Grade IIIb), all resolved without sequelae. LATSP showed superior symptom resolution versus historical Malone ACE cohorts (73.4% vs. 20% at 6 years). CONCLUSIONS: LATSP is a safe and effective intervention for carefully selected children with refractory constipation, providing sustained symptom relief without permanent stomas. Multidisciplinary postoperative protocols are essential for optimal outcomes.