Invasive tests [such as colon manometry (CM)] and surgeries [such as diverting ostomy (DO)] may be needed to diagnose and treat pediatric functional constipation (FC) properly. Following DO, researchers assessed CM’s ability to guide future surgical procedures. Osteotomized children with medically intractable FC were included. Institutional Review Board approval was obtained for this retrospective investigation. Demographics and CM characteristics [high amplitude propagating contractions (HAPCs)] were monitored. Response to ostomy closure was considered successful if there was no need for additional surgery following ostomy closure, and an increase in CM from pre-ostomy levels was considered positive. A CM-guided ostomy closure algorithm was developed based on prior findings. They used an algorithm to assess the importance of CM in predicting response to ostomy closure in relation to demographics, ostomy indication, and CM improvement.

A total of 60 children, with a median age of 7.1 years (range: 0.15–23.6 years), and a gender split of 50:50, underwent ostomy surgery for FC. Ostomy was closed in 30 patients and deemed successful in 23 of 30. Out of the 60 patients, 42 had CM done before their ostomies were made, and another 29 had it done before their ostomies were closed. Investigators could not find any correlation between ostomy outcome and demographic variables such as age, gender, weight, imaging investigations, follow-up duration, ostomy duration, HAPC use, or CM progression. Ostomy indication of antegrade colonic enemas (ACE) failure was associated with a negative reaction (P=0.026), but algorithm-guided ostomy closure was associated with a positive response (P=0.03).

Selected children with medically refractory FC can benefit from DO, and most see an improvement in colon motility due to this treatment. CM can successfully guide both the timing and the method of ostomy closure. Larger studies are needed to validate the findings further.