Resection of the extravertebral portion of the filum terminale with posterior internal sphincterotomy, a surgical technique for managing chronic constipation and encopresis in children

Abstract

Background: Constipation is a frequent digestive complaint in children and can be refractory to treatment in approximately 30% of patients. Etiologies that are linked to this pathology include rectal hyporeflexia, achalasia of the internal anal sphincter, and neurological disorders such as tight filum terminale syndrome. For these conditions, the resection of the extra vertebral portion of the filum terminale and posterior internal sphincterotomy has shown potential benefits for management. Methods: We conducted a cross-sectional descriptive study between 2020 and 2021. We collected data from 219 children's medical records at Saint Petersburg State Pediatric Hospital, Russia, that fulfilled the diagnostic criteria and were managed surgically. We analyze their demographic characteristics and clinical outcomes. Results: We found that 83.6% (n=183) of participants showed improvement, while 16.4% (n=36) experienced no improvement or complications. Patients in the 16-17 age group had the highest proportion of lack of improvement or complications, with 12.8% and the 1-5 age group exhibited a 100% improvement rate. Male patients exhibited a decreased probability of experiencing complications in the postoperative period.Conclusion: Resection of the extravertebral portion of the filum terminale with posterior internal sphincterotomy has shown potential benefits in managing chronic constipation and encopresis in pediatric patients. However, further research is warranted to investigate the benefits and risks of this surgical technique.