Is all constipation congenital megacolon? What is the difference between congenital megacolon and megacolon homozygosity? Do they both require surgery? Congenital megacolon can cause constipation, but not all constipation is caused by congenital megacolon. In typical congenital megacolon, there is a loss of ganglion cells in the distal intestinal canal (starting from the rectum and going retrograde to the proximal end), while in megacolon homozygosity and other causes of constipation, there are ganglion cells in the intestinal canal, but the number and function of ganglion cells are impaired, and both manifest as constipation. In principle, surgery is preferred for typical congenital megacolon, while conservative treatment is preferred for megacolon homozygosity, and surgery is considered if it fails. What tests are needed to confirm the diagnosis of congenital megacolon? Is a barium enema sufficient for diagnosis? Generally, congenital megacolon and megacolon homoeopathy require: 1 barium enema + 24-hour review, 2 rectal mucosal biopsy with acetylcholinesterase staining, 3 rectal anal canal manometry, these three tests to confirm the diagnosis, and some children even need whole gastrointestinal tract passage time and laparoscopic whole bowel wall biopsy to confirm the diagnosis. The barium enema alone is likely to lead to errors in preoperative evaluation, resulting in treatment and surgical failure What are the conservative treatment modalities for congenital megacolon? Defecation training, i.e., using induction methods to guide the child to defecate at regular intervals every day. Rectal canal dilation: i.e. anal dilation for 15 to 30 minutes per day depending on the age of the child. If necessary, break rectal irrigation with a small amount of laxative medication, but it should not be used for a long time. Who can be treated conservatively? Can all short-segment types be treated conservatively? For children with congenital megacolon of ultra-short segment type and those who are considered to have megacolon homozygosity, conservative treatment can be implemented first on a trial basis, and if regular conservative treatment is still not effective for 3-6 months, surgery will be considered. In short-segment type, conservative treatment is often ineffective or effective at first, but constipation reappears later, so surgery is recommended. Can congenital megacolon be cured by conservative treatment? Is it possible to keep treating it conservatively? Some children with congenital megacolon and megacolon homozygosity can be completely cured by conservative treatment, but if the results are still poor after regular treatment, surgery is recommended. Long-term conservative treatment is not recommended because prolonged constipation can lead to degeneration of the proximal intestinal ganglion cells, resulting in more extensive resection of the intestinal canal, and long-term use of laxative drugs can cause degeneration of the intestinal epithelial cells. Can surgical treatment completely cure it? Surgery consists of removing the diseased intestinal canal and reestablishing the bowel function, and there are many factors that affect it. The vast majority of children can achieve controlled bowel movements without feces and without affecting their development, but there are still a few children who are forced to have a permanent artificial anus for various reasons. Is there an age requirement for radical surgery? Do I have to wait until I am half a year old to have surgery? Due to the improvement of modern surgical skills, nutrition and management, the age requirement for surgery is not too high. The risk of surgery will be greatly reduced. At present, due to advances in surgery, most of the surgeries can be done laparoscopically. Among the giant colon surgeries that I have done since 2011, open surgery is very rare, and often there are various special circumstances that require open surgery (e.g. history of previous surgery, those who have undergone fistula surgery). What are the advantages of minimally invasive treatment? Is the treatment as effective as open surgery? The advantages of minimally invasive treatment are: 1) aesthetically pleasing, with almost no wound to be found after six months; 2) fast recovery of the child; 3) low possibility of re-adhesion of the abdominal cavity; 4) no complication of wound dehiscence. The treatment effect is the same as that of open abdomen. However, due to the high technical requirements and the low field of vision, other specific complications may occur intraoperatively. Is it possible to cure it in one operation? Why do some children need a second or third surgery? Most of the short-segmented, common type of megacolon can be cured together. However, if the diagnosis of the child is unclear, sometimes it is necessary to perform multiple biopsies to clarify the extent of the lesion before a second surgery is needed. If various surgical complications occur after surgery, such as wound dehiscence, anastomotic fistula, intestinal bleeding, perforation, necrosis, etc., reoperation is required and often a fistula is required depending on the situation. Radical megacolon surgery is a very major operation, and such children often have malnutrition, which triggers impaired recovery after surgery. When is it necessary to perform a fistula first rather than a direct radical surgery? The child is too debilitated to undergo a major radical surgery and requires a fistula. It is the most common way to spread the risk of surgery and manage surgical comorbidities. At what point in recovery can I have a second surgery after having a fistula? Usually after 3-6 months, weight gain and improved nutrition allow for surgery Is it risky for the child to have a second surgery? How does it compare to direct radical surgery? The risk of surgery varies depending on the child’s condition, but it is often complicated children who need a second surgery, and the initial surgery is often followed by abdominal adhesions, so it is more difficult to manage, but overall there is no difference in outcome.