{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:50:28Z","timestamp":1791355828028,"version":"4.3.1"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K08DK133673"],"award-info":[{"award-number":["K08DK133673"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R03DK144289"],"award-info":[{"award-number":["R03DK144289"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic idiopathic constipation (CIC) is a common childhood gastrointestinal disorder that substantially affects quality of life and healthcare utilization. Most children are managed successfully with dietary modification, behavioral interventions, and medical therapies. However, many patients experience severe or refractory symptoms that necessitate surgical intervention. We sought to identify patient factors associated with progression to surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective multi-institutional cohort study was performed of children (&amp;lt;18 years of age) who presented to a pediatric surgeon for chief complaint of CIC between 2017 and 2022. The primary outcome was major surgical intervention for the management of CIC. Patient characteristics, including demographic characteristics and clinical variables, were queried, and multivariable logistic regression was used to assess the association between patient factors and surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 188 patients were included. Forty patients (21.3%) had a major operation for CIC, including antegrade continence enema (ACE) procedures, intestinal resection, and intestinal diversion. Patients who underwent surgery were older at the time of first visit (mean 9.12 vs. 4.64 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In multivariable logistic regression, older age at first pediatric surgery visit was independently associated with surgical intervention. Each additional year of age was associated with approximately 30% higher adjusted odds of surgical intervention (adjusted OR 1.29, 95% CI 1.14\u20131.48;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Sex, race, ethnicity, insurance type, and neurodiversity were not significantly associated with surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Approximately one in five patients referred to a pediatric surgeon for refractory constipation undergo surgical intervention to treat constipation. Older age at presentation was associated with surgical treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1955197","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:52Z","timestamp":1791352732000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns and predictors of surgical management in pediatric chronic idiopathic constipation"],"prefix":"10.3389","volume":"14","author":[{"given":"Prisca C.","family":"Obidike","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katlyn A.","family":"Droke","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant F.","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecily A.","family":"Wainstein","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor C.","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb","family":"Hemmer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bea B.","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Texas Children\u2019s Hospital","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy L.","family":"Rialon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Texas Children\u2019s Hospital","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily S.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of Virginia","place":["Charlottesville, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e01029","DOI":"10.14309\/ctg.0000000000001029","article-title":"Global prevalence of functional constipation across all age groups according to Rome II\u2013IV criteria, 1999\u20132025: a systematic review and meta-analysis","volume":"17","author":"Youn","year":"2026","journal-title":"Clin Transl Gastroenterol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1097\/00005176-200411000-00002","article-title":"Childhood constipation: is there new light in the tunnel?","volume":"39","author":"Benninga","year":"2004","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.jpeds.2008.07.060","article-title":"Health utilization and cost impact of childhood constipation in the United States","volume":"154","author":"Liem","year":"2009","journal-title":"J Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1038\/s41398-026-04138-8","article-title":"Constipation is associated with an increased risk of depression: a systematic review and meta-analysis of observational studies","volume":"16","author":"Ren","year":"2026","journal-title":"Transl Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0239092","DOI":"10.1371\/journal.pone.0239092","article-title":"Behavioral and emotional problems in adolescents with constipation and their association with quality of life","volume":"15","author":"Rajindrajith","year":"2020","journal-title":"PLoS One"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e156","DOI":"10.1542\/peds.2009-1009","article-title":"Long-term prognosis for childhood constipation: clinical outcomes in 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Nutr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"089","DOI":"10.1055\/s-0037-1609023","article-title":"Surgical management of idiopathic constipation in pediatric patients","volume":"31","author":"Cheng","year":"2018","journal-title":"Clin Colon Rectal Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1053\/j.gastro.2005.08.063","article-title":"Childhood functional gastrointestinal disorders: child\/adolescent","volume":"130","author":"Rasquin","year":"2006","journal-title":"Gastroenterology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3390\/children11070768","article-title":"Exploring diagnostic priorities: the role of colonic manometry in evaluating pediatric patients with intractable idiopathic constipation prior to sacral nerve stimulation","volume":"11","author":"Dorfman","year":"2024","journal-title":"Children"},{"key":"B13","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jpedsurg.2022.09.024","article-title":"Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery","volume":"58","author":"Smith","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1016\/j.jpedsurg.2022.04.008","article-title":"The presence of a neurodiverse disorder is associated with increased use of antegrade enema therapy in children with severe constipation: a study from the pediatric colorectal and pelvic learning consortium (PCPLC)","volume":"57","author":"Short","year":"2022","journal-title":"J Pediatr Surg"}],"container-title":["Frontiers in 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