Clinical results of colectomy for severe constipation

Abstract

Subtotal colectomy has been performed in 40 patients with severe constipation. Only one patient was male. Five patients (13 per cent) had a history of a serious psychiatric disorder. Twenty-six patients (65 per cent) could not expel a 100-ml air-filled balloon and 19 patients (48 per cent) had electromyographic evidence of abnormal puborectalis contraction during attempted defaecation before operation. Median preoperative passage of 50 radio-opaque markers over 5 days was 16 per cent. Sixteen patients had had a previous anorectal myectomy to exclude Hirschsprung's disease. Initial resections were subtotal colectomy and ileorectal anastomosis (n = 34), caecorectal (n = 5) or ileosigmoid (n = 1) anastomosis. Secondary operations included restorative proctocolectomy and ileal pouch-anal anastomosis (n = 6) and six patients eventually had an ileostomy. Median bowel frequency per week significantly increased after operation (0.3 (range 0-1) preoperatively to 21 (range 2-70) postoperatively, P less than 0.005), the percentage of patients with abdominal pain fell after operation from 93 to 39 per cent but symptoms of abdominal distension remained the same (86 per cent preoperatively and 82 per cent postoperatively).

Long-Term Results of Subtotal Colectomy with Antiperistaltic Cecoproctostomy

“…Reports on the surgical treatment of chronic constipation (CC), which is one of the main indications of subtotal colectomy with CRA, yield conflicting results. 8,[11][12][13]17 We recently reported very good results, in terms of functional outcome and complications, in patients who underwent this technique for CC caused by colonic inertia. 17 This experience is similar to that reported by others, 8,13 although Preston et al 11 noted a higher postoperative rate of constipation, and Todd 12 reported frequent cecal distension.…”

“…[2][3][4][5] Subtotal colectomy with cecorectal anastomosis (CRA) has also been performed for idiopathic megacolon, 6,7 and more recently, for slow transit constipation. [8][9][10][11][12][13] The alternative to this procedure would have been an ileoproctostomy, which is associated with unacceptable morbidity and mortality. 14,15 Theoretically, there are advantages in sparing the ileocecal junction and cecum after removal of the remaining part of the colon; however, these advantages do not always prevail in clinical practice 9 and, for diseases such as chronic constipation, some surgeons prefer to perform ileorectostomy.…”

Indikationen und Therapieoptionen aus chirurgischer Sicht bei der Kolontransitstörung

“…Bei einzelnen Patienten kann nach totaler Kolektomie und bei Rezidivobstipation die Anlage eines ileoanalen Pouches individuell in Betracht gezogen werden; dieser wurde aufgrund der seltenen Notwendigkeit an kleinen Fallzahlen bei der STC untersucht und weist teilweise gute Therapieerfolge auf [29][30][31].…”

Die schwere idiopathische Obstipation Pathophysiologie, Diagnose und Therapie

“…W~ihrend Yoshioka et al [68] keine funktionellen Unterschiede zwischen Patienten mit einer z6korektalen und solchen mit einer fleorektalen Anastomose rinden konnten, berichten andere Autoren [11,48] …”