Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders

Abstract

The transverse colonic conduit offers better relief from the symptoms of constipation due to rectal evacuatory dysfunction than the sigmoid conduit.

Use of a continent colonic conduit for treatment of refractory evacuatory disorder following construction of an electrically stimulated gracilis neoanal sphincter

“…In adults, the appendix is often absent or obliterated, and when present it is usually of insufficient calibre to admit a sufficiently large irrigation catheter to allow for the flow rates necessary to achieve colonic and rectal emptying. Stenosis at skin level occurs in 30 per cent of patients who undergo an ACE procedure28, but the rate is much lower in those who have a CCC21. Furthermore, it is not necessary to irrigate the whole colon in patients with outlet obstruction; this would require a larger volume of irrigant, which may reflux into the ileum and give rise to abdominal cramps18.…”

“…. Construction of a CCC from the transverse colon was favoured in later patients as it was shown to be more effective at producing evacuation and symptomatic relief21. A reversed appendicostomy was formed in the remaining patient because the construction of a conduit was precluded owing to dense intra‐abdominal adhesions.…”

The antegrade continence enema procedure and total anorectal reconstruction

“…The comparative functional results appear excellent, although there is a considerable morbidity which, in a small percentage, can be life-threatening [46, 47]. Norman Williams and his group from the London Hospital have used an alternative here, describing a continent colonic conduit with a full-thickness intussuscepted valve, similar to a Kock continent ileostomy [48], with others describing a retubularized ileal segment for this purpose [49]; still others using a retubularized stomach segment [50]. It would appear that antegrade irrigation provides better results than retrograde irrigation [26, 51, 52], although patients should be warned that some symptoms such as bloating—and nausea if there is coincident constipation—may be essentially unaffected.…”

Constipación crónica y cirugía

“…La mayoría de los pacientes (sobre el 90%), que tienen IC responden al tratamiento médico 4 ; Sin embargo, algunos pacientes tienen tal intensidad de síntomas, que no responden a tratamiento médico alguno y llegan a alterar su calidad de vida en forma significativa. En este seleccionado grupo de pacientes la cirugía puede ser la solución definitiva.…”