Is total colectomy the right choice in intractable slow-transit constipation?

Searching for a definition for pharmacologically refractory constipation: A systematic review

“…Surgery for constipation would normally be carried out on patients with the most refractory symptoms. In this review, 48 studies involving surgical treatment of constipation were included: 32 of which were surgical series, 6,[14][15][16]21,[26][27][28][29][30][32][33][34][35]37,39,41,43,45,46,48,49,[51][52][53][54]56,[58][59][60]63 while 16 were studies on colonic tissue obtained at colectomy. [8][9][10][11][17][18][19][20]22,23,25,31,36,44,62,66 Seven of the pathological series came from one center 10,11,…”

Percutaneous endoscopic colostomy for adults with chronic constipation: Retrospective case series of 12 patients

“…Subtotal and segmental colectomy often fail to improve symptoms, which might be due to the presence of a more generalized motility disorder or coexisting pelvic floor disorders . After total colectomy, functional outcomes vary; constipation persists in 8%‐30% of patients . Others have reported better outcomes with 79%‐90% of patients having satisfactory results, see Table .…”

Long-term Follow-up of the Jinling Procedure for Combined Slow-Transit Constipation and Obstructive Defecation

“…33,34 Total abdominal colectomy with ileorectal anastomosis represents the procedure of choice in patients with pure slow-transit constipation and relieves constipation in most patients. 35 However, a significant proportion continues to experience other symptoms, particularly urgency and diarrhea. According to Ternent et al, 2 studies have shown that, postoperatively, 41% of patients are affected with abdominal pain, 65% with bloating, 29% require assistance with bowel movements, 47% have some incontinence to gas or liquid stool, and 46% may be affected with diarrhea.…”