Surgery for constipation

Patients with intractable chronic constipation should be evaluated with physiologic tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried excessively. If surgery is indicated subtotal colectomy with IRA is the treatment method of choice. However, segmental resection may be a good option for isolated megasigmoid, sigmoidocele or recurrent sigmoid volvulus. In general patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection as they tend to have poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist even if surgery normalizes bowel frequency. Patients with associated problems may be better served by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is no option to treat pain and/or abdominal bloating.