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Videoproctography in selecting patients with constipation for colectomy.

G T Sunderland¹, F W Poon, J Lauder

¹Department of Surgery, Royal Infirmary, Glasgow, United Kingdom.

Diseases of the Colon and Rectum

|March 1, 1992

Summary

Colectomy for severe constipation shows poor results if outlet obstruction is present. Combining videoproctography and marker studies accurately identifies patients with slow-transit constipation who benefit from surgery.

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Area of Science:

Gastroenterology
Colorectal Surgery

Background:

Colectomy for constipation based solely on delayed colonic markers yields disappointing outcomes.
Failure may stem from undiagnosed rectal outlet obstruction preventing evacuation.

Purpose of the Study:

To predict favorable colectomy outcomes by excluding patients with outlet obstruction.
To identify true idiopathic slow-transit constipation.

Main Methods:

Utilized videoproctography and transit marker studies in 228 constipated patients.
Assessed proctogram for normal evacuation of liquid barium.
Identified patients with delayed colonic markers.

Main Results:

111 patients (38%) had normal proctograms; 21 (19%) of these had delayed markers.

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18 patients underwent colectomy and ileorectal anastomosis.

16 of 18 patients (89%) were symptom-free after two years.

Conclusions:

True idiopathic slow-transit constipation is rare.
Colectomy with ileorectal anastomosis offers excellent outcomes when constipation is due to slow transit and not outlet obstruction.