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Slow-transit constipation: evaluation and treatment.

Shing Wai Wong1, David Z Lubowski

  • 1Department of Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.

ANZ Journal of Surgery
|May 15, 2007
PubMed
Summary
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Slow-transit constipation, a delay in colonic stool movement due to myopathy or neuropathy, may require surgery for treatment-resistant cases. Subtotal colectomy with ileorectal anastomosis is preferred, with less invasive options available.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Physiology

Background:

  • Slow-transit constipation involves delayed stool passage in the colon, stemming from myopathy or neuropathy.
  • Constipation severity varies, potentially leading to a complete halt in bowel movements.

Purpose of the Study:

  • To outline diagnostic and therapeutic strategies for slow-transit constipation.
  • To emphasize the importance of comprehensive preoperative assessment for surgical candidates.

Main Methods:

  • Diagnostic evaluation includes radiopaque marker studies, radioisotope transit studies, and intraluminal tests like manometry.
  • Treatment involves laxatives, biofeedback, and in refractory cases, surgical intervention.
  • Preoperative assessment includes small bowel motility evaluation, obstructed defecation identification, and psychological assessment.

Related Experiment Videos

Main Results:

  • Most patients respond to laxatives, but a subset requires advanced therapies.
  • Subtotal colectomy with ileorectal anastomosis is the surgical procedure of choice.
  • Less invasive surgical options like laparoscopic ileostomy and sacral nerve stimulation are also considered.

Conclusions:

  • Comprehensive preoperative assessment is crucial for patients with slow-transit constipation undergoing surgery.
  • Subtotal colectomy with ileorectal anastomosis is the standard surgical approach for severe, refractory cases.
  • Emerging less invasive surgical techniques offer alternative management options.