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Colectomy for refractory constipation.
Dennis Raahave1, Franck Bjørn Loud, Elsebeth Christensen
1Department of Surgery, Copenhagen University North Sealand Hospital, Helsingore, Denmark. dera@noh.regionh.dk
Scandinavian Journal of Gastroenterology
|April 23, 2010
Summary
Colectomy surgery improved constipation symptoms like pain and bloating, but increased colonic transit time (CTT) and faecal load. Patients reported high satisfaction despite risks of complications and further operations.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Constipation refractory to conservative therapy presents a significant clinical challenge.
- Surgical intervention, specifically colectomy, is considered for severe, intractable cases.
Purpose of the Study:
- To evaluate colectomy outcomes for refractory constipation, including complications, functional results, and patient satisfaction.
- To compare colonic transit time (CTT), faecal load, and colon length in operated versus non-operated patients.
Main Methods:
- A cohort of 35 patients (30 women, 5 men) with refractory constipation underwent colectomy.
- Clinical and physiological investigations were performed, with a control group of 44 healthy individuals.
Main Results:
- Colectomy (hemicolectomy or subtotal colectomy) improved pain and defecation patterns, with 1-4 daily bowel movements without uncontrolled diarrhea.
- Operated patients showed significantly increased mean CTT (65.0 h) and faecal load compared to non-operated patients (37.9 h) and controls (24.75 h).
- Increased colon length in operated patients correlated with higher CTT and aggravated symptoms; histology revealed degenerative changes.
Conclusions:
- Segmental or subtotal colectomy offers significant symptom relief for refractory constipation but carries risks.
- Postoperative complications and the need for further surgery are notable concerns.
- Colectomy leads to increased CTT, faecal load, and colon length, impacting long-term outcomes.
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