Role of surgical treatment in patients with severe constipation

Surgery for severe constipation is necessary in only a small minority of patients. For those patients with a normal diameter colon, the standard procedure remains a colectomy with ileorectal anastomosis. Although the bowel frequency is usually improved, a third of patients experience post-operative diarrhoea, 10% remain constipated, and two thirds continue to experience some pain. Psychological evaluation is essential preoperatively. In patients with an idiopathic megarectum or megacolon, the best operation is less well defined. In those patients with a moderately dilated rectum or colon, a colonic resection offers the best results with a low morbidity. In those patients with a widely dilated rectum, a Duhamel procedure is reasonable but there is a higher morbidity and the results are less uniformly satisfactory.