[Surgical therapy of severe idiopathic constipation]

Because surgery for severe idiopathic constipation is seldom indicated, careful preoperative evaluation is mandatory (colonoscopy with biopsy, whole gut transit study, evacuation proctography, electromyography, anorectal manometry) in order to classify chronic idiopathic constipation into two broad functional groups: "outlet obstruction" and "colonic inertia". Subtotal colectomy with ileorectal anastomosis yields a good outcome in 70-100% of cases with slow transit constipation. In contrast, there is a broad spectrum of surgical techniques in the treatment of outlet obstruction, among which anorectal myectomy seems to be appropriate for selected patients with good results in 54-92%. Our own small surgical experience with chronically constipated patients (n = 4, 1987-1989) is discussed and compared with the results in the literature.