Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Outcomes

Background:

• Patient selection is critical for total abdominal colectomy and ileorectal anastomosis (TAC/IRA) in refractory constipation.
• Differentiating between pure slow transit constipation (STC) and STC with obstructive defecation (STC + OD) is important for surgical planning.

Purpose of the Study:

• To compare short- and long-term outcomes of TAC/IRA in patients with pure STC versus STC + OD.
• To evaluate patient satisfaction following TAC/IRA in these two distinct patient groups.

Main Methods:

• Retrospective review of 144 patients undergoing TAC/IRA for constipation (1999-2010).
• Patients categorized into STC (n=103) or STC + OD (n=41) groups based on testing and clinical assessment.
• Short-term outcomes, operative variables, and long-term functional outcomes (bowel movements, medication use, satisfaction) assessed via chart review and telephone survey.

Main Results:

• No significant difference in short- or long-term functional outcomes between STC and STC + OD groups (5% in each group required subsequent ileostomy).
• Patient satisfaction rates were high and equivalent in both groups (89% vs. 85%, p=0.7).
• Laparoscopic and open surgical approaches were utilized.

Conclusions:

• Total abdominal colectomy and ileorectal anastomosis can yield equivalent long-term results for carefully selected patients with STC and STC + OD.
• TAC/IRA is a viable surgical option for both patient profiles with comparable functional outcomes and satisfaction.