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Related Experiment Videos

Constipation: another indication for restorative proctocolectomy.

K B Hosie1, W A Kmiot, M R Keighley

  • 1Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.

The British Journal of Surgery
|July 1, 1990
PubMed
Summary
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Restorative proctocolectomy with ileoanal anastomosis offers a viable alternative to a permanent stoma for severe functional bowel disorders. Despite complications, most patients reported improved quality of life and symptom relief.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Surgical Innovation

Background:

  • Functional bowel disorders, including severe constipation and incontinence, significantly impair quality of life.
  • Colectomy for slow transit constipation or megarectum/megacolon can lead to persistent or new functional deficits.
  • A permanent stoma is often the only alternative for refractory cases.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of restorative proctocolectomy and ileoanal anastomosis in patients with severe functional bowel disorders.
  • To assess symptom improvement, quality of life, and complication rates in this patient cohort.

Main Methods:

  • Retrospective review of 13 patients undergoing restorative proctocolectomy and ileoanal anastomosis.
  • Patients presented with recurrent constipation post-colectomy or constipation/incontinence due to megarectum/megacolon.

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  • Outcomes assessed included defaecation frequency, incontinence, soiling, and overall patient satisfaction.

    • Main Results:

    • 11 out of 13 patients (85%) found the procedure worthwhile, reporting symptom improvement and enhanced quality of life.
    • Mean daytime defaecation frequency was 4.8 times, with 1.2 times nocturnally; no frank incontinence was reported.
    • Night-time soiling occurred in six patients; two patients required conversion to an ileostomy due to complications or poor function.

    Conclusions:

    • Restorative proctocolectomy and ileoanal anastomosis can be a beneficial option for carefully selected patients with severe functional bowel disorders refractory to other treatments.
    • While associated with a high complication rate, the procedure offers significant improvements in quality of life for the majority of patients.
    • Patient selection and management of potential complications are crucial for optimizing outcomes.