A modified total colonic exclusion for elderly patients with severe slow transit constipation

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Geriatric Medicine

Background:

• Slow transit constipation (STC) significantly impacts elderly patients' quality of life.
• Surgical interventions for severe STC in the elderly require careful evaluation of outcomes.

Purpose of the Study:

• To assess the efficacy and safety of total colonic exclusion with antiperistaltic ileorectal anastomosis (TCE-AIA) in elderly patients with STC.
• To evaluate postoperative outcomes, including symptom scores and patient satisfaction.

Main Methods:

• Retrospective review of elderly patients (>65 years) who underwent TCE-AIA for severe idiopathic STC.
• Postoperative assessment using Wexner constipation score (WCS), gastrointestinal quality of life index (GIQLI), and satisfaction scales.

Main Results:

• 13 elderly patients (mean age 74) underwent TCE-AIA with minimal operative complications.
• Significant improvements observed in WCS (22.8 to 5.4) and GIQLI (93.6 to 120.8) at 6 months post-surgery.
• High patient satisfaction reported, with no cases of fecal incontinence or constipation recurrence; however, four patients developed diversion colitis.

Conclusions:

• TCE-AIA is a feasible and effective surgical option for selected elderly patients suffering from severe STC.
• The procedure offers significant symptom relief and improved quality of life, despite a risk of diversion colitis.