Surgical options to treat constipation: A brief overview

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Physiology

Background:

• Intractable chronic constipation necessitates a thorough diagnostic approach.
• Conservative management is paramount, with newer pharmacological agents showing promise.
• Surgical intervention is considered only after exhausting conservative and less invasive options.

Purpose of the Study:

• To provide a colorectal surgeon's perspective on diagnosing and treating chronic constipation.
• To review the mechanisms, diagnostic tools, and treatment strategies for chronic constipation.
• To clarify the role of surgery in the context of chronic constipation management.

Main Methods:

• Exclusion of structural disorders and extracolonic causes.
• Evaluation of conservative treatment options, including new drugs like prucalopride and linaclotide.
• Consideration of surgical interventions, prioritizing less invasive procedures like sacral nerve modulation (SNM) before colectomy.

Main Results:

• New drugs represent a significant advancement in chronic constipation treatment.
• Sacral nerve modulation (SNM) should be attempted before colectomy.
• Surgery is not indicated for gastrointestinal dysmotility syndrome (GID) or psychiatric disorders; colectomy is not for pain/bloating.

Conclusions:

• Chronic constipation management requires a stepwise approach, prioritizing conservative and less invasive methods.
• Surgical treatment for chronic constipation is exceptional and should be carefully considered.
• A 'too long gut' (dolichocolon) alone is not an indication for surgery.