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Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation
Fareed Iqbal1, Valerie van der Ploeg, Franklin Adaba
1Fareed Iqbal, MBChB, BMedSci (Hons), MRCS (Eng), Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Valerie Van der Ploeg, MSc, Sir Alan Department of Physiology, St Mark's Hospital, London, England. Franklin Adaba, MRCS (Eng), MBBS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Alan Askari, MBChB, MRCS (Eng), Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital, London, England. Jamie Murphy, PhD, MB ChirB, FRCS, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Paddington, London, England. R. John Nicholls, MS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Carolynne Vaizey, MBBS, FCS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.
Ostomy surgery for severe constipation can negatively impact quality of life, but most patients remain satisfied. Patients should be informed about potential psychological effects and complication risks associated with ostomy procedures.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Quality of Life Research
Background:
- Severe, chronic constipation significantly impacts patient well-being.
- Ostomy surgery is a potential, albeit last-resort, treatment option for refractory cases.
Purpose of the Study:
- To evaluate the psychosocial experiences and health-related quality of life (HRQoL) in patients who have undergone ostomy surgery for severe, chronic constipation.
Main Methods:
- Retrospective review of clinical notes and prospective data collection using validated questionnaires (City of Hope Ostomy Quality of Life, SF-36, HADS).
- Data sourced from a tertiary referral center's ostomy archive and hospital episode statistics.
- Postal questionnaires were administered to assess outcomes.
Main Results:
- Twenty-four patients (75% female, median age 44) underwent ileostomy or colostomy.
- 58.3% of patients responded to questionnaires, reporting negative impacts on physical and social well-being domains.
- Despite psychological morbidity (86%) and a 20% reoperation rate, over 70% expressed satisfaction with their quality of life.
Conclusions:
- Ostomy surgery is a viable last-resort option for selected patients with severe chronic constipation.
- Patients require comprehensive counseling regarding potential adverse effects on HRQoL and complication risks.
- An algorithmic approach to patient selection and management is recommended.
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