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[Slow Transit Constipation].

Marco Sailer1

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Zentralblatt Fur Chirurgie
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Summary
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Slow transit constipation, a rare condition in middle-aged women, requires excluding other causes. Subtotal colectomy offers over 80% success for persistent symptoms.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Slow transit constipation (STC) is a rare functional gastrointestinal disorder predominantly affecting middle-aged women.
  • Its pathophysiology and etiology are not fully understood, suggesting a multifactorial pathogenesis.
  • Diagnosis requires excluding various organic, iatrogenic, and functional causes through an interdisciplinary approach.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for slow transit constipation.
  • To emphasize the importance of excluding differential diagnoses and performing physiological investigations.
  • To discuss surgical options and outcomes for refractory STC.

Main Methods:

  • Differential diagnosis involving exclusion of mechanical, drug-induced, metabolic, neurological, and psychiatric causes.
  • Gastrointestinal physiological investigations, including colonic transit time measurement.
  • Exclusion of pangastrointestinal transit delay, pelvic floor dysfunction, and irritable bowel syndrome.

Main Results:

  • Conservative management is the initial treatment of choice for STC.
  • Subtotal colectomy with ileorectal anastomosis is the standard surgical procedure for refractory cases.
  • With strict patient selection, subtotal colectomy achieves over 80% success rates.
  • Potential postoperative complications include small bowel obstruction, incontinence, and persistent symptoms.

Conclusions:

  • A comprehensive diagnostic workup is essential for managing slow transit constipation.
  • Conservative measures should be tried first, with surgery considered for persistent or progressive disease.
  • Subtotal colectomy is an effective treatment for selected patients with STC, offering high success rates despite potential complications.