[Surgical treatment for slow transit constipation: total colectomy and subtotal colectomy]

Although the surgical treatment of slow transit constipation (STC) has been around for over a century, the choice of surgical method is still controversial. Specifically, the two most widely used operations in the world are total colectomy ileorectostomy (TC-IRA) and subtotal colectomy. Subtotal colectomy offers many methods for anastomosis, including ileocecal and cecorectal anastomoses and so on. Cecorectal anastomosis can be divided into two types: isoperistaltic anastomosis and antiperistaltic anastomosis. It is generally believed that total colectomy provides definitive effects but results in more severe postoperative diarrhea, while subtotal colectomy may reduce postoperative diarrhea but potentially increase the risk of constipation recurrence. Most studies of these surgical methods are retrospective small-sample studies with low-quality evidence. This is also one of the reasons for the lack of STC gold standard surgery in clinical practice. This paper discusses the selection of surgical methods for intractable slow transit constipation (STC) based on a review of literature published within the past 10 years, as well as our team's extensive 33-year experience in diagnosing and treating constipation surgically.