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Surgery for constipation

E S Hughes, F T McDermott, W R Johnson

    The Australian and New Zealand Journal of Surgery
    |April 1, 1981
    PubMed
    Summary
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    Colectomy and anastomosis can effectively treat severe constipation in adults, including functional constipation and Hirschsprung's disease. While generally successful, some patients may experience complications like adhesions or rectal inertia.

    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Pediatric Surgery

    Background:

    • Constipation significantly impacts quality of life, necessitating surgical intervention in refractory cases.
    • Surgical options for severe constipation include colectomy and anastomosis, with varying outcomes.
    • Four patient groups were identified: functional constipation, adult megacolon, megasigmoid, and Hirschsprung's disease.

    Purpose of the Study:

    • To evaluate the long-term outcomes of colectomy and anastomosis for severe constipation.
    • To assess the efficacy of surgical interventions across different etiologies of constipation.
    • To identify potential complications associated with colectomy for constipation.

    Main Methods:

    • A retrospective review of 27 patients undergoing partial or complete colectomy and anastomosis over 30 years.

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  • Patients were categorized into four groups based on the cause of constipation.
  • Outcomes assessed included functional results and complication rates.

    • Main Results:

    • Seventeen patients with functional constipation or adult megacolon showed good functional results, but 41% required reoperation for adhesions, and 2 needed permanent ileostomy.
    • Five patients with megasigmoid experienced good outcomes after sigmoid colon resection.
    • Five patients with Hirschsprung's disease responded well to pull-through resection or colectomy and anastomosis.

    Conclusions:

    • Colectomy and anastomosis are effective for severe constipation, particularly in megasigmoid and Hirschsprung's disease.
    • While functional outcomes are often good, surgeons must be aware of potential complications like adhesions and rectal inertia.
    • Tailoring surgical approach based on the specific cause of constipation is crucial for optimal results.