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Long-term results of surgery for chronic constipation
D C Nyam1, J H Pemberton, D M Ilstrup
1Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Diseases of the Colon and Rectum
|March 1, 1997
Summary
Physiologic testing accurately identifies patients with severe chronic constipation for surgery. Ileorectostomy (IRA) surgery is safe and effective for relieving constipation, improving quality of life.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- Anorectal physiologic testing advances understanding of defecation and chronic constipation.
- Severe idiopathic chronic constipation presents diagnostic and therapeutic challenges.
Purpose of the Study:
- To evaluate colonic transit and pelvic floor function in patients with severe chronic constipation.
- To identify surgical candidates for aggressive intervention.
Main Methods:
- 1,009 patients underwent colonic transit and pelvic floor function tests.
- Patients were categorized based on findings: slow-transit constipation (STC), pelvic floor dysfunction (PFD), or both.
- Surgical intervention (abdominal colectomy and ileorectostomy - IRA) or conservative management was applied accordingly.
Main Results:
- 74 patients underwent surgery (IRA), 68 women, mean age 53, mean follow-up 56 months.
- No operative mortality; complications included small-bowel obstruction (9%) and prolonged ileus (12%).
- 97% patient satisfaction and 90% improved quality of life; no difference in outcomes between STC alone vs. STC with PFD.
Conclusions:
- Physiologic evaluation reliably identifies severe chronic constipation patients who benefit from surgery.
- Ileorectostomy (IRA) is a safe and effective procedure for prompt and sustained constipation relief.