Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2013

01-06-2013 | Original Article

Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation

Authors: Avraham Reshef, Patricia Alves-Ferreira, Massarat Zutshi, Tracy Hull, Brooke Gurland

Published in: International Journal of Colorectal Disease | Issue 6/2013

Login to get access

Abstract

Background

Patient selection is a crucial step when considering total abdominal colectomy and ileorectal anastomosis (TAC/IRA) for refractory constipation.

Purpose

This study aimed to evaluate the results of short- and long-term outcomes for patients with pure slow transit constipation (STC) compared to those with slow transit and features of obstructive defecation (STC + OD).

Methods

This study included all patients who underwent TAC/IRA for constipation from 1999–2010. Patients were divided into two groups: group A (STC) and group B (STC + OD) based on abnormal physiology or motility testing in addition to the surgeon's clinical impression of symptomatic obstructive defecation. Demographics, operative variables, and short-term outcomes were collected by retrospective chart review and were compared between groups. Long-term functional outcomes were assessed by telephone survey. This included: number of bowel movements, use of laxatives, antidiarrheal medications, and surgery satisfaction. Validated questionnaires were collected postoperatively.

Results

One hundred forty-four patients (143 females; mean age, 40 (18–68) years old) underwent TAC/IRA by either laparoscopic (63 (44 %)) or open (81 (56 %)) techniques. One hundred three patients had pure STC and 41 had STC + OD. Four patients underwent TAC with end ileostomy at first procedure. Seven patients underwent surgery after a trial of diverting ileostomy. One patient died unexpectedly, 2 days after uneventful surgery. Median follow-up was 43 (IQR, 16–75) months. Five (5 %) patients in group A and two (5 %) in group B underwent subsequent ileostomy for poor functional outcomes. Eighty-eight (68 %) patients were available by telephone. Short- and long-term outcomes were equivalent in both groups as well as patient satisfaction (89 vs. 85 %, p = 0.7).

Conclusions

Total abdominal colectomy can be offered to selective patients with slow transit constipation and obstructive defecation with equivalent long-term results.
Literature
1.
Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99(4):750–759PubMedCrossRef
2.
Pemberton JH, Rath DM, Ilstrup DM (1991) Evaluation and surgical treatment of severe chronic constipation. Ann Surg 214(4):403–411, discussion 411-3PubMedCrossRef
3.
Webster C, Dayton M (2001) Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surg 182(6):639–644PubMedCrossRef
4.
Gurland B, Alves-Ferreira PC, Sobol T, Kiran RP (2010) Using technology to improve data capture and integration of patient-reported outcomes into clinical care: pilot results in a busy colorectal unit. Dis Colon Rectum 53(8):1168–1175PubMedCrossRef
5.
Fazio VW, O'Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230(4):575–584, discussion 584–586PubMedCrossRef
6.
Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRef
7.
Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532PubMedCrossRef
8.
Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL (2008) The constipation severity instrument: a validated measure. Dis Colon Rectum 51(2):162–172PubMedCrossRef
9.
Kalbassi MR, Winter DC, Deasy JM (2003) Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum 46(11):1508–1512PubMedCrossRef
10.
Hosie KB, Kmiot WA, Keighley MR (1990) Constipation: another indication for restorative proctocolectomy. Br J Surg 77(7):801–802PubMedCrossRef
11.
Preston DM, Hawley PR, Lennard-Jones JE, Todd IP (1984) Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease). Br J Surg 71(7):547–552PubMedCrossRef
12.
Thakur A, Fonkalsrud EW, Buchmiller T, French S (2001) Surgical treatment of severe colonic inertia with restorative proctocolectomy. Am Surg 67(1):36–40PubMed
13.
Knowles CH, Scott M, Lunniss PJ (1999) Outcome of colectomy for slow transit constipation. Ann Surg 230(5):627–638PubMedCrossRef
14.
Zutshi M, Hull TL, Trzcinski R, Arvelakis A, Xu M (2007) Surgery for slow transit constipation: are we helping patients? Int J Colorectal Dis 22(3):265–269PubMedCrossRef
15.
Platell C, Scache D, Mumme G, Stitz R (1996) A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation. Aust N Z J Surg 66(8):525–529PubMedCrossRef
16.
Ghosh S, Papachrysostomou M, Batool M, Eastwood MA (1996) Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol 31(11):1083–1091PubMedCrossRef
17.
Hassan I, Pemberton JH, Young-Fadok TM, You YN, Drelichman ER, Rath-Harvey D et al (2006) Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg 10(10):1330–6, discussion 1336-7PubMedCrossRef
18.
Nyam DC, Pemberton JH, Ilstrup DM, Rath DM (1997) Long-term results of surgery for chronic constipation. Dis Colon Rectum 40(3):273–279PubMedCrossRef
19.
Bernini A, Madoff RD, Lowry AC, Spencer MP, Gemlo BT, Jensen LL et al (1998) Should patients with combined colonic inertia and nonrelaxing pelvic floor undergo subtotal colectomy? Dis Colon Rectum 41(11):1363–1366PubMedCrossRef
20.
Wong PW, Kadakia S (1999) How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Postgrad Med 106(6):199–200, 203-4, 207-10PubMedCrossRef
21.
Lubowski DZ, Chen FC, Kennedy ML, King DW (1996) Results of colectomy for severe slow transit constipation. Dis Colon Rectum 39(1):23–29PubMedCrossRef
22.
Bordeianou L, Savitt L, Dursun A (2011) Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum 54(1):60–65PubMedCrossRef
23.
Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE (1997) Chronic constipation—is the work-up worth the cost? Dis Colon Rectum 40(3):280–286PubMedCrossRef
24.
Halverson AL, Orkin BA (1998) Which physiologic tests are useful in patients with constipation? Dis Colon Rectum 41(6):735–739PubMedCrossRef
25.
Pluta H, Bowes KL, Jewell LD (1996) Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum 39(2):160–166PubMedCrossRef
26.
Nylund G, Oresland T, Fasth S, Nordgren S (2001) Long-term outcome after colectomy in severe idiopathic constipation. Colorectal Dis 3(4):253–258PubMedCrossRef
27.
O'Brien S, Hyman N, Osler T, Rabinowitz T (2009) Sexual abuse: a strong predictor of outcomes after colectomy for slow-transit constipation. Dis Colon Rectum 52(11):1844–1847PubMedCrossRef
Metadata
Title
Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation
Authors
Avraham Reshef
Patricia Alves-Ferreira
Massarat Zutshi
Tracy Hull
Brooke Gurland
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 6/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-012-1498-3

Other articles of this Issue 6/2013

International Journal of Colorectal Disease 6/2013 Go to the issue

Letter to the Editor

Surgical management of rectal cancer in pregnancy

Letter to the Editor

Colon ischaemia following surgery for sigmoid colon and rectal cancer

Original Article

Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results

Original Article

Recurrent desmoids determine outcome in patients with Gardner syndrome: a cohort study of three generations of an APC mutation-positive family across 30 years

Original Article

Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon

Original Article

Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients