pp 145-159

Surgical Treatment of Colonic Inertia

  • Shing W. WongAffiliated withDepartment of Colorectal Surgery, St. George Hospital
  • , David Z. LubowskiAffiliated withDepartment of Colorectal Surgery, St. George Hospital

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Elective colectomy for chronic constipation can potentially yield very rewarding results. As has been shown in this chapter, dramatic symptomatic relief including improvement in the frequency of spontaneous bowel movements, decrease in the use of enemas and digitation, and in some cases improvement or resolution of pain or bloating may occur. However, conversely in other patients constipation may persist and abdominal pain may even worsen. It should also be remembered that potential adverse sequelae may result from surgery for a benign condition, including anastomotic leak, small bowel obstruction, and even an ileostomy. The chapter authors and the book editors concur that very stringent investigation including physiological, medical, and psychosocial investigations are required before contemplating this type of resectional surgery for a functional disorder. Sufficiently motivated patients who have been carefully selected through intensive investigation in a specialist unit may, in appropriate circumstances, be offered this option. It is the book editors’ belief that the “ideal” patient is one with reproducible colonic inertia on multiple transit studies with normal gastric emptying and small-bowel function; no evidence of any physiologic, functional, or structural pelvic outlet obstruction; and no associated symptoms like nausea, bloating, abdominal or pelvic pain, or difficult or incomplete evacuation. The patient who understands that all of these symptoms may either persist or develop after surgery and a permanent stoma may be necessary is best prepared to pursue this option.