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Subtotal colectomy and ileorectal anastomosis for slow transit constipation: clinical follow-up at median of 15 years

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Abstract

Background

Slow transit constipation is characterised by prolonged colonic transit and reliance on laxatives. The pathophysiology is poorly understood and in its most severe form, total colectomy with ileorectal anastomosis is the final treatment option. We present a follow-up study of the long-term function in patients who had surgery for laxative-resistant slow transit constipation.

Methods

A postal survey was sent to assess bowel frequency, abdominal pain, St Mark’s continence score, satisfaction with procedure, likelihood to choose the procedure again, and long-term rates of small bowel obstruction and ileostomy. Longitudinal data from a subgroup studied 23 years previously are reported.

Results

Forty-two patients (male = 2) were available for follow-up out of an initial cohort of 102. Mean time since surgery was 15.9 years (range 1.7–29.7) years. Fifty percent had < 4 bowel motions per day, most commonly Bristol stool 6, mean St Mark’s score 7.45. Twenty-one percent had severe incontinence. Satisfaction and likelihood to choose surgery were high (median 10/10). There was a high rate of small bowel obstruction, suggesting pan-intestinal dysmotility in some cases. Conversion to ileostomy occurred in 8 patients. In the longitudinal follow-up in 15 subjects, continence deteriorated (p < 0.01), stool consistency softened (p < 0.01), and stool frequency fell (p < 0.01).

Conclusions

Satisfactory stool frequency was achieved in the long term, and although 21% had incontinence scores > 12, patient satisfaction was high. This is the longest reported follow-up of colectomy for slow transit constipation, with longitudinal outcomes reported. There was considerable attrition of patients, so larger, longitudinal studies are required to better ascertain the functional outcomes of these patients.

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Funding

There was no external funding source for the research.

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Authors and Affiliations

  1. Department Colorectal Surgery, St George Clinical School, St George Hospital, University of New South Wales, Kogarah, NSW, Sydney, 2217, Australia

    V. Patton, V. Balakrishnan, C. Pieri, P. Doherty, K. C. Phan-Thien, D. W. King & D. Z. Lubowski

  2. School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia

    V. Patton

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  1. V. Patton
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  2. V. Balakrishnan
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  3. C. Pieri
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  4. P. Doherty
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  5. K. C. Phan-Thien
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  6. D. W. King
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  7. D. Z. Lubowski
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Correspondence to V. Patton.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval for this study was obtained from the South Eastern Sydney Human Research Ethics Committee ref: 16/263(LNR/16/POWH/508).

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Patients were given an information sheet via email or post and informed consent was obtained.

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Patton, V., Balakrishnan, V., Pieri, C. et al. Subtotal colectomy and ileorectal anastomosis for slow transit constipation: clinical follow-up at median of 15 years. Tech Coloproctol 24, 173–179 (2020). https://doi.org/10.1007/s10151-019-02140-5

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  • DOI: https://doi.org/10.1007/s10151-019-02140-5

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