Abstract
The results of colectomy for constipation based only on evidence of delayed colonic markers have been disappointing. The operation may fail because these patients are unable to evacuate the rectum owing to outlet obstruction. In the present study, we have used a combination of videoproctography and transit marker studies in an attempt to predict patients who will have a favorable outcome after colectomy by excluding patients with outlet obstruction. Videoproctography was performed in 228 patients referred for consideration of surgery for constipation. Only 111 (38 percent) had a normal proctogram with complete evacuation of liquid barium. Of these 111 patients, 21 (19 percent) had delayed colonic marker studies. Colectomy and ileorectal anastomosis were performed in 18 of these 21 patients; two years later, 16 were symptom free, with a median daily bowel frequency of four (range, two to six). The remaining two patients failed to respond to surgery. These data suggest that true idiopathic, slow-transit constipation is uncommon, but, when identified on the basis of delayed markers and the ability to expel liquid on proctography, an excellent result can be anticipated from colectomy and ileorectal anastomosis.
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References
Arbuthnot-Lane W. Remarks on the results of the operative treatment of chronic constipation. BMJ 1908;1:126–30.
Klatt GR. Role of subtotal colectomy in the treatment of incapacitating constipation. Am J Surg 1983;145:623–5.
Keighley MR, Shouler P. Outlet syndrome: is there a surgical option. J R Soc Med 1984;77:559–63.
Kamm MA, Hawley PR, Lennard-Jones JE. Outcome of colectomy for severe idiopathic constipation. Gut 1988;29:969–73.
Yoshioka K, Keighley MR. Clinical results of colectomy for severe constipation. Br J Surg 1989;76:600–4.
Martelli H, Devroede G, Arhan P, Duguay C. Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology 1978;75:623–31.
Henry MM. Surgery for constipation. BMJ 1989;298:346.
Jones PN, Lubowski DZ, Swash M, Henry MM. Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 1987;30:667–70.
Duthie GS, Bartolo DCC. Improved anorectal sensitivity relates to improved postoperative function in patients with slow transit constipation irrespective of preoperative anismus. Gut 1989;30:A714–5.
Youle MS, Read NW. Effects of painless rectal distention on gastrointestinal transit of a solid meal. Dig Dis Sci 1984;29:902–6.
Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE. Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 1985;88:26–34.
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Read at the World Congress of Gastroenterology, Sydney, Australia, 1990.
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Sunderland, G.T., Poon, F.W., Lauder, J. et al. Videoproctography in selecting patients with constipation for colectomy. Dis Colon Rectum 35, 235–237 (1992). https://doi.org/10.1007/BF02051013
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DOI: https://doi.org/10.1007/BF02051013