Conclusion
Patients with intractable chronic constipation should be evaluated with physiological tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried until they are exhausted. If surgery is indicated, STC with IRA is the treatment method of choice, although segmental resection may be a good option for isolated megasigmoid, sigmoidocele, or recurrent sigmoid volvulus. In general, patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection, as they tend to have a poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist, even if surgery normalizes bowel frequency. Patients with associated problems may be served better by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is not a treatment option for pain and/or abdominal bloating.
Keywords
- Rectal Prolapse
- Chronic Constipation
- Subtotal Colectomy
- Sacral Nerve Stimulation
- Pudendal Nerve Terminal Motor Latency
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
Lane WA. Results of the operative treatment of chronic constipation. BMJ. 1908;1:1126–30.
Whitehead WE, Chaussade S, Corazziari E, and Kumar D. Report of an international workshop on management of constipation. Gastroenterol Int. 1991;4:99–113.
Agachan F, Chen T, Pfeifer J, Reissman P, and Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39:681–5.
Knowles CH, Eccersley AJ, Scott SM, Walker S, Reeves B, and Lunniss PJ. Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Dis Colon Rectum. 2000;43:1419–26.
Martinelli E, Altomare DF, Rinaldi M, and Portincasa P. Constipation after hysterectomy: fact or fiction? Eur J Surg. 2000;166:356–68.
Heslop JH. Piles and rectoceles. Aust N Z J Surg. 1987;57:935–8.
Nichols DH and Randall CL. Enterocele. In: Nichols, DH, editor. Vaginal surgery. Baltimore: Williams & Wilkins; 1996. pp. 319–20.
Hammer H, Hammer J, and Gasche Ch. Polyäthylenglykol (Macrogol)—Übersicht über seine pharmakologischen Eigenschaften und seine Verwendung in der Diagnostik und Therapie gastroenterologischer Erkrankungen. Wien Klin Wochenschr. 2000;112:53–60.
Pfeifer J, Oliveira L, Park UC, Gonzales A, Agachan F, and Wexner SD. Are interpretation of video defecographies reliable and reproducible? Int J Colorectal Dis. 1997;12:67–72.
Pfeifer J, Teoh T-A, Salanga VD, Agachan F, and Wexner SD. Comparative study between intra-anal sponge and needle electrode for electromyographic evaluation of constipated patients. Dis Colon Rectum. 1998;41:1153–7.
Henry MM, Parks AG, and Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg. 1982;69:470–2.
Kiff ES, Barnes RPH, and Swash M. Evidence of pudendal nerve neuropathy in patients with perineal descent and chronic straining at stool. Gut. 1984;25:1279–82.
Fleshman JW, Dreznik Z, Cohen E, Fry RD, and Kodner IJ. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum. 1992;35:1019–25.
Fleshman JW. Balloon expulsion. In: Smith LE, editor. Practical guide to anorectal testing. 2nd ed. New York: Igaku-Shoin; 1995. pp. 23–6.
Speakman CTM, Kamm MA, and Swash M. Cerebral evoked potentials—are they of value in anorectal disease? Gut. 1990;31:A1173.
Wexner SD, Daniel N, and Jagelman DG. Colectomy for constipation: physiologic investigation is the key to success. Dis Colon Rectum. 1991;34:851–6.
Redmond JM, Smith GW, Barofsky I, Ratych RE, Goldsborough DC, and Schuster M. Physiological tests to predict long term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol. 1995;90:748–53.
Wedel T, Roblick UJ, Ott V, Eggers R, Schiedeck TH, Krammer HJ, and Bruch HP. Oligoneuronal hypoganglionosis in patients with idiopathic slow-transit constipation. Dis Colon Rectum. 2001;45:54–62.
Voderholzer WA, Wiebecke B, Gerum M, and Muller-Lissner SA. Dysplasia of the submucous nerve plexus in slow-transit constipation of adults. Eur J Gastroenterol Hepatol. 2000;12:755–9.
Altomare DF, Portincasa P, Rinaldi M, Di Ciaula A, Martinelli E, Amoroso A, Palasciano G, and Memeo V. Slow-transit constipation: solitary symptom of a systemic gastrointestinal disease. Dis Colon Rectum. 1999;42:231–40.
Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, and Turner IC. Biofeedback provides long-term benefit for patients with intractable, slow, and normal transit constipation. Gut. 1998;42:517–21.
Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, and Kamm MA. Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg. 2002;26:166–70.
Malone PS, Ransley PG, and Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336:1217–8.
Hill J, Stott S, and MacLennan I. Antegrade enemas for the treatment of severe idiopathic constipation. Br J Surg. 1994;81:1490–1.
Rongen MJ, van der Hoop AG, and Baeten CG. Cecal access for antegrade colon enemas in medically refractory slow-transit constipation: a prospective study. Dis Colon Rectum. 2001;44:1644–9.
Eccersley AJ, Maw A, and Williams NS. Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders. Br J Surg. 1999;86:647–50.
Gerharz EW, Vik V, Webb G, Leaver R, Shah PJR, and Woodhouse RJ. The value of the MACE (malone antegrade colonic enema) Procedure in adult patients. J Am Coll Surg. 1997;185:544–7.
Preston DM, Hawley PR, Lennard-Jones JE, and Todd IP. Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane’s disease). Br J Surg. 1984;71:547–52.
Barnes PR, Lennard-Jones JE, Hawley PR, and Todd IP. Hirschsprung’s disease and idiopathic megacolon in adults and adolescents. Gut. 1986;27:534–41.
Akervall S, Fasth S, Nordgren S, Oreslund T, and Hulten L. The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane’s disease) as related to rectal sensory function. Int J Colorectal Dis. 1988;3:96–101.
Kamm MA, Hawley PR, and Lennard-Jones JE. Outcome of colectomy for severe idiopathic constipation. Gut. 1988;29:969–73.
Yoshioka K and Keighley MR. Clinical results of colectomy for severe constipation. Br J Surg. 1989;76:600–4.
Pena JP, Heine JA, Wong WD, Christenson CE, and Balcos EG. Subtotal colectomy for constipation—a long term follow up study [abstr]. Dis Colon Rectum. 1992;35:P19.
Takahashi T, Fitzgerald SD, and Pemberton JH. Evaluation and treatment of constipation. Rev Gastroenterol Mex. 1994;59:133–8.
Piccirillo MF, Reissman P, and Wexner SD. Colectomy as treatment for constipation in selected patients. Br J Surg. 1995;82:898–901.
Pluta H, Bowes KL, and Jewell LD. Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum. 1996;39:160–6.
Ghosh S, Papachrysostomou M, Batool M, and Eastwood MA. Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol. 1996;31:1083–91.
Christiansen J and Rasmussen OO. Colectomy for severe slow-transit constipation in strictly selected patients. Scand J Gastroenterol. 1996;31:770–3.
DeGraaf EJR, Gilberts LAM, and Schouten WR. Role of colonic transit time studies to select patients with slow transit constipation for partial left-sided or subtotal colectomy. Br J Surg. 1996;83:648–51.
Nyam DC, Pemberton JH, Ilstrup DM, and Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40:273–9.
Schiedeck TH, Schwandner O, and Bruch HP. Laparoscopic therapy of chronic constipation. Zentralbl Chir. 1999;124:818–24.
Fan CW and Wang JY. Subtotal colectomy for colonic inertia. Int Surg. 2000;85:309–12.
Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, and Wexner SD. Long-term follow-up in patients undergoing colectomy for colonic inertia. Dis Colon Rectum. 2001;44:179–83.
Athanasakis H, Tsiaoussis J, Vassilakis JS, and Xynos E. Laparoscopically assisted subtotal colectomy for slow-transit constipation. Surg Endosc. 2001;15:1090–2.
FitzHarris GP, Garcia-Aguilar J, Parker SC, Bullard KM, Madoff RD, Goldberg SM, and Lowry A. Quality of life after subtotal colectomy for slow-transit constipation: the quality and quantity count. Dis Colon Rectum. 2003;46:433–40.
Pfeifer J, Agachan F, and Wexner SD. Surgery for constipation: a review. Dis Colon Rectum. 1996;39:444–60.
McCready RA, Grace RH, and Todd IP. Organic constipation in adults. Br J Surg. 1977;64:305–10.
Coremans GE. Surgical aspects of severe chronic non-Hirschsprung’s constipation. Hepatogastroenterology. 1990;37:588–95.
Lundin E, Karlbom U, Pahlman L, and Graf W. Outcome of segmental colonic resection for slow-transit constipation. Br J Surg. 2002;89:1270–4.
Jennings PJ. Megarectum and megacolon in adolescents and young adults: results of treatment at St. Mark’s hospital. J R Soc Med. 1967;60:805–6.
Lane RH and Todd IP. Idiopathic megacolon: a review of 42 cases. Br J Surg. 1977;64:305–10.
Smith B, Grace RH, and Todd IP. Organic constipation in adults. Br J Surg. 1977;64:313–4.
Hughes ES, McDermott FT, Johnson WR, and Polglase AL. Surgery for constipation. Aust N Z J Surg. 1981;51:144–8.
Belliveau P, Goldberg SM, Rothenberger DA, and Nivatvongs S. Idiopathic acquired megacolon: the value of subtotal colectomy. Dis Colon Rectum. 1982;25:118–21.
Järvinen HJ and Rintala R. Funnel anus and megacolon in adult. Dis Colon Rectum. 1985;28:957–9.
Gasslander T, Larsson J, and Wetterfors J. Experience of surgical treatment for chronic idiopathic constipation. Acta Chir Scand. 1987;153:553–5.
Kamm MA, van der Sijp JR, Hawley PR, Phillips RK, and Lennard-Jones JE. Left hemicolectomy with rectal excision for severe idiopathic constipation. Int J Colorectal Dis. 1991;6:49–51.
Keighley MR. Megacolon and megarectum. In: Keighley MR and Williams NS, editors. Surgery of the anus, rectum and colon. Vol 1. London: WB Saunders; 1993. pp. 658–73.
Stabile G, Kamm MA, Phillips RK, Hawley PR, and Lennard-Jones JE. Partial colectomy and coloanal anastomosis for idiopathic megarectum and megacolon. Dis Colon Rectum. 1992;35:158–62.
You YT, Wang JY, Changchien CR, Chen JS, Hsu KC, Tang R, Chiang JM, and Chen HH. Segmental colectomy in the management of colonic inertia. Am Surg. 1998;64:775–7.
Nicholls RJ and Kamm MA. Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation. Report of two cases. Dis Colon Rectum. 1988;31:968–9.
Hosie KB, Kmiot WA, and Keighley MR. Constipation: another indication for restorative proctocolectomy. Br J Surg. 1990 Jul;77:801–2.
Keighley MR, Grobler S, and Bain I. An audit of restorative proctocolectomy.
Stewart J, Kumar D, and Keighley MR. Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon. Br J Surg. 1994;81:1051–3.
Brown SR and Shorthouse AJ. Restorative proctocolectomy for idiopathic megarectum: postoperative recovery of hypotonic anal sphincters. Report of two cases. Dis Colon Rectum. 1997;40:625–7.
O’Sulleabhain CB, Anderson JH, McKee RF, and Finlay IG. Strategy for the surgical management of patients with idiopathic megarectum and megacolon. Br J Surg. 2001;88:1392–6.
Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD, Wolff BG, Roberts PL, Smith LE, Sweeney SA, and Moore M. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomised, double-blind multicenter study. J Am Coll Surg. 1996;183:297–306.
Eu KW, Lim SL, Seow-Choen F, Leong AF, and Ho YH. Clinical outcome and bowel function following total abdominal colectomy and ileorectal anastomosis in the Oriental population. Dis Colon Rectum. 1998;41:215–8.
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Pfeifer, J. (2005). Managing Slow-Transit Constipation. In: Complex Anorectal Disorders. Springer, London. https://doi.org/10.1007/1-84628-057-5_24
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