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Long-term results of surgery for chronic constipation

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Diseases of the Colon & Rectum

Abstract

BACKGROUND: Developments in anorectal physiologic testing have facilitated better understanding of the process of defecation and factors that might cause chronic constipation. AIM: Patients with severe idiopathic chronic constipation were evaluated using colonic transit and pelvic floor function in an attempt to identify those patients suitable for aggressive surgical intervention. MATERIALS AND RESULTS: Among 1,009 patients studied using either a marker or scintigraphic transit technique and tests of pelvic floor function, 52 with slow-transit constipation (STC) were identified and underwent abdominal colectomy and ileorectostomy (IRA). Twenty-two patients had pelvic floor dysfunction and STC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without evidence of slow-transit and were offered pelvic floor retraining alone. The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constipation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, seven patients (9 percent) had small-bowel obstruction, and nine patients (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the results of surgery, and 90 percent have a good or improved quality of life. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction. CONCLUSION: Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery. IRA is safe and effective, resulting in prompt and prolonged relief of constipation.

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Authors and Affiliations

  1. Section of Colon & Rectal Surgery, the Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Denis C. N. K. Nyam M.D., John H. Pemberton M.D., Duane M. Ilstrup M.S. & Doris M. Rath R.N.

  2. Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Denis C. N. K. Nyam M.D., John H. Pemberton M.D., Duane M. Ilstrup M.S. & Doris M. Rath R.N.

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  1. Denis C. N. K. Nyam M.D.
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  2. John H. Pemberton M.D.
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  3. Duane M. Ilstrup M.S.
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  4. Doris M. Rath R.N.
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Nyam, D.C.N.K., Pemberton, J.H., Ilstrup, D.M. et al. Long-term results of surgery for chronic constipation. Dis Colon Rectum 40, 273–279 (1997). https://doi.org/10.1007/BF02050415

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