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Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Patient selection is a crucial step when considering total abdominal colectomy and ileorectal anastomosis (TAC/IRA) for refractory constipation.

Purpose

This study aimed to evaluate the results of short- and long-term outcomes for patients with pure slow transit constipation (STC) compared to those with slow transit and features of obstructive defecation (STC + OD).

Methods

This study included all patients who underwent TAC/IRA for constipation from 1999–2010. Patients were divided into two groups: group A (STC) and group B (STC + OD) based on abnormal physiology or motility testing in addition to the surgeon's clinical impression of symptomatic obstructive defecation. Demographics, operative variables, and short-term outcomes were collected by retrospective chart review and were compared between groups. Long-term functional outcomes were assessed by telephone survey. This included: number of bowel movements, use of laxatives, antidiarrheal medications, and surgery satisfaction. Validated questionnaires were collected postoperatively.

Results

One hundred forty-four patients (143 females; mean age, 40 (18–68) years old) underwent TAC/IRA by either laparoscopic (63 (44 %)) or open (81 (56 %)) techniques. One hundred three patients had pure STC and 41 had STC + OD. Four patients underwent TAC with end ileostomy at first procedure. Seven patients underwent surgery after a trial of diverting ileostomy. One patient died unexpectedly, 2 days after uneventful surgery. Median follow-up was 43 (IQR, 16–75) months. Five (5 %) patients in group A and two (5 %) in group B underwent subsequent ileostomy for poor functional outcomes. Eighty-eight (68 %) patients were available by telephone. Short- and long-term outcomes were equivalent in both groups as well as patient satisfaction (89 vs. 85 %, p = 0.7).

Conclusions

Total abdominal colectomy can be offered to selective patients with slow transit constipation and obstructive defecation with equivalent long-term results.

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References

  1. Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99(4):750–759

    Article  PubMed  Google Scholar 

  2. Pemberton JH, Rath DM, Ilstrup DM (1991) Evaluation and surgical treatment of severe chronic constipation. Ann Surg 214(4):403–411, discussion 411-3

    Article  PubMed  CAS  Google Scholar 

  3. Webster C, Dayton M (2001) Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surg 182(6):639–644

    Article  PubMed  CAS  Google Scholar 

  4. Gurland B, Alves-Ferreira PC, Sobol T, Kiran RP (2010) Using technology to improve data capture and integration of patient-reported outcomes into clinical care: pilot results in a busy colorectal unit. Dis Colon Rectum 53(8):1168–1175

    Article  PubMed  Google Scholar 

  5. Fazio VW, O'Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230(4):575–584, discussion 584–586

    Article  PubMed  CAS  Google Scholar 

  6. Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    Article  PubMed  Google Scholar 

  7. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532

    Article  PubMed  CAS  Google Scholar 

  8. Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL (2008) The constipation severity instrument: a validated measure. Dis Colon Rectum 51(2):162–172

    Article  PubMed  Google Scholar 

  9. Kalbassi MR, Winter DC, Deasy JM (2003) Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum 46(11):1508–1512

    Article  PubMed  CAS  Google Scholar 

  10. Hosie KB, Kmiot WA, Keighley MR (1990) Constipation: another indication for restorative proctocolectomy. Br J Surg 77(7):801–802

    Article  PubMed  CAS  Google Scholar 

  11. Preston DM, Hawley PR, Lennard-Jones JE, Todd IP (1984) Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease). Br J Surg 71(7):547–552

    Article  PubMed  CAS  Google Scholar 

  12. Thakur A, Fonkalsrud EW, Buchmiller T, French S (2001) Surgical treatment of severe colonic inertia with restorative proctocolectomy. Am Surg 67(1):36–40

    PubMed  CAS  Google Scholar 

  13. Knowles CH, Scott M, Lunniss PJ (1999) Outcome of colectomy for slow transit constipation. Ann Surg 230(5):627–638

    Article  PubMed  CAS  Google Scholar 

  14. Zutshi M, Hull TL, Trzcinski R, Arvelakis A, Xu M (2007) Surgery for slow transit constipation: are we helping patients? Int J Colorectal Dis 22(3):265–269

    Article  PubMed  CAS  Google Scholar 

  15. Platell C, Scache D, Mumme G, Stitz R (1996) A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation. Aust N Z J Surg 66(8):525–529

    Article  PubMed  CAS  Google Scholar 

  16. Ghosh S, Papachrysostomou M, Batool M, Eastwood MA (1996) Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol 31(11):1083–1091

    Article  PubMed  CAS  Google Scholar 

  17. Hassan I, Pemberton JH, Young-Fadok TM, You YN, Drelichman ER, Rath-Harvey D et al (2006) Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg 10(10):1330–6, discussion 1336-7

    Article  PubMed  Google Scholar 

  18. Nyam DC, Pemberton JH, Ilstrup DM, Rath DM (1997) Long-term results of surgery for chronic constipation. Dis Colon Rectum 40(3):273–279

    Article  PubMed  CAS  Google Scholar 

  19. Bernini A, Madoff RD, Lowry AC, Spencer MP, Gemlo BT, Jensen LL et al (1998) Should patients with combined colonic inertia and nonrelaxing pelvic floor undergo subtotal colectomy? Dis Colon Rectum 41(11):1363–1366

    Article  PubMed  CAS  Google Scholar 

  20. Wong PW, Kadakia S (1999) How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Postgrad Med 106(6):199–200, 203-4, 207-10

    Article  PubMed  CAS  Google Scholar 

  21. Lubowski DZ, Chen FC, Kennedy ML, King DW (1996) Results of colectomy for severe slow transit constipation. Dis Colon Rectum 39(1):23–29

    Article  PubMed  CAS  Google Scholar 

  22. Bordeianou L, Savitt L, Dursun A (2011) Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum 54(1):60–65

    Article  PubMed  Google Scholar 

  23. Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE (1997) Chronic constipation—is the work-up worth the cost? Dis Colon Rectum 40(3):280–286

    Article  PubMed  Google Scholar 

  24. Halverson AL, Orkin BA (1998) Which physiologic tests are useful in patients with constipation? Dis Colon Rectum 41(6):735–739

    Article  PubMed  CAS  Google Scholar 

  25. Pluta H, Bowes KL, Jewell LD (1996) Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum 39(2):160–166

    Article  PubMed  CAS  Google Scholar 

  26. Nylund G, Oresland T, Fasth S, Nordgren S (2001) Long-term outcome after colectomy in severe idiopathic constipation. Colorectal Dis 3(4):253–258

    Article  PubMed  CAS  Google Scholar 

  27. O'Brien S, Hyman N, Osler T, Rabinowitz T (2009) Sexual abuse: a strong predictor of outcomes after colectomy for slow-transit constipation. Dis Colon Rectum 52(11):1844–1847

    Article  PubMed  Google Scholar 

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Disclosures

All authors do not have any disclosures to report. This research did not receive any type of funding and we have no disclosures.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA

    Avraham Reshef, Patricia Alves-Ferreira, Massarat Zutshi, Tracy Hull & Brooke Gurland

Authors
  1. Avraham Reshef
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  2. Patricia Alves-Ferreira
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  3. Massarat Zutshi
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  4. Tracy Hull
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  5. Brooke Gurland
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Corresponding author

Correspondence to Brooke Gurland.

Additional information

This manuscript was accepted as an oral presentation at the annual meeting of the American Society of Colon and Rectal Surgeons—Vancouver, British Columbia, Canada, 14–18 May 2011.

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Reshef, A., Alves-Ferreira, P., Zutshi, M. et al. Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation. Int J Colorectal Dis 28, 841–847 (2013). https://doi.org/10.1007/s00384-012-1498-3

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  • DOI: https://doi.org/10.1007/s00384-012-1498-3

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