The researchers assessed the long-term results of subtotal colectomy with ileorectal anastomosis in patients with severe idiopathic constipation.
40 patients with severe idiopathic constipation, who were operated on between 1981 and 1993, were included in the study.
|Secondary morbidity is common after colectomy for severe idiopathic constipation.
Patients were accepted for a colectomy and an ileo-rectal anastomosis after a thorough gastro-intestinal investigation.
Pre-operative bowel frequency was less than 2 movements per week, and slow transit was documented.
Postoperative complications occurred in 8 patients. Early re-operation was performed in 2 patients for small bowel obstruction.
The mean follow-up was 11 years (range, 5-16 years). The mean defecation frequency at follow-up was 3 times per day.
29 patients stated that they were satisfied and 11 were dissatisfied with the procedure.
The outcome did not correlate with observed signs of outlet obstruction, blunted rectal sensation, or presence of a psychiatric diagnosis.
The researchers found that, at 5-16 years after the procedure, 33 patients still retained the ileo-rectal anastomosis.
7 patients had further procedures: 5 patients had an ileo-anal pouch; 1 had a continent ileostomy; and 1 had a conventional ileostomy.
Small bowel obstruction was encountered in 17 patients. In 10 of these, surgical treatment was necessary.
Author G. Nylund, of the University of Göteborg, said on behalf of fellow colleagues, "Colectomy and ileorectal anastomosis, for the treatment of severe idiopathic constipation, causes an increase in the number of bowel motions.
"However, it is deemed successful only by 3 out of 4 patients. Secondary morbidity is considerable," it was concluded.