Researchers from the University of Copenhagen, Denmark, evaluated the long-term results after subtotal colectomy with ileo-rectal anastomosis for severe slow-transit constipation, in patients with normal rectal function.
Of 273 patients with constipation referred for surgical evaluation, 18 (7%) fulfilled the authors' criteria for subtotal colectomy.
Slow-transit was confirmed by radio-opaque marker studies. Emptying of viscous fluid and normal emptying at defecography established normal rectal function.
At follow-up between 3 and 9 years, 15 patients had a bowel frequency between 2 and 6 times daily.
|High rectal volume tolerability may predict complications.
| Colorectal Disease |
One patient, who had an ileostomy because of anastomotic leak, had not wanted bowel continuity restored.
Another patient with opiate abuse became less constipated, with 2-3 bowel movements a week.
The researchers found that 1 patient was still constipated 1 year after the operation, and subsequently had an ileal pouch-anal anastomosis. This patient, who had normal rectal emptying, had very high volume tolerability. Their maximum tolerable volume was 700 ml.
In 4 of 7 patients, abdominal pain persisted after the operation. Of these, 3 developed diarrhea and required daily intake of loperamide.
Investigator B. H. Aldulaymi, of the Department of Surgery, D Herlev Hospital, Copenhagen, said on behalf of fellow authors, "Subtotal colectomy for severe slow-transit constipation is justified, provided anorectal function is normal.
"In spite of normal rectal emptying, very high rectal volume tolerability may be an indicator of functional megarectum and impaired rectal emptying postoperatively," it was concluded.