title: Left hemicolectomy with rectal excision for severe idiopathic constipation.
abstract: The standard surgical therapy for severe idiopathic constipation is total colectomy with ileorectal anastomosis, but this results in intractable diarrhoea in a third of the patients and recurrent constipation in another 10%. Studies which employ either radio-isotopes or radio-opaque markers permit the delineation of regional delay in colonic transit. Based on these studies, and evidence that the rectum is also abnormal in these patients, we have performed a left hemicolectomy with rectal excision in 2 patients with proven left colonic delay. After 2 and 3 years of follow-up, both patients have normal frequency, transit studies and anorectal physiology studies. Segmental resection based on physiological studies may offer better relief of symptoms with a lower chance of side effects in selected patients.
authors.affiliation: St. Mark's Hospital, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
authors.forename: J R
authors.initials: JR
authors.lastname: van der Sijp
authors.forename: P R
authors.initials: PR
authors.lastname: Hawley
authors.forename: R K
authors.initials: RK
authors.lastname: Phillips
authors.forename: J E
authors.initials: JE
authors.lastname: Lennard-Jones
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D003248:Constipation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D012007:Rectum / Q000601:surgery*; D013997:Time Factors