Outcome of segmental colonic resection for slow-transit constipation.
BACKGROUND
The standard surgical treatment for slow-transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side-effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.


METHODS
Selection criteria included prolonged segmental transit on oral 111In-labelled diethylene triamine penta-acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty-eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.


RESULTS
After a median of 50 (range 16-78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0-7) to 7 (0-63) per week (P < 0.001). The number of patients passing hard stools and straining excessively decreased (P = 0.016 and P = 0.041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P < 0.001).


CONCLUSIONS
With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side-effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome.
Lundin
E
E
Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden. erik.lundin@kirurgi.uu.se
Karlbom
U
U
Påhlman
L
L
Graf
W
W
D000328:Adult; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000503:physiopathology / Q000601:surgery*; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012684:Sensory Thresholds; D016896:Treatment Outcome