title: A novel surgical approach to slow-transit constipation: report of two cases.
abstract: BACKGROUND
  Slow-transit constipation after proper diagnosis and extensive medical therapy may have a surgical solution. Total abdominal colectomy and ileorectal anastomosis, at our institution, is the surgical procedure of choice. Nonetheless, patients may reject this alternative because of morbidity.
  
  
  CONCLUSIONS
  We report two cases of slow-transit constipation diagnosed after a thorough investigation with two colonic transit tests showing slow-transit constipation, a normal anorectal manometry, balloon expulsion test, small-bowel follow-through, defecography, laboratory and psychologic tests. The patients rejected standard surgical treatment (total colectomy + ileorectal anastomosis). A colonic bypass with an ileorectal anastomosis, leaving the colon in situ, was offered and accepted by the two patients. This was performed laparoscopically liberating the cecum and terminal ileum, transecting the terminal ileum through a small suprapubic incision, and anastomosing the terminal ileum to the rectosigmoid junction intracorporeally. The total surgical time was 50 and 60 minutes, respectively. Both patients made uneventful recoveries and were discharged on the fourth postoperative day. They have completed four and two months of close follow-up and at present have one to four bowel movements per day with mild abdominal distension and pain. To our knowledge this is the first report of colonic bypass for the treatment of slow-transit constipation.
authors.affiliation: Division of Surgery, Department of Digestive Surgery, Catholic University School of Medicine, Marcoleta 367, Santiago, Chile. gpinedom@hotmail.com
authors.forename: George
authors.initials: G
authors.lastname: Pinedo
authors.forename: Francisca
authors.initials: F
authors.lastname: León
authors.forename: María Elena
authors.initials: ME
authors.lastname: Molina
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Soto
authors.forename: Francisco
authors.initials: F
authors.lastname: López
authors.forename: Alvaro
authors.initials: A
authors.lastname: Zúñiga
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D007082:Ileum / Q000601:surgery*; D012007:Rectum / Q000601:surgery*