Colectomy for refractory constipation.
OBJECTIVE
This study evaluated the type of colectomy, postoperative complications, functional results, and satisfaction in patients with constipation refractory to conservative therapy. Further, colonic transit time (CTT), faecal load (coprostasis), and colon length (redundancies) were compared between operated and non-operated patients.


METHODS
Out of 281 patients, 30 women and 5 men underwent surgery. All patients were evaluated by clinical and physiological investigations. Forty-four randomly selected healthy persons constituted the control group.


RESULTS
Twenty-one patients had at hemicolectomy, 11 patients a subtotal colectomy and 3 patients an ileostomy. Two patients had an anastomotic leak and one died. In 11 patients, further surgery was necessary, because of recurrent constipation. Abdominal pain disappeared and defecation patterns improved significantly to 1-4 per day after a colectomy with no uncontrolled diarrhoea. The mean CTT was 65.0 h for patients operated, 37.9 h in non-operated patients and 24.75 h in controls (p < 0.05). Abdominal bloating and pain and defecation parameters correlated significantly positively with CTT and faecal loading, which were significantly increased in operated patients (p < 0.05). The colon was significantly longer in operated patients compared to non-operated, which significantly increased CTT and aggravated symptoms. The histology of the removed colon revealed degenerative changes.


CONCLUSIONS
A segmental or a subtotal colectomy reduced bloating and pain and improved defecation patterns significantly. Although patient satisfaction was rather high, there are significant risks of postoperative complications and future operations. The operated patients had a significant increased CTT, faecal load and colon length, compared to non-operated patients.
Raahave
Dennis
D
Department of Surgery, Copenhagen University North Sealand Hospital, Helsingore, Denmark. dera@noh.regionh.dk
Loud
Franck Bjørn
FB
Christensen
Elsebeth
E
Knudsen
Lisbet Lomholdt
LL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods*; D003248:Constipation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003287:Contrast Media; D003718:Denmark / Q000453:epidemiology; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014463:Ultrasonography
D003287:Contrast Media; D001466:Barium Sulfate