title: Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation.
abstract: BACKGROUND
  Patient selection is a crucial step when considering total abdominal colectomy and ileorectal anastomosis (TAC/IRA) for refractory constipation.
  
  
  OBJECTIVE
  This study aimed to evaluate the results of short- and long-term outcomes for patients with pure slow transit constipation (STC) compared to those with slow transit and features of obstructive defecation (STC + OD).
  
  
  METHODS
  This study included all patients who underwent TAC/IRA for constipation from 1999-2010. Patients were divided into two groups: group A (STC) and group B (STC + OD) based on abnormal physiology or motility testing in addition to the surgeon's clinical impression of symptomatic obstructive defecation. Demographics, operative variables, and short-term outcomes were collected by retrospective chart review and were compared between groups. Long-term functional outcomes were assessed by telephone survey. This included: number of bowel movements, use of laxatives, antidiarrheal medications, and surgery satisfaction. Validated questionnaires were collected postoperatively.
  
  
  RESULTS
  One hundred forty-four patients (143 females; mean age, 40 (18-68) years old) underwent TAC/IRA by either laparoscopic (63 (44 %)) or open (81 (56 %)) techniques. One hundred three patients had pure STC and 41 had STC + OD. Four patients underwent TAC with end ileostomy at first procedure. Seven patients underwent surgery after a trial of diverting ileostomy. One patient died unexpectedly, 2 days after uneventful surgery. Median follow-up was 43 (IQR, 16-75) months. Five (5 %) patients in group A and two (5 %) in group B underwent subsequent ileostomy for poor functional outcomes. Eighty-eight (68 %) patients were available by telephone. Short- and long-term outcomes were equivalent in both groups as well as patient satisfaction (89 vs. 85 %, p = 0.7).
  
  
  CONCLUSIONS
  Total abdominal colectomy can be offered to selective patients with slow transit constipation and obstructive defecation with equivalent long-term results.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH 44195, USA.
authors.forename: Avraham
authors.initials: A
authors.lastname: Reshef
authors.forename: Patricia
authors.initials: P
authors.lastname: Alves-Ferreira
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003248:Constipation / Q000503:physiopathology* / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult