Condition for Good Quality of Life after Surgery for Slow Transit Constipation

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J Korean Soc Coloproctol. 2011;27(4):165-165
Publication date (electronic) : 2011 August 31
doi : https://doi.org/10.3393/jksc.2011.27.4.165
Department of Surgery, Sahmyook Medical Center, Seoul, Korea.
Correspondence to: Yong Hee Hwang, M.D. Department of Sugery, Sahmyook Medical Center, 29-1 Hwigyeong 2-dong, Dongdaemun-gu, Seoul 130-711, Korea. Tel: +82-2-2210-3563, Fax: +82-2-2212-2673, hwangyon@hotmail.com

See Article on Page 180-187

We were able to identify subgroups of patients by using physiologic tests that accurately predicted those who would respond well to surgery [1]. Only those patients documented, by using a marker transit study or by using scintigraphic transit, as having slow-transit constipation were deemed to be candidates for surgery, and the success rate of a colectomy for colonic inertia was significantly higher in patients who underwent a repeat transit study confirming inertia than in patients who underwent a colectomy based on a single study. Thus, consideration should be given to repeating the colonic transit study before a colectomy to help secure the diagnosis and to improve the outcome [2].

Surgeons have performed a total abdominal colectomy with ileorectal anastomosis and a subtotal colectomy with ileosigmoid or cecorectal anastomosis for colonic inertia. A cecorectal anastomosis, while preserving the ileocecal valve with the theoretical advantage of water preservation, is often complicated by cecal distention. Sigmoid preservation also predisposes patients to postoperative constipation. Today, a total abdominal colectomy remains the treatment of choice for colonic inertia. However, despite its excellent success rate, postoperative morbidity remains a discouraging problem. The incidence of abdominal pain and bloating are less likely to subside after a colectomy perhaps because of irritable bowel syndrome [3]. A long-term follow-up study reported a slight decrease in bowel frequency, a change in stool consistency (semi-liquid to semi-solid), and a decreased incidence of fecal incontinence, possibly because of small-bowel adaptation [4]. In summary, I agree with the author's opinion, and I think a total abdominal colectomy can be recommended to patients with well-established colonic inertia.

References

1. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg 1991;214:403–411. 1953096.
2. Nam YS, Pikarsky AJ, Wexner SD, Singh JJ, Weiss EG, Nogueras JJ, et al. Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum 2001;44:86–92. 11805568.
3. Kamm MA, Hawley PR, Lennard-Jones JE. Outcome of colectomy for severe idiopathic constipation. Gut 1988;29:969–973. 3396968.
4. Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, Wexner SD. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum 2001;44:179–183. 11227933.

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