LONG-TERM RESULTS OF TOTAL ABDOMINAL COLECTOMY FOR CHRONIC IDIOPATHICCONSTIPATION - VALUE OF PREOPERATIVE ASSESSMENT

PURPOSE: A small proportion of patients with chronic idiopathic consti pation are incapacitated by the problem. We have assessed 1) the effic acy of total abdominal colectomy, and 2) the predictive value of preop erative testing. METHODS: Preoperative testing included complete histo ry and physical examination, appropriate biochemical and hematologic a ssessment, psychiatric interview, colon transit studies using ingested radiopaque pellets, anorectal manometry, colonic intraluminal manomet ry, and measurement of colon diameters and length on barium enema exam ination. All patients were followed for 65 +/- 40 months. RESULTS: Sev enty-one percent had excellent or very good results. Twenty-one percen t were satisfied, had improved the quality of their life, and felt the operation was worthwhile despite frequent residual or new symptoms. T wo (8 percent) patients did not improve. Patients with a psychiatric h istory or physiologic evidence of an afferent nerve defect had poorer results (P < 0.05). CONCLUSIONS: Total abdominal colectomy with ileore ctal anastomosis is highly effective in alleviating symptoms in patien ts with chronic idiopathic constipation.