LONG-TERM RESULTS OF SURGERY FOR CHRONIC CONSTIPATION

BACKGROUND: Developments in anorectal physiologic testing have facilit ated better understanding of the process of defecation and factors tha t might cause chronic constipation. AIM: Patients with severe idiopath ic chronic constipation were evaluated using colonic transit and pelvi c floor function in an attempt to identify those patients suitable for aggressive surgical intervention. MATERIALS AND RESULTS: Among 1,009 patients studied using either a marker or scintigraphic transit techni que and tests of pelvic floor function, 52 with slow-transit constipat ion (STC) were identified and underwent abdominal colectomy and ileore ctostomy (IRA). Twenty-two patients had pelvic floor dysfunction and S TC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without e vidence of slow-transit and were offered pelvic floor retraining alone . The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constip ation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, s even patients (9 percent) had small-bower obstruction, and nine patien ts (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the re sults of surgery, and 90 percent have a good or improved quality of li fe. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction. CONCLUSION: Physiologic evaluation reliably identified patients with severe chron ic constipation who might benefit from surgery. IRA is safe and effect ive, resulting in prompt and prolonged relief of constipation.