SUBTOTAL COLECTOMY WITH CAECO-RECTAL ANAS TOMOSIS (DELOYERS) FOR SEVERE SLOW TRANSIT CONSTIPATION - COMPARISON WITH TOTAL COLECTOMY

Purpose: Functional results of total colectomy (TC) and ileorectal ana stomosis for colonic inertia are often impaired by postoperative obstr uction and diarrhea. In order to avoid these postoperative complicatio ns, we propose a subtotal colectomy (STC) preserving the ileo-caecal j unction. Methods: Since 1989, 18 consecutive patients (17 F, 1 M; mean age. 54 years) with intractable constipation underwent TC (n = 6) or STC with caecorectal anastomosis (Deloyers Procedure) (n = 12). Mean p reoperative bowel frequency was two movments every month. Colonic iner tia was defined as diffuse marker delay during transit study without o bstructed defecation on manometry or digitalised rectography. Rectocel e (n = 10), rectal (n = 5) and genital prolapse (n = 6) were treated i n the same operative time. Results: Postoperative course was uneventfu l after STC but bowel obstruction, requiring laparotomy, occured in 3 patients (50%) after TC: enterolysis (n = 2), bowel resection (n = 2). Mean postoperative day stool frequency of TC (4.2 +/- 1.2) was higher than STC (1.2 +/- 0.1). Half of patients after TC needed anti-diarrhe al treatment and diet, 33% had rectal evacuation difficulties despite liquid stools, 17% had episodic incontinence, 66% had persistent abdom inal pain. Compared to TC, the functional results of STC were signific antly better: regular normal transit return without diet or treatment in 75% of cases, 25% had rectal emptying difficilties easily treated b y mild laxatives, only 17% had persistent abdominal pain. Postoperativ e obstruction, diarrhea or fecal incontinence never occurred after STC . Conclusion: Compared to TC, STC with Deloyers procedure seems to red uce significantly the postoperative incidence of bowel obstruction, di arrhea and abdominal pain. Expected regular transit return after STC n eeds a careful selection of patients and simultaneous treatment of ano -rectal and pelvic floor abnormalities frequently associated with colo nic inertia.