G. Costalat et al., SUBTOTAL COLECTOMY WITH CAECO-RECTAL ANAS TOMOSIS (DELOYERS) FOR SEVERE SLOW TRANSIT CONSTIPATION - COMPARISON WITH TOTAL COLECTOMY, Annales de chirurgie, 51(3), 1997, pp. 248-255
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.