Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders

Background: Chronic constipation may be treated by antegrade colonic irriga tion via a colonic conduit. Methods: Two alternative sites of colonic conduit construction were evaluat ed for their effect on the symptoms of 21 consecutive women with intractabl e constipation primarily due to rectal evacuatory disorders. The conduit wa s constructed in the sigmoid colon in the first 11 patients and in the tran sverse colon in the subsequent ten. Symptomatic outcome was evaluated clini cally and by questionnaires, with a prospective quality of life assessment in the transverse group. Results: During a median follow-up of 12 (range 6-60) months, reflux or ste nosis necessitated revision or dilatation in six patients. Irrigation with a median of 1.3 (0.8-2.0) litres of water achieved evacuation in all patien ts. Improvements in abdominal pain and bloating were reported by seven of t he ten patients in the transverse conduit group, but benefit was found in o nly three of 11 in the sigmoid group. There was no significant improvement in quality of life scores. In the medium term, seven patients retained a tr ansverse conduit compared with three with a sigmoid conduit. Conclusion: The transverse colonic conduit offers better relief from the sy mptoms of constipation due to rectal evacuatory dysfunction than the sigmoi d conduit.