Colectomy for slow-transit constipation: Preoperative functional evaluation is important but not a guarantee for a successful outcome

PURPOSE: This study was designed to assess the results of preoperative func tional evaluation of patients with severe slow-transit constipation in rela tion to functional outcome. METHODS: Four hundred thirty-nine patients with chronic intractable constipation were evaluated by marker studies. Twenty- one patients underwent colectomy and ileorectal anastomosis for slow-transi t constipation. Mean colorectal transit time was 156 hours (normal, <45 hou rs). Small-bowel transit time was normal in ten patients and delayed in fiv e patients. Six were nonresponders. Morbidity was 33 percent. Small-bowel o bstruction occurred in six patients; relaparotomy was done in four patients . Follow-up varied from 14 to 153 (mean, 62) months. RESULTS: After three m onths, defecation frequency was increased in all. Mean stool frequency impr oved from one bowel movement per 5.9 days to 2.8 times per day. Sixteen pat ients felt improved after surgery. Seventeen continued to experience abdomi nal pain, and 13 still used laxatives and enemas. Satisfaction rate was 76 percent (16 patients). After one year, defecation frequency was back at the preoperative level in five patients. An ileostomy was created in two more patients because of incontinence and persistent diarrhea. Eleven patients ( 52 percent) still felt improved. A relation between small-bowel function an d functional results could not be demonstrated. CONCLUSIONS: Preoperative e valuation is important but not a guarantee for successful outcome. Colectom y remains an ultimate option for patients with disabling slow-transit const ipation, but patients should be informed that, despite an increased defecat ion frequency, abdominal symptoms might persist. Any promiscuous use of col ectomy to treat constipation should be discouraged.