Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy forthe treatment of chronic slow-transit constipation

PURPOSE: Functional results of total colectomy with ileorectal anastomosis for the treatment of chronic constipation caused by colonic inertia are oft en considered unsatisfactory because of the frequency of postoperative diar rhea and the high rate of postoperative small-bowel obstruction. Patients a ffected by severe colonic inertia underwent a subtotal colectomy with a nov el antiperistaltic cecorectal anastomosis. The aim of the study was to asse ss the functional results after preservation of the cecorectal junction. ME THODS: Eight females affected by isolated colonic inertia and two females w ith both paradoxical puborectalis contraction and colonic inertia, of a med ian age of 40 years, underwent subtotal colectomy with antiperistaltic ceco rectal anastomosis. Before antiperistaltic cecorectal anastomosis all ten p atients were laxative-dependant, with a mean bowel frequency of ten days; e ight of them (80 percent) had distention, seven (70 percent) bloating, and three (30 percent) abdominal pain. RESULTS: There was no mortality or major postoperative morbidity. One month after antiperistaltic cecorectal anasto mosis, bowel frequency was a mean of 2.2 (range, 1-4) per day, with a semil iquid stool consistency. After one year, bowel frequency was a mean of 1.3 (range, 0.5-3) per day, with a solid stool consistency; the same results we re recorded at last follow-up. Although no patients used antidiarrheal medi cine, laxatives continued to be used by both patients with paradoxical pubo rectalis contraction, All ten (100 percent) of the patients reported a good or improved quality of life. CONCLUSION: This preliminary experience seems to show that antiperistaltic cecorectal anastomosis is safe and effective for patients with colonic inertia. It results in prompt and prolonged relie f from constipation for patients with isolated colonic inertia.