Cecal access for antegrade colon enemas in medically refractory slow-transit constipation - A prospective study

PURPOSE: The current surgical treatment for therapy-resistant slow-transit constipation consists of either subtotal colectomy or ileostomy. This prosp ective study was performed to examine the creation of an access enabling an tegrade enemas of the colon as an alternative to these interventions. Devel opment of symptoms associated with constipation wits also a study subject. METHODS: Twelve patients with a median defecation frequency of once a week were evaluated preoperatively, using marker-transit studies, defecography, manometry, and colonoscopy. All patients subsequently received an enema acc ess, placed in the lower right abdomen. The appendix (available in seven ca ses) was laparoscopically fixed to the abdominal wall and served as a stoma , a procedure that required a conversion in one case. In five previously ap pendectomized cases, the terminal part of the ileum was transected. the dis tal side fixed to the abdominal wall to serve as a stoma, and the proximal side anastomosed to the ascending colon. Quality-of-life-assessment wits in cluded. This consisted of Nottingham Health Profile, State Trait Anxiety In ventory, and Zung tests, as well as disease specific questions. Besides per ioperative and outpatient evaluations, patients were asked about and scored on constipation associated symptoms. RESULTS: Twelve patients (8 female) w ith a mean age of 43 (17-66) years were treated. Using various enema regime s, frequency of defecation (median one daily) without major complications w as established. In four cases, a subtotal colectomy was required in the lon g run. Two of these four patients needed,in ileostomy after for persisting symptoms. State Trait Anxiety Inventory and Zung results improved, as did s everal associated symptoms. Overall, constipation scores dropped from a med ian of 21.5 to 5.5. CONCLUSION: Cecal access for antegrade colon enemas in medical therapy-resistant slow-transit constipation is a minimally invasive procedure with promising results. In case of failure, further surgery is n ot compromised by this procedure.