Outcome of colectomy for slow transit constipation

C H Knowles, M Scott, P J Lunniss, C H Knowles, M Scott, P J Lunniss

Abstract

Objective: To review the outcome data for colectomy performed for patients with slow transit constipation (STC).

Background: The outcome of surgical intervention in patients with STC is unpredictable. This may be a consequence of the lack of effectiveness of such interventions or may reflect heterogeneity within this group of patients.

Methods: The authors reviewed the data of all series in the English language that document the outcome of colectomy in > or = 10 patients in the treatment of STC.

Results: Thirty-two series fulfilled the entry criteria. There was widespread variability in patient satisfaction rates after colectomy (39% to 100%), reflecting large differences in the incidence of postoperative complications and in long-term functional results. Outcome was dependent on several clinical and pathophysiologic findings and on the type of study, the population studied, and the surgical procedure used.

Conclusions: It may be possible to predict outcome on the basis of preoperative clinical and pathophysiologic findings. This review suggests a rationale for the selection of patients for colectomy.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1420916/bin/4FF1.jpg
Figure 1. Schematic for the evaluation and selection for colectomy of patients with slow transit constipation, highlighting clinical and physiologic criteria. Dotted line indicates pathways for exclusion; solid line indicates pathways for inclusion.

References

    1. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum 1989; 32:1–8.
    1. Whitehead WE, Chaussade S, Corazziari E, Kumar D. Report of an international workshop on management of constipation. Gastroenterol Intl 1991; 4:99–113.
    1. Arbuthnot Lane W. The results of operative treatment of chronic constipation. Br Med J 1908; I:1:26–30.
    1. Arbuthnot Lane W. Chronic intestinal stasis. Br Med J 1909; I:1:408–411.
    1. Preston DM, Hawley PR, Lennard-Jones JE, Todd IP. Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane’s Disease). Br J Surg 1984; 71:547–552.
    1. Takahashi T, Fitzgerald SD, Pemberton JH. Evaluation and treatment of constipation. Rev Gastroenterol Mex 1994; 59:133–138.
    1. Hughes ES, McDermott FT, Johnson WR, Poglase AC. Surgery for constipation. Aust NZ J Surg 1981; 51:144–148.
    1. Keighley MRB, Shouler P. Outlet syndrome: is there a surgical option? J Royal Soc Med 1984; 77:559–563.
    1. Todd IP. Constipation: results of surgical treatment. Br J Surg 1985; 72:S1:2–3.
    1. Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE II. Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 1985; 88:26–34.
    1. Leon SH, Krishnamurthy S, Schuffler MD. Subtotal colectomy for severe idiopathic constipation. Dig Dis Sci 1987; 32:1249–1254.
    1. Walsh PV, Peebles-Brown DA, Watkinson G. Colectomy for slow transit constipation. Ann R Coll Surg Engl 1987; 69:71–75.
    1. Akervall S, Fasth S, Nordgren S, Oresland T, Hulten L. The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane’s disease) as related to rectal sensory function. Int J Colorectal Dis 1988; 3:96–101.
    1. Kamm MA, Hawley PR, Lennard-Jones JE. Outcome of colectomy for severe idiopathic constipation. Gut 1988; 29:969–973.
    1. Vasilevsky CA, Nemer FD, Balcos EG, et al. Is subtotal colectomy a viable option in the management of chronic constipation? Dis Colon Rectum 1988; 31:679–681.
    1. Zenilman ME, Dunnegan DL, Soper NJ, Becker JM. Successful surgical treatment of idiopathic colonic dysmotility. The role of preoperative evaluation of coloanal motor function. Arch Surg 1989; 124:947–951.
    1. Beck DE, Fazio VW, Jagelman DG, Lavery IC. Surgical management of colonic inertia. South Med J 1989; 82:305–309.
    1. Yoshioka K, Keighley MRB. Clinical results of colectomy for severe constipation. Br J Surg 1989; 76:600–604.
    1. Kuijpers HC. Application of the colorectal laboratory in diagnosis and treatment of functional constipation. Dis Colon Rectum 1990; 33:35–39.
    1. Coremans GE. Surgical aspects of severe chronic non-Hirschsprung constipation. Hepatogastroenterology 1990; 37:588–595.
    1. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg 1991; 214:403–411.
    1. Wexner SD, Daniel N, Jagelman DG. Colectomy for constipation: physiological investigation is the key to success. Dis Colon Rectum 1991; 34:851–856.
    1. Rex DK, Lappas JC, Goulet RC, Madura JA. Selection of constipated patients as subtotal colectomy candidates. J Clin Gastroenterol 1992; 15:212–217.
    1. Sunderland GT, Poon FW, Lauder J, Finlay IG. Videoproctography in selecting patients with constipation for colectomy. Dis Colon Rectum 1992; 35:235–237.
    1. Piccirillo MF, Reissman P, Wexner SD. Colectomy as treatment for constipation in selected patients. Br J Surg 1995; 82:898–901.
    1. Redmond JM, Smith GW, Barofsky I, et al. Physiological tests to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol 1995; 90:748–753.
    1. Christiansen J, Rasmussen OO. Colectomy for severe slow-transit constipation in strictly selected patients. Scand J Gastroenterol 1996; 31:770–773.
    1. de Graaf EJ, Gilberts EC, Schouten WR. Role of segmental colonic transit time studies to select patients with slow transit constipation for partial left-sided or subtotal colectomy. Br J Surg 1996; 83:648–651.
    1. Lubowski DZ, Chen FC, Kennedy ML, King DW. Results of Colectomy for severe slow transit constipation. Dis Colon Rectum 1996; 39:23–29.
    1. Pluta H, Bowes KL, Jewell LD. Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum 1996; 39:160–166.
    1. Platell C, Scache D, Mumme G, Stitz R. A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation. Aust NZ J Surg 1996; 66:525–529.
    1. Ho YH, Tam M, Eu KW, Choen FS. Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation. Aust NZ J Surg 1997; 67:562–565.
    1. Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum 1997; 40:273–279.
    1. Hasegawa H, Radley S, Keighley MRB. Long-term results of colorectal resection for chronic constipation [abstract]. Association of Coloproctology of Great Britain and Ireland conference proceedings 1998. Oxford: Blackwell Science; 1998:3.
    1. You YT, Wang JY, Changchien CR, et al. Segmental colectomy in the management of colonic inertia. Am Surg 1998; 64:775–777.
    1. Ghosh S, Papachrysostomou M, Batool M, Eastwood MA. Long-term results of sub-total colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol 1996; 31:1083–1091.
    1. Bernini A, Madoff RD, Lowry AC, et al. Should patients with combined colonic inertia and nonrelaxing pelvic floor undergo subtotal colectomy? Dis Colon Rectum 1998; 41:1363–1366.
    1. Fasth S, Hedlund H, Svaninger G, et al. Functional results after subtotal colectomy and cecorectal anastomosis. Acta Chir Scand 1983; 149:623–627.
    1. Gray EJ, Marteinsson TH. Dolichocolon: indications for operations. Am Surg 1971; 37:509–511.
    1. Arhan P, Devroede G, Jehannin B, et al. Segmental colonic transit time. Dis Colon Rectum 1981; 24:625–629.
    1. Nicholls RJ, Kamm MA. Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation: report of 2 cases. Dis Colon Rectum 1988; 31:968–969.
    1. Hosie KB, Kmiot WA, Keighley MR. Constipation: another indication for restorative proctocolectomy. Br J Surg 1990; 77:801–802.
    1. Keighley MRB, Grobler S, Bain I. An audit of restorative proctocolectomy. Gut 1993; 34:680–684.
    1. McCourtney JS, Finlay IG. Totally stapled restorative proctocolectomy. Br J Surg 1997; 84:808–812.
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 1983; 67:361–370.
    1. Johansen OB, Wexner SD, Daniel N, et al. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 1993; 36:767–772.
    1. Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 1986; 27:41–48.
    1. Vierhout ME, Schreuder HW, Veen HF. Severe slow-transit constipation following radical hysterectomy. Gynecol Oncol 1993; 51:401–403.
    1. McDonald A, Baxter JN, Bessent RG, et al. Gastric emptying in patients with constipation following childbirth and due to idiopathic slow transit. Br J Surg 1997; 84:1141–1143.
    1. Lincoln J, Crowe R, Kamm MA, et al. Serotonin and 5-hydroxyindoleacetic acid are increased in the sigmoid colon in severe idiopathic constipation. Gastroenterology 1990; 98:1219–1225.
    1. Schouten WR, ten Kate FJ, de Graaf EJ, et al. Visceral neuropathy in slow transit constipation: an immunohistochemical investigation with monoclonal antibodies against neurofilament. Dis Colon Rectum 1993; 36:1112–1117.
    1. Roe AM, Bartolo DCC, Mortenson NJ McC. Slow transit constipation. Comparison between patients with or without previous hysterectomy. Dig Dis Sci 1988; 3:1159–1163.
    1. Smith AN, Varma JS, Binnie NR. Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 1990; 77:1361–1365.
    1. Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39:681–685.
    1. Devroede G, Girard G, Bouchoucha M, et al. Idiopathic constipation by colonic dysfunction. Relationship with personality and anxiety. Dig Dis Sci 1989; 34:1428–1433.
    1. Heyman S, Wexner SD, Gulledge AD. MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum 1993; 36:593–596.
    1. Bassotti G, Gaburri M, Imbimbo BP, et al. Colonic mass movements in idiopathic chronic constipation. Gut 1988; 29:1173–1179.
    1. van der Sjip JRM, Kamm MA, Nightingale JMD, et al. Radioisotope determination of regional colonic transit in severe constipation: comparison with radioopaque markers. Gut 1993; 34:402–408.
    1. Kamm MA. Surgery for idiopathic megarectum and megacolon. In: Kamm MA, Lennard-Jones JE, eds. Constipation. Petersfield, UK: Wrightson Biomedical Publishing Ltd.; 1994: 233–238.
    1. Roberts JP, Newell MS, Deeks JJ, et al. Oral [111In] DTPA scintigraphic assessment of colonic transit in constipated subjects. Dig Dis Sci 1993; 8:1032–1039.
    1. Mclean R, Smart R, Barbagallo S, et al. Colonic transit scintigraphy using oral indium-111-labeled DTPA. Can scan predict the final diagnosis? Dig Dis Sci 1995; 40:2660–2668.
    1. Krevsky B, Maurer AH, Fisher RS. Patterns of colonic transit in chronic idiopathic constipation. Am J Gastroenterol 1989; 84:127–132.
    1. Kamm MA, Lennard-Jones JE. Rectal mucosal electrosensory testing: evidence for a rectal sensory neuropathy in idiopathic constipation. Dis Colon Rectum 1990; 33:419–423.
    1. Bassotti G, Stanghellini V, Chiarioni G, et al. Upper gastrointestinal motor activity in patients with slow-transit constipation. Further evidence for an enteric neuropathy. Dig Dis Sci 1996; 41:1999–2005.
    1. Camilleri M, Hasler WL, Parkman HP, et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998; 115:747–762.
    1. Abdel-Rahman M, Toppercer A, Duguay C, et al. Urorectodynamics in patients with colonic inertia. Urology 1981; 18:428–432.
    1. Knowles CH, Scott SM, Wellmer AC, et al. Sensory and autonomic neuropathy in patients with idiopathic slow transit constipation. Br J Surg 1999; 86:54–60.

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