Long-term outcome after segmental colonic resection for slow transit constipation

Konstantinos E Tsimogiannis,U Karlbom,W Graf,E Lundin

doi:10.1007/s00384-019-03283-5

Konstantinos E Tsimogiannis, U Karlbom + Show 2 more

Open Access

https://doi.org/10.1007/s00384-019-03283-5

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Abstract

PurposeColectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC.MethodsFifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n = 43) received a bowel function questionnaire and a questionnaire about patient-reported outcome.ResultsAfter a median follow-up of 19.8 years, 13 patients had undergone rescue surgery (n = 12) or used irrigation (n = 1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p = 0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p = 0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients’ global assessment, 10 stated a very good result, seven a good result and two a poor result.ConclusionsHemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders.

Highlights

The clinical presentation of slow transit constipation (STC) is heterogeneous and includes a range of symptoms like abdominal pain, hard stools and bloating [1, 2]
Enemas and pharmaceuticals like prucalopride and linaclotide are firstline treatment [3] but in case of failure, surgery might be considered with colectomy and ileorectal anastomosis (IRA) as a standard procedure [4]
Colectomy with IRA is associated with side effects such as diarrhoea, incontinence and an increased risk of small bowel obstruction (SBO) [5]

Summary

Introduction

The clinical presentation of slow transit constipation (STC) is heterogeneous and includes a range of symptoms like abdominal pain, hard stools and bloating [1, 2]. The idea of a limited resection (e.g., hemicolectomy) is supported by the finding that some patients have a segmental defect in the colonic innervation [6]. This knowledge led to a previous study in our department where right- or left-sided colonic delay was identified with scintigraphy and determined the segment for resection in patients with STC [7, 8]. The short- and medium-term results after hemicolectomy were promising, with a comparable symptomatic relief compared with that after ileorectal anastomosis and possibly less severe side-effects, which could make it a better alternative for selected patients with STC [9].

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