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Is total colectomy the right choice in intractable slow-transit constipation?
Surgery. 2006 Sep; 140(3):435-40.S

Abstract

BACKGROUND

The aim of the study was to evaluate the functional results of surgical treatment for intractable slow-transit constipation and to establish that the importance of correct diagnosis and type of colon resection (total or segmental) is essential to achieve optimal outcome while minimizing side effects.

METHODS

Between 1995 and 2004, of the 450 patients presenting with chronic constipation, we further investigated 33 patients with a diagnosis of slow-transit constipation that had not improved with medical or rehabilitative treatment. Preoperative evaluation included a daily evacuation diary compiled using Wexner score, psychologic assessment, Medical Outcomes Study 36-item Short Form Health Survey (SF-36), radiologic investigation of colonic transit time, enema radiograph, colpo-cysto-defecography, anal manometry, and, in selected patients, colonoscopy and pudendal nerve terminal motor latency. In 15 cases, the cause of constipation was colonic slow-transit (with a mean Wexner score of 22), which was always associated with dolichocolon. The other 18 patients presented outlet obstruction, and, therefore, these results are not included in the present report. The 15 patients with slow-transit constipation were submitted to total laparoscopic colectomy (2), total open colectomy (6), and left laparoscopic hemicolectomy for left colonic slow-transit (7).

RESULTS

Mean follow-up was 38 months. All patients except 1 presented improvement in symptoms with daily evacuations (P < .01; mean Wexner score, 6). Furthermore, results of the SF-36 test showed an improvement in the perception of physical pain, and the emotional, psychologic, and general health spheres after surgical treatment.

CONCLUSIONS

Meticulous preoperative evaluation of intractable slow-transit constipation may discriminate between the different causes of chronic constipation and thus avoid the well-known "Iceberg syndrome," which is responsible for many treatment failures.

Authors+Show Affiliations

Department of Digestive Diseases, Campus Bio-Medico University of Rome, Italy. v.ripetti@unicampus.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16934606

Citation

Ripetti, Valter, et al. "Is Total Colectomy the Right Choice in Intractable Slow-transit Constipation?" Surgery, vol. 140, no. 3, 2006, pp. 435-40.
Ripetti V, Caputo D, Greco S, et al. Is total colectomy the right choice in intractable slow-transit constipation? Surgery. 2006;140(3):435-40.
Ripetti, V., Caputo, D., Greco, S., Alloni, R., & Coppola, R. (2006). Is total colectomy the right choice in intractable slow-transit constipation? Surgery, 140(3), 435-40.
Ripetti V, et al. Is Total Colectomy the Right Choice in Intractable Slow-transit Constipation. Surgery. 2006;140(3):435-40. PubMed PMID: 16934606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is total colectomy the right choice in intractable slow-transit constipation? AU - Ripetti,Valter, AU - Caputo,Damiano, AU - Greco,Santi, AU - Alloni,Rossana, AU - Coppola,Roberto, PY - 2005/06/09/received PY - 2006/02/09/revised PY - 2006/02/10/accepted PY - 2006/8/29/pubmed PY - 2006/10/6/medline PY - 2006/8/29/entrez SP - 435 EP - 40 JF - Surgery JO - Surgery VL - 140 IS - 3 N2 - BACKGROUND: The aim of the study was to evaluate the functional results of surgical treatment for intractable slow-transit constipation and to establish that the importance of correct diagnosis and type of colon resection (total or segmental) is essential to achieve optimal outcome while minimizing side effects. METHODS: Between 1995 and 2004, of the 450 patients presenting with chronic constipation, we further investigated 33 patients with a diagnosis of slow-transit constipation that had not improved with medical or rehabilitative treatment. Preoperative evaluation included a daily evacuation diary compiled using Wexner score, psychologic assessment, Medical Outcomes Study 36-item Short Form Health Survey (SF-36), radiologic investigation of colonic transit time, enema radiograph, colpo-cysto-defecography, anal manometry, and, in selected patients, colonoscopy and pudendal nerve terminal motor latency. In 15 cases, the cause of constipation was colonic slow-transit (with a mean Wexner score of 22), which was always associated with dolichocolon. The other 18 patients presented outlet obstruction, and, therefore, these results are not included in the present report. The 15 patients with slow-transit constipation were submitted to total laparoscopic colectomy (2), total open colectomy (6), and left laparoscopic hemicolectomy for left colonic slow-transit (7). RESULTS: Mean follow-up was 38 months. All patients except 1 presented improvement in symptoms with daily evacuations (P < .01; mean Wexner score, 6). Furthermore, results of the SF-36 test showed an improvement in the perception of physical pain, and the emotional, psychologic, and general health spheres after surgical treatment. CONCLUSIONS: Meticulous preoperative evaluation of intractable slow-transit constipation may discriminate between the different causes of chronic constipation and thus avoid the well-known "Iceberg syndrome," which is responsible for many treatment failures. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/16934606/Is_total_colectomy_the_right_choice_in_intractable_slow_transit_constipation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(06)00155-3 DB - PRIME DP - Unbound Medicine ER -