Long-term results of surgery for chronic constipation

Dis Colon Rectum. 1997 Mar;40(3):273-9. doi: 10.1007/BF02050415.


Background: Developments in anorectal physiologic testing have facilitated better understanding of the process of defecation and factors that might cause chronic constipation.

Aim: Patients with severe idiopathic chronic constipation were evaluated using colonic transit and pelvic floor function in an attempt to identify those patients suitable for aggressive surgical intervention.

Materials and results: Among 1,009 patients studied using either a marker or scintigraphic transit technique and tests of pelvic floor function, 52 with slow-transit constipation (STC) were identified and underwent abdominal colectomy and ileorectostomy (IRA). Twenty-two patients had pelvic floor dysfunction and STC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without evidence of slow-transit and were offered pelvic floor retraining alone. The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constipation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, seven patients (9 percent) had small-bowel obstruction, and nine patients (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the results of surgery, and 90 percent have a good or improved quality of life. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction.

Conclusion: Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery. IRA is safe and effective, resulting in prompt and prolonged relief of constipation.

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Constipation / classification
  • Constipation / diagnosis
  • Constipation / physiopathology
  • Constipation / surgery*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Transit
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Patient Selection
  • Pelvic Floor / physiopathology
  • Quality of Life
  • Time Factors
  • Treatment Outcome