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Is total colectomy the right choice in intractable slow-transit constipation?
- Source :
- Surgery. 140:435-440
- Publication Year :
- 2006
- Publisher :
- Elsevier BV, 2006.
-
Abstract
- 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.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).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.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.
- Subjects :
- Adult
medicine.medical_specialty
Constipation
Colon
Radiography
Pudendal nerve
medicine.medical_treatment
Colonoscopy
Severity of Illness Index
medicine
Humans
Slow transit constipation
Hemicolectomy
Colectomy
Aged
Chronic constipation
medicine.diagnostic_test
business.industry
General surgery
Enema
Middle Aged
Prognosis
Surgery
Treatment Outcome
Chronic Disease
Quality of Life
Female
Peristalsis
medicine.symptom
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 140
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....bb1ec18404fd72080bdcb07e42baa68a