Subtotal colectomy and ileorectal anastomosis for slow transit constipation: clinical follow-up at median of 15 years
| Autor: | C. Pieri, V. Balakrishnan, P. Doherty, Denis W. King, David Z. Lubowski, V. Patton, K. C. Phan-Thien |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Abdominal pain Constipation medicine.medical_treatment 03 medical and health sciences Ileostomy 0302 clinical medicine medicine Humans Gastrointestinal Transit Colectomy business.industry Anastomosis Surgical Rectum Gastroenterology medicine.disease Colorectal surgery Surgery Bowel obstruction Treatment Outcome 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology medicine.symptom business Follow-Up Studies Abdominal surgery Cohort study |
| Zdroj: | Techniques in Coloproctology. 24:173-179 |
| ISSN: | 1128-045X 1123-6337 |
| Popis: | Slow transit constipation is characterised by prolonged colonic transit and reliance on laxatives. The pathophysiology is poorly understood and in its most severe form, total colectomy with ileorectal anastomosis is the final treatment option. We present a follow-up study of the long-term function in patients who had surgery for laxative-resistant slow transit constipation.A postal survey was sent to assess bowel frequency, abdominal pain, St Mark's continence score, satisfaction with procedure, likelihood to choose the procedure again, and long-term rates of small bowel obstruction and ileostomy. Longitudinal data from a subgroup studied 23 years previously are reported.Forty-two patients (male = 2) were available for follow-up out of an initial cohort of 102. Mean time since surgery was 15.9 years (range 1.7-29.7) years. Fifty percent had 4 bowel motions per day, most commonly Bristol stool 6, mean St Mark's score 7.45. Twenty-one percent had severe incontinence. Satisfaction and likelihood to choose surgery were high (median 10/10). There was a high rate of small bowel obstruction, suggesting pan-intestinal dysmotility in some cases. Conversion to ileostomy occurred in 8 patients. In the longitudinal follow-up in 15 subjects, continence deteriorated (p 0.01), stool consistency softened (p 0.01), and stool frequency fell (p 0.01).Satisfactory stool frequency was achieved in the long term, and although 21% had incontinence scores 12, patient satisfaction was high. This is the longest reported follow-up of colectomy for slow transit constipation, with longitudinal outcomes reported. There was considerable attrition of patients, so larger, longitudinal studies are required to better ascertain the functional outcomes of these patients. |
| Databáze: | OpenAIRE |
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