This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Outcome of segmental colonic resection for slow‐transit constipation. BJS 2002; 89: 1270-1274.
Published: 29th November 2002
Authors: E. Lundin, U. Karlbom, L. Påhlman, W. Graf
Background
The standard surgical treatment for slow‐transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side‐effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.
Method
Selection criteria included prolonged segmental transit on oral 111In‐labelled diethylene triamine penta‐acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty‐eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.
Results
After a median of 50 (range 16–78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0–7) to 7 (0–63) per week (P < 0·001). The number of patients passing hard stools and straining excessively decreased (P = 0·016 and P = 0·041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P < 0·001).
Conclusion
With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side‐effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome. © 2002 British Journal of Surgery Society Ltd
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