What are the indications for colon resection (colectomy) in patients with slow-transit constipation?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Colonic inertia, a very specific form of slow-transit constipation, may be treated with subtotal colectomy. Surgery is advised when diagnostic tests such as a sitz marker study reveal profound dysmotility of the colon. Medical measures (eg, fiber supplementation, stool softeners, laxatives, enemas, rectal suppositories, and biofeedback) should be tried first. In addition, the surgeon should also evaluate the patient for obstructive defecation and pelvic floor dysfunction as part of the preoperative workup.

Obstructive defecation, whether due to muscle dysfunction or a rectocele, may coexist with a transit abnormality. If the patient has both, the obstructive defecation should ideally be resolved before surgery, but if it cannot be resolved, the surgeon may still proceed with colectomy. If a colon resection is to be performed, a subtotal colectomy with an ileorectal anastomosis is the procedure of choice.

There is some controversy in this area. Many surgeons believe that leaving some of the distal sigmoid colon may help prevent debilitating diarrhea. Partial colon resection has met with very limited success in the past and has been abandoned by the overwhelming majority of surgeons. [13] Preoperatively, the surgeon should obtain objective documentation of slow colonic transit by ordering a colon transit study. Tests such as anorectal manometry, electromyography (EMG), and defecography are useful in assessing for obstructive causes.

The surgeon should also be wary of patients who have adult-onset constipation. Both iatrogenic (eg, narcotic use, medicinal side effects) and psychological causes of constipation (eg, voluntarily withholding stools out of fear of pain or fear of public restrooms) should be ruled out. Colectomies should be performed only in psychologically stable patients with an identifiable physiologic abnormality.


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