| Abstract: | Results of the surgical treatment for conservative intractable constipation in 70 adult patients are reviewed. 49 patients with severe symptoms have been treated by partial colectomy as sigmoid colectomy (n = 23) or left hemicolectomy (n = 26). 33 patients underwent colectomy with cecorectal anastomosis (n = 25) or ileorectal anastomosis (n = 8). Out of these patients with colectomy seven had undergone previous segmental colonic resection or internal sphincterotomy. Of those patients with cecorectal anastomosis who were dissatisfied, three underwent ileorectal anastomosis. Overall, a mortality rate of 3.3% and morbidity rate of 22.5 resp. 54.5% for partial and total colectomy were observed. The most frequent occurring complication after colectomy was small bowel obstruction in 30% requiring laparotomy in 40%. Of 45 patients who underwent partial colectomy, 34 (75%) had normal bowel function or were markedly improved. In 28 of 32 patients (87.5%) treated by colectomy a successful result has been achieved. The operation of sigmoid colectomy or left hemicolectomy may be recommended as a treatment for constipation only in patients with less severe symptoms or patients with recurrent sigmoid volvulus. For those patients with severe constipation, at present, colectomy with ileorectal anastomosis seems to be the surgical procedure that offers the greatest probability of improvement. However, the significant morbidity claimed the need for a careful patient selection. |
