Colonic Inertia
Colonic Inertia
Colonic Inertia
DOI 10.1007/s00595-012-0464-6
ORIGINAL ARTICLE
Abstract
Purpose To assess the functional outcomes and quality of
life in patients with laparoscopic total colectomy for slowtransit constipation (STC).
Methods All patients undergoing laparoscopic colectomy
with ileorectal anastomosis for colonic inertia at two
referral centers were analyzed. Their preoperative, intraoperative and postoperative details were recorded with a
one-year follow-up. Their quality of life was assessed using
the SF-36 questionnaire.
Results Between 2004 and 2007, 710 patients were
evaluated. Eight female patients (1.1 %) fulfilled the criteria for STC without obstructive defecation syndrome.
Their mean age was 38 years 15 (range from 22 to 62).
The conversion rate was 12.5 %. The morbidity rate was
37.5 %, and mortality was nil. The preoperative abdominal
pain was 6.6 0.3 and had decreased to 3.6 2.3 postoperatively (P = 0.008). At 1 year, the defecation frequency per week had increased from 0.84 0.24 to
6.75 3.4 (P = 0.001). Three patients developed
Introduction
Constipation is a common symptom affecting between 2
and 34 % of the general population in Western countries.
This disease is responsible for over 2.5 million medical
consultations per year in the United States, and predominantly affects females with risk factors such as physical
inactivity, low socioeconomic status, a limited education,
depression, and those with a history of sexual abuse [1, 2].
Constipation has been defined as the incapacity to
evacuate the bowel in a complete and spontaneous form at
least three or more times a week. In addition, most patients
with constipation present one or more of the following
symptoms: hard infrequent stools, excessive straining, a
feeling of incomplete evacuation, excessive time attempting to evacuate or as dissatisfaction with defecation [36].
This condition has been classified in three types:
(1) constipation with normal colonic transit, (2) constipation
with slow colonic transit, and (3) outlet obstruction. Slowtransit constipation (STC) is characterized by a loss in the
motor activity of the bowel, occurring more frequently in
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Results
Between 2004 and 2007, 710 patients were evaluated for
constipation in two referral centers. Eight female patients
(1.1 %) fulfilled the criteria for STC without obstructive
defecation syndrome. All patients were included after a
failure of medical treatment. The mean age of these
patients was 38 years 15 (range 2262 years). The
anastomoses performed were end-to-side in three and endto-end in five patients. A conversion to open surgery was
needed in one of the patients (12.5 %). None of the patients
had anastomotic leakage detected by the hydropneumatic
test performed during surgery. With regard to the surgical
variables, the median skin incision length was 5 cm (range
47 cm), the median length of the operation was 240 min
(range 150320 min), and the median intraoperative blood
loss was 100 ml (range 50180 ml). Abdominal distention
was present in seven patients before the surgery and in
three after the surgery (87.55 vs. 37.5 %, P = 0.034). The
quantification of preoperative abdominal pain was
6.6 0.3 (range from 4 to 8) and decreased to 3.6 2.3
postoperatively (range from 2 to 8; P = 0.008). The
number of patients with nausea prior to surgery was six,
and had decreased to two after the procedure (P = 0.157).
Vomiting during a 1-week period was reported by four
patients before the surgery and by only one patient after
surgery (P = 0.034). None of the patients was incontinent
to gases, liquids or solid stool before or after the procedure.
Three patients presented with nocturnal leakage after the
surgery (37.5 %).
The median bowel movements per week, the quantity of
laxatives used per day and the percentage of patients who
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Discussion
The majority of patients with constipation are treated with
simple measures such as changes in their diet and the use of
laxatives; however, when the condition proves to be
recalcitrant, it is imperative to rule out secondary causes,
among which may be metabolic, organic or pharmacological factors. Chronic primary constipation is present in up
to 9.9 % of patients; these are the ones who must be
evaluated for the possibility of surgical treatment. Total
abdominal colectomy with ileorectal anastomosis is the
Table 1 Number of bowel movements, laxatives used and defecatory
maneuvers used before and after surgery
Outcomes
Before
surgery
One-year
follow-up
0.84 0.24
(12)
6.75 3.45
(112)
0.001
4.12 (39)
0.37 (03)
0.0001
62.5
25
0.157
* Mean (range)
One-year follow-up
Physical function
37.5 17.7
88.7 10.2
Role physical
37.5 17.6
83.3 14.4
0.002
Bodily pain
21.6 20.2
81.2 24.6
0.009
General health
18.5 17.9
77.12 18.88
Vitality
10 13
83 14.4
0.0001
0.001
0.0001
Social function
18.7 23.9
85.7 28
Role emotional
37.5 20.9
93.7 12.5
0.001
0.0001
Mental health
41.2 25.03
87.14 12.8
0.001
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