Long-term results of colorectal resection for slow transit constipation

Objective To determine the long-term outcome for surgery for slow transit constipation. Patients and methods A long-term retrospective review of 61 patients who had undergone surgery for slow transit constipation between 1977 and 1996. Patients with megabowel, Hirschsprung's disease or primary anorectal pathology were excluded from the study. Results Subtotal colectomy was performed in 48 patients and segmental colectomy in 13. Twenty-four patients (39%) required further surgery. Fourteen patients (23%) eventually had a permanent stoma. Twenty-nine patients (48%) had normal bowel habit and improved symptoms (grade 1) following treatment. The permanent stoma rate was significantly higher in patients with proven psychological disturbance (70% vs 14%, P = 0.0005). Unsatis factory outcomes (grades 3 and 4) were more common in patients with a psychological disorder (n = 10), 70% vs 18% (P = 0.002), and those with slow transit and impaired rectal evacuation, 39% vs 11% (P = 0.025). Satisfactory outcomes (grades 1 and 2) were achieved in 95% of the psychologically stable patients with slow transit constipation after subtotal colectomy. Conclusion The long-term results of surgery for slow transit constipation may be poor. However, a good outcome can be predicted in patients with slow transit constipation without impaired evacuation and overt psychological or psychiatric disease.