Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 28, 2012; 18(32): 4441-4446
Published online Aug 28, 2012. doi: 10.3748/wjg.v18.i32.4441
Favorable surgical treatment outcomes for chronic constipation with features of colonic pseudo-obstruction
Eon Chul Han, Heung-Kwon Oh, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park
Eon Chul Han, Heung-Kwon Oh, Heon-Kyun Ha, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
Eun Kyung Choe, Seoul National University Hospital Gangnam Center, Seoul 110-744, South Korea
Author contributions: Han EC and Oh HK contributed equally to this work; Han EC and Oh HK designed the methods, analyzed the data and wrote the manuscript; Choe EK and Ryoo SB interpreted the results; Ha HK and Moon SH co-worked on associated data collection; Park KJ was involved in writing and editing the manuscript.
Correspondence to: Kyu Joo Park, MD, Professor, Department of Surgery, Seoul National University College of Medicine, 101 Daehangno, 28 Yongon-dong, Jongno-Gu, Seoul 110-744, South Korea. kjparkmd@plaza.snu.ac.kr
Telephone: +82-2-20722901 Fax: +82-2-7663975
Received: June 9, 2012
Revised: July 16, 2012
Accepted: July 18, 2012
Published online: August 28, 2012
Abstract

AIM: To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.

METHODS: Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected. We identified a subgroup with colonic pseudo-obstruction (CPO) features, with dilatation of the colon proximal to the narrowed transitional zone, in contrast to typical slow-transit constipation (STC), without any dilated colonic segments. The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.

RESULTS: Of the 42 patients who underwent surgery for constipation, 33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone. There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years. All had symptoms of chronic intestinal obstruction, including abdominal distension, pain, nausea, or vomiting, and the mean duration of symptoms was 67 mo (range: 6-252 mo). Preoperative defecation frequency was 1.5 ± 0.6 times/wk (range: 1-2 times/wk). Thirty-two patients underwent total colectomy, and one patient underwent diverting transverse colostomy. There was no surgery-related mortality. Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients. In contrast, histology of STC group revealed intestinal neuronal dysplasia type B (n = 6) and visceral myopathy (n = 3). Early postoperative complications developed in six patients with CPO; wound infection (n = 3), paralytic ileus (n = 2), and intraabdominal abscess (n = 1). Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d (range: 1-15 times/d). Long-term follow-up (median: 39.7 mo) was available in 32 patients; all patients had improvements in constipation symptoms, but two patients needed intermittent medication for management of diarrhea. All 32 patients had distinct improvements in constipation symptoms (with a mean bowel frequency of 3.3 ± 1.3 times/d), social activities, and body mass index (20.5 kg/m2 to 22.1 kg/m2) and were satisfied with the results of their surgical treatment. In comparison with nine patients who underwent colectomy for STC without colon dilatation, those in the CPO group had a lower incidence of small bowel obstructions (0% vs 55.6%, P < 0.01) and less difficulty with long-distance travel (6.7% vs 66.7%, P = 0.007) on long-term follow-up.

CONCLUSION: Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.

Keywords: Constipation; Total colectomy; Pseudo-obstruction; Surgical outcome; Hypoganglionosis