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Int Surg. 2000 Oct-Dec;85(4):309-12.
Subtotal colectomy for colonic inertia.

Fan CW, Wang JY.

Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.

The aim of this study was to assess the outcome of subtotal colectomy for colonic inertia (idiopathic slow transit constipation) that was resistant to laxative treatment. Twenty-four patients, 19 women and 5 men, with a mean age of 37 years, underwent subtotal colectomy with ileorectal or ascendo-rectal anastomosis. All patients were available for follow-up, with a mean follow-up of 23 months. Bowel frequency was significantly increased from 1.4+/-0.9 times per week to 22.8+/-9 times per week (average 3.2/day) after surgery (P <0.0001). The incidence of abdominal pain was decreased from 75% to 17%, as well as the severity (P <0.0001). Two patients who underwent ascendo-rectal anastomosis developed recurrent constipation. Two patients used antidiarrheal medication regularly. There was no major postoperative morbidity. Five patients were re-admitted due to small bowel obstruction; four received successful conservative management, and one required enterolysis. 'Excellent' or 'good' outcomes were reported by 21 patients (87.5%). Subtotal colectomy with ileorectal anastomosis produces satisfactory results in the majority of patients with proven colonic inertia.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11589597&dopt=Abstract constipation laxative

Dis Colon Rectum. 2001 Oct;44(10):1514-20.
Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation.

Sarli L, Costi R, Sarli D, Roncoroni L.

Institute of General Surgery, University of Parma, School of Medicine, Parma, Italy.

PURPOSE: Functional results of total colectomy with ileorectal anastomosis for the treatment of chronic constipation caused by colonic inertia are often considered unsatisfactory because of the frequency of postoperative diarrhea and the high rate of postoperative small-bowel obstruction. Patients affected by severe colonic inertia underwent a subtotal colectomy with a novel antiperistaltic cecorectal anastomosis. The aim of the study was to assess the functional results after preservation of the cecorectal junction. METHODS: Eight females affected by isolated colonic inertia and two females with both paradoxical puborectalis contraction and colonic inertia, of a median age of 40 years, underwent subtotal colectomy with antiperistaltic cecorectal anastomosis. Before antiperistaltic cecorectal anastomosis all ten patients were laxative-dependant, with a mean bowel frequency of ten days; eight of them (80 percent) had distention, seven (70 percent) bloating, and three (30 percent) abdominal pain. RESULTS: There was no mortality or major postoperative morbidity. One month after antiperistaltic cecorectal anastomosis, bowel frequency was a mean of 2.2 (range, 1-4) per day, with a semiliquid stool consistency. After one year, bowel frequency was a mean of 1.3 (range, 0.5-3) per day, with a solid stool consistency; the same results were recorded at last follow-up. Although no patients used antidiarrheal medicine, laxatives continued to be used by both patients with paradoxical puborectalis contraction. All ten (100 percent) of the patients reported a good or improved quality of life. CONCLUSION: This preliminary experience seems to show that antiperistaltic cecorectal anastomosis is safe and effective for pati

Gastrointest Endosc. 2001 Nov;54(5):558-62.
Factors predictive of difficult colonoscopy.

Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, Coman E, Polito J.

Department of Gastroenterology and Hepatology, State University of New York at Stony Brook, 11794, USA.

BACKGROUND: Prediction of a technically difficult colonoscopy may influence patient selection and procedure scheduling. Identification of predictive factors may be difficult because a common endpoint used to evaluate the success of colonoscopy is intubation of the cecum, which is usually achieved. The goal of this study was to examine the feasibility of using an alternative measure, time required for cecal intubation, to identify factors that can impact performance of colonoscopy. METHODS: The time required for cecal intubation was prospectively recorded for 802 consecutive outpatient colonoscopies performed by 7 experienced gastroenterologists. Patient data collected included height, weight, age, bowel habits, surgical history, and findings at colonoscopy. Forty-seven examinations that were stopped because of disease or unacceptable bowel preparation were excluded. The impact of the patient characteristics of the remaining sample of 755 patients on the median time required for cecal intubation for men and women was examined. RESULTS: Older age and female gender, body mass index < or =25.0 (regardless of gender), diverticular disease in women, and a history of constipation or reported laxative use in men were predictors of difficult colonoscopy. CONCLUSIONS: By using median time required for cecal intubation, several patient characteristics were identified that may predict technical difficulty at colonoscopy. These findings have implications for practice and teaching.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11677470&dopt=Abstract constipation laxative

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