[Subtotal colectomy with ceco-rectal anastomosis (Deloyers) for severe idiopathic constipation: an alternative to total colectomy reducing risks of digestive sequelae].

PURPOSE: Functional results of total colectomy (TC) and ileorectal anastomosis for colonic inertia are often impaired by postoperative obstruction and diarrhea. In order to avoid these postoperative complications, we propose a subtotal colectomy (STC) preserving the ileo-caecal junction.

METHODS

Since 1989, 18 consecutive patients (17 F, 1 M; mean age: 54 years) with intractable constipation underwent TC (n = 6) or STC with caecorectal anastomosis (Deloyers Procedure) (n = 12). Mean preoperative bowel frequency was two movements every month. Colonic inertia was defined as diffuse marker delay during transit study without obstructed defecation on manometry or digitalised rectography. Rectocele (n = 10), rectal (n = 5) and genital prolapse (n = 6) were treated in the same operative time.

RESULTS

Postoperative course was uneventful after STC but bowel obstruction, requiring laparotomy, occurred in 3 patients (50%) after TC: enterolysis (n = 2), bowel resection (n = 2). Mean postoperative day stool frequency of TC (4.2 +/- 1.2) was higher than STC (1.2 +/- 0.1). Half of patients after TC needed anti-diarrheal treatment and diet, 33% had rectal evacuation difficulties despite liquid stools, 17% had episodic incontinence, 66% had persistent abdominal pain. Compared to TC, the functional results of STC were significantly better: regular normal transit return without diet or treatment in 75% of cases, 25% had rectal emptying difficulties easily treated by mild laxatives, only 17% had persistent abdominal pain. Postoperative obstruction, diarrhea or fecal incontinence never occurred after STC.

CONCLUSION

Compared to TC, STC with Deloyers procedure seems to reduce significantly the postoperative incidence of bowel obstruction, diarrhea and abdominal pain. Expected regular transit return after STC needs a careful selection of patients and simultaneous treatment of ano-rectal and pelvic floor abnormalities frequently associated with colonic inertia.