Is subtotal colectomy a viable option in the management of chronic constipation?

To determine if subtotal colectomy constitutes a valuable alternative in the treatment of patients with chronic constipation, a retrospective review of 52 consecutive patients who underwent subtotal colectomy between January 1980 and August 1985 was undertaken. Forty-six patients underwent ileodistal sigmoidostomy while five patients underwent ileoproctostomy and five with concomitant rectal prolapse underwent simultaneous proctopexy. A mortality rate of 3.8 percent and morbidity rate of 60 percent were encountered. The most frequently occurring complication was small-bowel obstruction, which occurred in 36 percent, and necessitated laparotomy in 66 percent. Additional procedures were necessary in five patients because of newly discovered rectal prolapse (two patients), rectocele (one patient), unrelieved constipation (one patient), and incapacitating incontinence (one patient). Follow-up data available in 94 percent (mean, 46 months) disclosed that patients had an average of 2.8 bowel movements per day without the use of laxatives (89 percent) or enemas (80 percent). Overall, 79 percent were satisfied with the final outcome. It is concluded that subtotal colectomy constitutes a viable option in the treatment of chronic constipation. However, the significant morbidity and mortality associated with the procedure dictate the need for careful patient selection on the basis of appropriate physiologic testing.