TITLE

Operative Management of Severe Constipation

AUTHOR(S)
Lahr, Stepanie J.; Lahr, Christopher J.
PUB. DATE
December 1999
SOURCE
American Surgeon;Dec1999, Vol. 65 Issue 12, p1117
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
This report investigates the concept that severe constipation requiring major abdominal surgery may result from one of three common causes: 1) colonic inertia, 2) pelvic hiatal hernia, or 3) both colonic inertia and pelvic hernia. This study evaluates the symptoms, anatomy and outcome in 201 patients with severe surgical constipation treated by a single surgeon. In 2042 patients with constipation referred to one colon and rectal surgeon, 211 major abdominal surgical procedures were performed on 201 patients for severe constipation between 1989 and 1999. There were 187 women and 14 men. Mean age was 49 years (range, 9-84). Five high-risk patients had ileostomy; 196 had major colonic surgery for anatomic or physiologic causes of constipation, excluding malignancy, diverticular disease, and inflammatory bowel disease. Pelvic hiatal hernia was defined as the herniation of bowel through the hiatus of the pelvic diaphragm seen on pelvic videofluoroscopy or physical examination. Of these 196 patients, 44 per cent had pelvic hiatal hernia repair (PHHR), 27 per cent had total abdominal colectomy and ileorectal anastomosis for colonic inertia, and 29 per cent had surgery for both colonic inertia and pelvic hiatal hernia. Of the 144 patients undergoing PHHR, 95 had Gore-Tex Registered Trademark patch (W. L. Gore and Associates, Inc., Phoenix, AZ) sacral colpopexy. PHHR for pelvic hiatal hernia without colonic inertia included sigmoid resection, rectopexy, and Gore-Tex patch sacral colpopexy. Mean duration of follow-up was 20 months. Symptoms noted preoperatively included abdominal pain (84%), straining at stool (90%), incomplete rectal emptying (85%), painful bowel movements (74%), pelvic pain (69%), vaginal bulge (55%), digital assistance with evacuation (35%), and incontinence of stool (38%). Outcome assessed by symptom relief was successful in 89.1 per cent of patients. 8.6 per cent of patient conditions were unchanged, and 2.3 per cent were unsatisfied with the outcome...
ACCESSION #
2603907

 

Related Articles

  • Surgery for constipation. Henry, M.M. // BMJ: British Medical Journal (International Edition);2/11/89, Vol. 298 Issue 6670, p346 

    Examines the efficacy of surgery in treating idiopathic constipation. Causes of constipation; Lack of clinical results of partial colectomy in patients with constipation; Conclusion that surgery cannot be advocated for pelvic outlet obstruction.

  • Intractable constipation in children treated by forceful anal stretch or anorectal myectomy: preliminary communication. Freeman, N. V. // Journal of the Royal Society of Medicine (Supplement);Jan1984, Vol. 77 Issue 3, p6 

    Sixty-one children with intractable constipation admitted between 1978-1981 under the care of the author were studied retrospectively. Ten of these patients were also studied prospectively by means of defaecating proctograms, and pre- and postoperative evoked anal potentials. It was found that...

  • Constipation: A common postoperative complication of cardiac surgery. Myatt, Rebecca // British Journal of Cardiac Nursing;Apr2012, Vol. 7 Issue 4, p172 

    Constipation is a common problem for the cardiac patient in the postoperative period. It can have a profound negative impact on quality of life, which is frequently underestimated by health-care professionals. Active prevention of constipation remains in its infancy with few assessment tools...

  • Surgical Management of Primary Dysmenorrhea: Anything New? Ling, Frank W. // OB/GYN Clinical Alert;Dec2007, Vol. 24 Issue 8, p60 

    In a study of 82 patients with primary dysmenorrhea who had been randomized to undergoing either LUNA or LUNA + PN, the two groups had comparable results (69% improved in the LUNA group; 73% in the LUNA+PN group) at up to 12 months of follow-up. LUNA + PN was associated with more surgical...

  • RECTAL PROLAPSE AND ASSOCIATED CONDITIONS. Andrews, N.J.; Jones, D.J. // BMJ: British Medical Journal (International Edition);7/25/92, Vol. 305 Issue 6847, p243 

    Examines the prolapse of the rectum that causes discomfort during bowel action in Great Britain. Types of rectal prolapse; Occurrence of mucosal prolapse on adults with large hemorrhoids; History of constipation.

  • Eosinophilic colitis. Velchuru, V. R.; Khan, M. A. B.; Hellquist, H. B.; Studley, J. G. N. // Journal of Gastrointestinal Surgery;Oct2007, Vol. 11 Issue 10, p1373 

    Eosinophilic colitis is a rare chronic inflammatory bowel condition of unknown etiology. We report a case of cecal volvulus causing obstruction in a patient with eosinophilic colitis. A 48-year-old lady presented with abdominal pain, constipation, and abdominal distension. Clinically and...

  • Extensive Investigation on Colonic Motility with Pharmacological Testing Is Useful for Selecting Surgical Options in Patients with Inertia Colica. Bassotti, Gabrio; Betti, Cesare; Pelli, Maria Antonietta; Morelli, Antonio // American Journal of Gastroenterology;Jan1992, Vol. 87 Issue 1, p143 

    Three women with idiopathic severe chronic constipation and inertia colica, who failed to respond to medical treatment, were extensively investigated for gut motor function, especially that of the colon. Twentyfour- hour manometric recordings disclosed that motility was severely reduced...

  • Pain or constipation: A difficult choice. Anjan, Trikha; PM, Singh // Journal of Anaesthesiology Clinical Pharmacology;Oct2012, Vol. 28 Issue 4, p426 

    The article discusses how using opioids could lead to constipation following nongastrointestinal surgery. Opioids are used during the perioperative period for pain relief. The drugs inhibit peristalsis by interrupting nerve transmission within the neural pathways which govern the contractions of...

  • PERCUTANEOUS ENDOSCOPIC COLOSTOMY (PEC)--ROLE IN RECURRENT SIGMOID VOLVULUS AND CHRONIC CONSTIPATION. Eltringham, M. T.; Watson, C.; Bain, I. M.; Green, S. E.; Yiannakou, J. Y. // Gut;Apr2004 Supplement 3, Vol. 53, pA19 

    This article presents information on the role of percutaneous endoscopic colostomy (PEC) in recurrent sigmoid volvulus and chronic constipation. PEC is a relatively new technique with several indications. Patients having failed standard methods of conservative treatment for recurrent sigmoid...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics