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

Abstract

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.