Postoperative course and long term follow up after colectomy for slow transit constipation--is surgery an appropriate approach?

OBJECTIVE: Patients with slow transit constipation who do not respond satisfactorily to common medical treatment are considered candidates for colectomy. The present observational long term study was designed to assess outcome after surgery.
METHOD: Twenty consecutive patients were treated by colectomy for slow transit constipation between 1996 and 2004. Preoperative and postoperative data were reviewed by using our institutional database. A questionnaire including validated scoring systems and questions about complications and subsequent surgical interventions was sent to all available patients.
RESULTS: Three patients (15%) died perioperatively. Median long term follow up was 84 months. Ten patients (50%) needed further operations after colectomy: Three patients (15%) had surgery during the early postoperative period, seven patients (35%) during follow up. A total of 31 operations had to be performed in these patients. Twelve patients (86%) responded to the questionnaires. Their median Wexner constipation score was 11.5 (range 8-23). Six patients fulfilled the Rome II criteria for constipation. The median Vaizey incontinence score was 7.5 (range 0-22). The median GIQLI showed 80 points (range 32-129).
CONCLUSION: Morbidity and mortality rate after colectomy were inadmissibly high. Taking into account the poor functional results, we cannot recommend colectomy for slow transit constipation.