Successful surgical treatment of idiopathic colonic dysmotility. The role of preoperative evaluation of coloanal motor function.

Identification of patients with severe idiopathic colonic dysmotility who would benefit from surgery can be difficult. Colonic transit studies and anorectal manometry were applied to 12 women with severe constipation before subtotal colectomy. Delayed transit was noted in all patients with most exhibiting left-sided colonic arrest. Mean anal resting pressure and rectal capacity were similar to that in healthy controls. Pathologic examination results revealed decreased argyrophilic neurons in the colonic myenteric plexus. At 24 months postoperatively, all patients were satisfied with their results and mean (+/- SEM) weekly bowel movement frequency was 17 +/- 3 (compared with 0.8 +/- 0.2 preoperatively). Preoperative coloanal function studies therefore aid in the selection of patients who will be successfully treated by surgery. Subtotal colectomy with ileorectal anastomosis is the preferred operation because dysmotility can originate from either side of the colon.