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Outcome of segmental colonic resection for slow-transit constipation.

Lundin, Erik, (författare)
Uppsala universitet, Kolorektalkirurgi
Karlbom, Urban (författare)
Påhlman, Lars, (författare)
Uppsala universitet, Kolorektalkirurgi
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Graf, Wilhelm, (författare)
Uppsala universitet, Kolorektalkirurgi
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Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 89:10
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
  • <p><strong>BACKGROUND:</strong> The standard surgical treatment for slow-transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side-effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.</p><p><strong>METHODS:</strong> Selection criteria included prolonged segmental transit on oral 111In-labelled diethylene triamine penta-acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty-eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.</p><p><strong>RESULTS:</strong> After a median of 50 (range 16-78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0-7) to 7 (0-63) per week (P &lt; 0.001). The number of patients passing hard stools and straining excessively decreased (P = 0.016 and P = 0.041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P &lt; 0.001).</p><p><strong>CONCLUSION:</strong> With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side-effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome.</p>



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