Colorectal surgery for functional bowel disorders

• Published in: Journal of visceral surgery 2022-03, Vol.159 (1), p.S35-S39
• Main Authors: Bretagnol, F., Hain, E., Moszkowicz, D., Giovinazzo, D.
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical; Colectomy; Colectomy - methods; Colon - surgery; Constipation - surgery; Constipation - therapy; Humans; Malone procedure; Rectum - surgery; Severe constipation; Surgery; Treatment Outcome
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2021.12.008

•The Malone procedure (antegrade colonic irrigation), a so-called conservative surgery, can be a good therapeutic alternative. Conversely, sacral root neuromodulation has not shown benefit in chronic constipation.•Colectomy has a very limited place in the treatment of chronic constipation and should be offered only after failure of all medical and conservative treatments. Analysis of the literature shows a low level of “evidence-based” data due to the paucity and heterogeneity of the results.•Subtotal colectomy with ileo-rectal anastomosis is the standard surgical procedure.•The success rate after subtotal colectomy is 85%, with a recurrence rate of 15%. Abdominal pain and/or abdominal bloating are noted in 50% of cases.•Adhesion-related small bowel obstruction is the main long-term surgical complication after total colectomy, with a prevalence of 15%.•Other types of surgery (segmental colectomy or ceco-rectal anastomosis) may be offered, but the risk of failure is greater than after subtotal colectomy with ileo-rectal anastomosis. Surgery is a last-resort treatment for the management of severe constipation, an alternative after failure of medical treatment. We can distinguish two types of management: “conservative” colon-sparing surgery, i.e. the Malone procedure (MP), or sacral neuromodulation (SNM), and “radical” surgery such as colorectal resection. While the place of SNM remains to be defined, the MP is well codified and has shown very satisfactory results. For radical treatment, total colectomy with ileo-rectal anastomosis is the reference procedure because it is the best documented. The place of more limited segmental colectomies is poorly defined and needs a more precise identification of the colonic segment involved. Finally, it is imperative that any severe constipation be managed within a multidisciplinary radiology-medico-surgical consultative program. Indeed, a multidisciplinary strategy allows rigorous selection of patients, the only guarantee of better long-term functional results, even though they unfortunately remain uncertain.