National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK.
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zrab049.
Colectomy remains a treatment option for a minority of patients with slow-transit constipation (STC) refractory to conservative treatment. However careful patient selection is essential to maximize benefits and minimize risk of adverse outcome. This study determined the proportion of patients with chronic constipation that would meet criteria for colectomy based on recent European graded practice recommendations derived by expert consensus.
Retrospective application of graded practice recommendations was undertaken on a prospectively maintained data set of consecutive adult patients with chronic constipation who underwent whole-gut transit studies using radio-opaque markers. Primary analysis applied contraindications achieving high level of expert consensus (normal whole-gut transit as an absolute contraindication and faecal incontinence as a relative contraindication for colectomy). Secondary analysis applied contraindications with less certain consensus.
Primary analysis of 1568 patients undergoing a whole-gut transit study between January 2004 and March 2016 found 208 (13.3 per cent) met published criteria to be selected for colectomy, with 974 excluded for normal whole-gut transit and 386 for faecal incontinence. Secondary analysis demonstrated high prevalence of other relative contraindications to colectomy: 165 concomitant upper gastrointestinal symptoms, 216 abdominal pain (including 126 irritable bowel syndrome), and 446 evacuation disorder. The majority of patients (416 of 594) had two or more relative contraindications. If these patients were excluded, only 26 (1.7 per cent) chronically constipated patients retrospectively met selection criteria for colectomy.
The retrospective application of selection criteria is a limitation. However, the data highlight the high prevalence of factors associated with poor postoperative outcome and provide further caution to surgeons undertaking colectomy for STC.
结肠切除术仍然是少数对保守治疗无效的慢传输型便秘（STC）患者的治疗选择。然而，为了最大限度地提高获益并降低不良结局的风险，仔细选择患者至关重要。本研究根据最近由专家共识得出的欧洲分级实践建议，确定了符合结肠切除术标准的慢性便秘患者的比例。
对前瞻性维护的连续成人慢性便秘患者全胃肠道转运研究的数据集进行分级实践建议的回顾性应用，这些患者使用不透射线标志物进行全胃肠道转运研究。主要分析应用达成高度专家共识的禁忌症（正常全胃肠道转运为绝对禁忌症，粪便失禁为结肠切除术的相对禁忌症）。次要分析应用共识不太确定的禁忌症。
2004 年 1 月至 2016 年 3 月期间进行全胃肠道转运研究的 1568 例患者的主要分析发现，208 例（13.3%）符合发表的选择结肠切除术的标准，974 例因正常全胃肠道转运而被排除，386 例因粪便失禁而被排除。次要分析显示，结肠切除术的其他相对禁忌症的患病率很高：165 例伴有上消化道症状，216 例腹痛（包括 126 例肠易激综合征），446 例排便障碍。大多数患者（594 例中有 416 例）有两个或更多的相对禁忌症。如果排除这些患者，只有 26 例（1.7%）慢性便秘患者回顾性地符合结肠切除术的选择标准。
选择标准的回顾性应用是一个限制。然而，这些数据突出了与术后不良结局相关的因素的高患病率，并为进行结肠切除术治疗 STC 的外科医生提供了进一步的谨慎。
