eP319 - Functional Outcomes and Quality of Life Following Colectomy for Slow Transit Constipation with Ileosigmoid versus Ileorectal Anastomosis: A Case Series

Purpose/Background: Constipation is a common condition with prevalence estimated as high as 19%. In particular, slow transit constipation is a primary motility disorder of the colon that may not respond effectively to medical therapies. There is conflicting data about the benefit of subtotal colectomy for treatment of medically refractory slow transit constipation. This study aimed to use a standardized, validated set of questions to evaluate the postoperative functional outcomes and quality of life in patients undergoing subtotal colectomy with ileosigmoid versus ileorectal anastomosis for slow transit constipation.Methods/Interventions: A retrospective chart review and telephone interview were conducted for 24 patients who underwent subtotal colectomy for slow transit constipation between 2006 and 2017 at a single institution. Patient demographic, medical, surgical, and preoperative information were obtained. Interview questions were selected from the Gastrointestinal Quality of Life Index, with a focus on questions relevant to slow transit constipation. Data was analyzed with univariate analysis and cumulative logistic regression modeling. Comparison was made between those who underwent ileosigmoid versus ileorectal anastomosis.Results/Outcomes: Postoperatively, 25% of patients continued to experience constipation most or all of the time while 29% reported diarrhea most or all of the time. 46% and 54% of patients underwent ileosigmoid and ileorectal anastomosis, respectively. Compared to ileosigmoid anastomosis, those with ileorectal anastomosis were more likely to experience diarrhea (OR 0.20, CI 0.06-0.73) and urgent bowel movements (OR 0.21, CI 0.04-0.99). Ileosigmoid anastomosis did not increase likelihood for continued constipation (OR 1.29, CI 0.29-5.87). Patients’ postoperative quality of life varied widely.Conclusion/

Discussion: Patients who undergo subtotal colectomy for slow transit constipation have varying experiences. Some continue to have constipation while others have resulting diarrhea and urgency. When comparing anastomosis type, those with ileorectal anastomosis are more likely to experience diarrhea and urgency, while those with ileosigmoid anastomosis are not at increased risk of continued constipation. Patient counseling and selection for surgery with consideration of anastomosis type is important as surgery may change symptomatology but may not improve patient’s overall quality of life. Study limitations include small sample size and no preoperative interview for comparison.