Surgery for the failed ileorectal or caecorectal anastomosis in chronic constipation

This chapter discusses the reasons for clinical failure after subtotal or total colectomy when the indication is principally for chronic constipation. Well-known side effects of this treatment include diarrhea and urgency as well as fecal incontinence in up to 30 % of operated cases. As an alternative to a more radical resection, segmental left colectomy has been proposed, although the reported results have not been particularly successful: recent comparative, non-randomized data have shown a higher incidence of persistent constipation with a continued requirement for laxatives and enemas postoperatively in those patients undergoing a cecorectal anastomosis when compared with those undergoing an ileorectal anastomosis. The incidence of troublesome diarrhea and fecal incontinence does not, however, seem to differ between these operative groups. This chapter outlines the treatment options available and the approach used when ileorectal or cecorectal anastomoses performed for patients with intractable constipation do not function appropriately.