CR27P LAPAROSCOPIC TOTAL COLECTOMY FOR SLOW TRANSIT CONSTIPATION

Purpose:   Slow transit constipation (STC) is a debilitating condition mainly affecting young women. Total colectomy (TC) is an option for patients with severe symptoms who are unresponsive to conservative measures. Open TC has been the procedure of choice but is associated with long term SBO and ongoing symptoms. It is difficult to determine if these ongoing symptoms are related to gut dysmotility or to post operative adhesions. Laparoscopic TC appears equivalent open TC with the advantage of being able to perform a diagnostic laparoscopy at a later stage to divide or exclude adhesions as a cause of chronic obstructive symptoms or pain. Methods:   All consecutive patients undergoing a laparoscopic TC ± rectopexy for STC from 1991–2007 were reviewed. Results:   84 patients (81 female, 3 male) were included. Average operating time was 188 min, average LOS 8 days. Conversion rate was 1.2%. There were no post op mortalities. Anastomotic leaks occurred in 2.4%, pelvic collections in 2.4%, intra-abdominal bleeds in 4.7% and 3.5% developed wound infections. Bowel frequency was significantly improved however, 31% had at least 1 episode of obstructive symptoms. Ongoing pain was experienced by 38%. 57% underwent a further procedure a majority of which was a laparoscopy ± division of adhesions. Conclusion:   Lap TC is a feasible and acceptable option for patients with STC with reasonable operating times, low conversion rates and acceptable mortality and morbidity. Bowel frequency is significantly improved however long term chronic pain and SBO are common. Lap TC allows for a minimally invasive laparoscopy to be performed to divide or exclude adhesions as a cause for obstructive symptoms or ongoing pain.