|| Checking for direct PDF access through Ovid
The aetiology of chronic constipation is often unknown but it is likely to be multifactorial. Surgery may be undertaken if medical therapies fail. Outcomes following surgery are variable. The incidence of complications is high. Wepresent a review of the surgical management of patients with constipation over a 25-year period.A retrospective review of the case notes of all patients treated surgically for constipation between 1984 and 2009 by a single surgeon operating at one site.Thirty-five patients underwent surgery (33 female). Seven patients had a history of psychologicalproblems. Ileostomy was formed initially in 11 patients; eight went on to have further surgery. Seven patients underwent subtotal colectomy and ileorectal anastomosis as their firstprocedure. A trial of sacral nerve stimulation was attempted in seven patients; it was successful in two. Twelve patients improved following surgery; nine remain constipated. Sixteen patients still have a stoma. There were ten reported complications.Surgery may be appropriate in carefully selected patients. The formation of an ileostomy is helpful either as a temporary measure to achieve respite beforeproceeding to subtotal colectomy and ileorectal anastomosis or as a permanent way of managing the condition.