Role of Colonic Transit Study in Determining the Results of a Subtotal Colectomy for Colonic Inertia

Nam, Young Soo; Wexner, Steven D

Abstract

PURPOSE: The results of a subtotal colectomy in colonic inertia, even those reported in the most recent literature, vary dramatically. The purpose of this study was to assess the effect of a colonic transit study on the results of a subtotal colectomy in colonic inertia. METHODS: Between 1992 and 1997, 30 patients underwent a subtotal colectomy with ileorectal anastomosis due to colonic inertia. Twenty-one of them underwent a colonic transit study only one time preoperatively, and 9 patients underwent such a study two times. The success rate was calculated using traditional definition with two sets of criteria. We modi fied the criteria of success by including new symptoms, such as abdominal, pelvic, or rectal pain, difficult evacuation, and loose stool or diarrhea. The success rate was recalculated using our more stringent cri teria, and compared between group 1 and group 2. RESULTS: By the traditional definition, the functional success rate was 100% for patients undergoing a colonic transit study two times preoperatively and 90% for patients undergoing only one study (p=0.34). By our more stringent criteria, the success rate was 100% for patients undergoing studies two times and 62% for those undergoing only one study (p=0.03).
CONCLUSIONS
The success rate of a colectomy for colonic inertia was significantly higher for patients who underwent a repeat transit study than for those who underwent a single study. Patients who have two or more transit studies to confirm the diagnosis of inertia have a significantly higher probability of postoperative improvement of both bowel frequency and associated symptoms, such as pain and difficult evacuation. The mechanism for this discriminatory effect of repeated colonic transit studies requires elucidation by further study.