EP648 - Subtotal colectomy with ileorectal anastomosis for slow-transit constipation: Postoperative outcomes and long-term functional success

ePoster Presenter(s)

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  Ana Sofia Ore, MD MSc MPH (she/her/hers)

  Colon & Rectal Surgery Fellow
  Mayo Clinic Rochester
  Mayo Clinic - Rochester
  Rochester, Minnesota, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Maxwell D. Mirande, DO (he/him/his)

  Colon and Rectal Surgery Fellow
  Mayo Clinic
  Mayo Clinic Rochester
  Rochester, MN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AA

  Ahmed Amine Alaoui, MD MPH

  Colon and Rectal Surgery Fellow
  Mayo Clinic
  Mayo Clinic
  Rochester, MN, United States

  Disclosure information not submitted.
• 

  Matas Jakubauskas, MD, PhD (he/him/his)

  Colorectal surgery fellow
  Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
  Mayo Clinic, Rochester, Minnesota
  Rochester, MN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Danilo Tueme de la Pena, MD (he/him/his)

  Colon and Rectal Surgery Fellow
  Mayo Clinic
  Mayo Clinic
  Rochester, MN, United States

  Disclosure information not submitted.
• 

  Kellie L. Mathis, M.D. (she/her/hers)

  Professor of Surgery
  Mayo Clinic
  Mayo Clinic
  Oronoco, Minnesota, United States

  Disclosure information not submitted.
• 

  Robert Roland Cima, MD

  Professor of Surgery
  Mayo Clinic
  Mayo Clinic, Rochester
  Rochester, MN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  William R. Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

  Associate Professor of Surgery
  Mayo Clinic
  Mayo Clinic
  Rochester, Minnesota, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• NM

  Nicholas P. McKenna, M.D.

  Assistant Professor of Surgery
  Mayo Clinic
  Rochester, Minnesota, United States

  Disclosure information not submitted.

Purpose/Background: Surgery is an option for slow-transit constipation that is refractory to medical therapy. Subtotal colectomy with ileorectal anastomosis is the preferred approach with reported improvement in motility and reduction of constipation symptoms. However, concern remains as to the resultant surgical morbidity and functional outcomes. This study set out to ascertain the rate of postoperative functional failure after subtotal colectomy with ileorectal anastomosis.

Methods/Interventions: A retrospective chart review was conducted of all consecutive patients with slow transit constipation undergoing subtotal colectomy with ileorectal anastomosis at a large tertiary care referral center between January 2006 and January 2025. Preoperative characteristics, details of constipation work-up and medical treatment, operative characteristics, and postoperative outcomes, including long-term functional outcomes were collected. Postoperative functional failure (PFF) was measured as a composite primary outcome which included: conversion to end ileostomy, severe incontinence, or persistent constipation. Postoperative functional failure over time was determined with Kaplan Meier method. Univariate Cox regression followed by multivariable Cox regression was used to identify hazard ratios of risk factors associated with postoperative functional failure.

Results/Outcomes: During the study period, 80 patients (92.5% female, n=74) with a median age of 42 years underwent subtotal colectomy with ileorectal anastomosis. The median time of constipation symptoms prior to surgery was 10 years and all patients had failed medical management. Almost a third of patients (28.8%, n=23) had previous surgical intervention for constipation with the most common being a diverting loop ileostomy (n=13). Most operations were done laparoscopically (95.0%, n=76), and a diverting loop ileostomy was used in 7.5% (n=6). The median length of stay was 5 days (interquartile range (IQR), 3-9). The most common complications were ileus (19%, n=15) and anastomotic leak (10%, n=8). Median follow up time after surgery was 463 days (IQR, 131-1,889). 49.3% of patients reported 5 or more bowel movements a day. When evaluating the primary outcome, 22.5% (n=18) patients experienced PFF. This translated to an estimated 3-year PFF rate of 30% (95% CI 19.4-45.4%) and an estimated 5-year PFF of 37.2% (95% CI 24.4-53.8%). On multivariable analysis, unplanned reoperation after index surgery (HR 3.5, 95% CI 1.2-9.6) was associated with PFF.

Conclusion/Discussion: This 20-year experience with subtotal colectomy and ileorectal anastomosis for slow-transit constipation demonstrated a 70.0% functional success rate at 3 years with unplanned reoperation as a significant risk factor for functional failure. Additional studies using objective measures of success and longer follow-up will be necessary to confirm durability of this operation.

Postoperative Functional Failure After Ileorectal Anastomosis
Postoperative functional failure (composite primary outcome) which included: conversion to end ileostomy, severe incontinence, or persistent constipation