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

Sunday, May 10, 2026

4:33 PM - 4:38 PM ET

ePoster Presenter(s)

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

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

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

View ePoster

Author(s)

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

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

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
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 disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
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 disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
William R. Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

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

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

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