Surgery in Chronic Constip-WPS Office.pptx

The surgery in the condition chronic constipation

1. Chronic Constipation: Patient Characteristics, Indications, and Outcome of Surgery—An Indian Study Ravindra Budhwani1  · Ashok Kumar1  · Yajnadatta Sarangi1 Received: 16 October 2024 / Accepted: 28 December 2024 © Association of Surgeons of India 2025 Present e d b y D r . T h i r u m a l a i s a m y 3 r d y e a r p g Gu i d e - Dr.Mahadevi MS DGO P r o f D r . P . S u m a r t h i M S D G O

2. I n t r o d u c t i o n Chronic constipation i s c o m m o n i n Asian c o u n t r i e s Prev a l e nce I n India - 1 4 % I n i t i a l t r e a t m e n t i s medical , a n d n o t responding T o m e d i c a l t h e r a p y m a y b e n e f i t f r o m s u r g e r y . Here we present our experience with surgery in patients with chronic constipation and its outcomes from a tertiary care teaching hospital in north India. Classified into P r i m a r y a n d s e c o n d a r y t y p e s There is n o expert consensus statements or guidelines from professional societies in Asian countries that specifcally address the type of surgery required for chronic constipation and its outcomes for the Indian p o p u l a t i o n

3. The author previously published with 34 chronic constipation The present study was conducted on 97 patients who underwent surgery, showing improvements in median spontaneous bowel movements and satisfaction with the procedure Spontaneous bowel movement - SBM (SBM) was defned as the passage of stools without using laxatives, enemas, or digital evacuation

4. Patients and Methods retrospective analysis study 97 patients from a prospectively maintained database who had undergone surgery for chronic constipation from November 2009 to March 2021 in the Department of Surgical Gastroenterology at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, a tertiary referral centre in northern India .The data were retrieved from the hospital information INCLUSION CRITERIA constipation with rectal prolapse, slow transit constipation, constipation with rectocele

5. Evaluation clinical history a n d e x a m i n a t i o n Routinely evaluated by colonoscopy, colon transit study,(CTT), manometry, barium enema, and defecography according to their indications.

6. Surgery was considered 1) requiring excessive cathartics (failure of osmotic laxatives to work requiring stimulant laxatives or enema on a regular basis 2) not responding to cathartics (less than 3 bowel movements per week and with unusual, prolonged straining in spite of high dose of laxatives 3) faecal impaction and rectal prolapse on rectal examination 4) gastrointestinal transit test showing slow colonic transit on CTT 5) rectocele confrmed on defecography 6) paradoxical puborectalis syndrome and internal anal sphincter spasms. Response to treatment - was defned by the number of SBM per day, and it was considered satisfactory with a minimum of one SBM per day

7. Surgical Management

8. Post‑op Complications

9. Follow‑Up Follow-up information was available in 54 patients (55.6%), and median follow-up duration was 65.2 months

10. Discussion Once chronic constipation is diagnosed and organic causes are ruled out STC is more common in females In our study, the majority of patients were male (57.7%), the mean age was 44 years, and STC patients were more in the age group of 41–60 years (60%Most p at ie nt s respond to medical treatment, after surgery, the mean frequency increased from 1.1 to 19.7 evacuations per week compared to our study; it increased from a median of 2/week to 8/week in the STC group and in constipation with prolapse group increased from a median of 3.5/week to 10/ week (range 4–24/week)

11. In our study, 23.6% of patients had incontinence overall, 27.9% of patients with constipation with prolapse had incontinence, and 25% of patients in the STC group had incontinence our study, overall, 28.8% of patients had postoperative complications, and the satisfactory rate was 60% with mean follow-up of 65.2 months in patients of chronic constipations overall One of the limitations of our study is that it was a small follow-up with only 55.6% of patients and had no defned criteria for satisfaction as Quality of life (QOL) except that only bowel movement once per day was used

12. Conclusions Detailed clinical history, examination, appropriate investigations, and well-guided surgery will give good functional results in the form of bowel movement, satisfaction, and reduced laxatives requirement with acceptable and endurable morbidities in patients of chronic constipation.