Justification of the diagnostic algorithm and treatment strategies in patients with severe chronic slow-transit constipation

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 ± 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a “segmental” type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the “common” type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.

Full Text

Restricted Access

About the authors

Vadim B. Samedov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: samedov07@rambler.ru
ORCID iD: 0000-0002-4002-6913
SPIN-code: 1969-3264

graduate student

Russian Federation, Saint Petersburg

Pavel N. Romashchenko

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: romashchenko@rambler.ru
ORCID iD: 0000-0001-8918-1730
SPIN-code: 3850-1792

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

Gennady O. Revin

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: grevin@mail.ru
ORCID iD: 0000-0002-9499-2164
SPIN-code: 7946-9000

candidate of medical sciences

Russian Federation, Saint Petersburg


  1. Hassan I, Pemberton JH, Young-Fadok TM, et al. Ileorectal anastomosis for slow transit constipation: Long-term functional and quality of life results. J Gastrointest Surg. 2006;10(10):1330–1337. doi: 10.1016/j.gassur.2006.09.006
  2. Isaev GB, Kerimova TM. Otdalennye rezul’taty subtotal’noj kolektomii u bol’nyh s hronicheskim kolostazom. Vestnik hirurgii Kazahstana. 2018;(1):30–33. (In Russ.).
  3. Xie XY, Sun KL, Chen WH, et al. Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation. Gastroenterol Report. 2019;7(6):449–454. doi: 10.1093/gastro/goz014
  4. Serova LS, Kurygin AA, Kurygin AlA Hirurgicheskoe lechenie tyazhyolyh hronicheskih zaporov. Grekov’s Bulletin of Surgery. 1996;155(1):44–47. (In Russ.).
  5. Majstrenko NA, Kurygin AA, Revin GO. Motornaya funkciya tolstoj kishki pri yazvennoj bolezni i posle operacij na zheludke. Clinical Pathophysiology. 2002;(2):67–72. (In Russ.).
  6. Revin GO, Majstrenko NA, Kurygin AA. Hirurgicheskoe lechenie tyazhyolyh hronicheskih zaporov. Grekov’s Bulletin of Surgery. 2014;173(1):93–97. (In Russ.).
  7. Lacy B, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology. 2016;150(6):1393–1407. doi: 10.1053/j.gastro.2016.02.031
  8. Yuan W, Zhang Z, Liu J, et al. Simplified assessment of segmental gastrointestinal transit time with orally small amount of barium. Eur J Radiol. 2012;81(9):1986–1989. doi: 10.1016/j.ejrad.2011.05.040
  9. Karpukhin OY, Eleev AA, Kutyreva MP, et al. The use of original radiopaque markers in diagnosis of chronic constipation. Koloproktologia. 2016;2:6–11 (In Russ.).
  10. Mikakov AI, Revin GO. Dependence of the results of surgical treatment of patients with chronic constipation from the morphofunctional state of the distal part of the sigmoid colon. Izvestia of the Russian Military Medical Academy. 2018;37 (1S1–2):39–44 (In Russ.).
  11. Fomenko OYU, Morozov SV, Skott SM. Recommendations for the protocol of functional examination of the anorectal zone and disorders classification: the international anorectal physiology working group consensus and russian real-world practice. Therapeutic Archive. 2020;92(12):105–119 (In Russ.). doi: 10.26442/00403660.2020.12.200472
  12. Chedid V, Vijayvargiya P, Halawi H, et al. Audit of the diagnosis of rectal evacuation disorders in chronic constipation. Neurogastroenterol Motil. 2019;31(1):e13510. doi: 10.1111/nmo.13510
  13. Trofimova TN, Pirgulov SN. Irrigoscopy, CT colonography. MRI of the rectum: diagnostics in coloproctology at the present stage of development. Diagnostic Radiology and Radiotherapy. 2016;(4):20–28 (In Russ.). doi: 10.22328/2079-5343-2016-4-20-28
  14. Ivashkin VT, Mayev IV, Sheptulin AA, et al. Klinicheskie rekomendacii Rossijskoj gastrojenterologicheskoj associacii po diagnostike i lecheniju vzroslyh pacientov s hronicheskim zaporom. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014;24(4):70–97. (In Russ.).

Copyright (c) 2021 Samedov V.B., Romashchenko P.N., Revin G.O.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies