Quality of life after subtotal colectomy for slow-transit constipation - Both quality and quantity count

Purpose: Subtotal colectomy reliably increases bowel-movement frequency in patients with slow-transit constipation, but its impact on quality of life is unknown. The purpose of this study was to assess the relationship between functional outcomes and quality of life after subtotal colectomy for slow-transit constipation. Methods: We reviewed the charts and operative reports of all patients who underwent subtotal colectomy for slow-transit constipation from January 1992 to June 2001. We sent them a 54-question survey that inquired about bowel function and included a modified 36-item gastrointestinal quality-of-life index. Using Pearson's R, we correlated gastrointestinal quality-of-life index scores with specific functional outcomes. Results: Of 112 patients (109 females), 28 had been lost to follow-up and 2 had died. In all, 75 surveys ( 7 percent) were returned. Most of these 75 patients (81 percent) were at least somewhat pleased with their bowel-movement frequency, but 41 percent cited abdominal pain; 21 percent, incontinence; and 46 percent, diarrhea at least some of the time. The overall mean gastrointestinal quality-of-life index score was 103+/-22 of a maximum possible score of 144 (mean score for healthy controls, 126+/-13). We found no correlation between frequency of bowel movements and gastrointestinal quality-of-life index score (R=-0.03). Abdominal pain, diarrhea, and incontinence each had a statistically significant negative impact on gastrointestinal quality-of-life index scores (P=0.01). Patients who required permanent ileostomy had low gastrointestinal quality-of-life index scores (68+/-24). The vast majority (93 percent) of patients stated they would undergo subtotal colectomy again if given a second chance. CONCLUSION: Subtotal colectomy for slow-transit constipation increases bowel-movement frequency; however, the persistence of abdominal pain and the development of postoperative incontinence or diarrhea adversely affect quality of life. Although most patients in the present study were satisfied with their results, quality-of-life scores should be used to assess postoperative outcome.