A series of 21 patients (18 female) whose intractable constipation was treated by colectomy between 1976 and 1985 is reported. There was no mortality attributable to surgery in this series. Total colectomy with ileorectal anastomosis was the preferred operation, but it produced a satisfactory result in only 12 patients. Five patients were treated by a permanent ileostomy, as the primary procedure in two. Megarectum did not automatically preclude a good result from ileorectal anastomosis, but a poor result was associated with failure of either a rectal stump to conduct colonic movements or of the anal sphincter to relax. Long term follow-up is necessary for assessment of results since late relapse can occur.
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