Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders

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Abstract
Background: Chronic constipation may be treated by antegrade colonic irrigation via a colonic conduit. Methods: Two alternative sites of colonic conduit construction were evaluated for their effect on the symptoms of 21 consecutive women with intractable constipation primarily due to rectal evacuatory disorders. The conduit was constructed in the sigmoid colon in the first 11 patients and in the transverse colon in the subsequent ten. Symptomatic outcome was evaluated clinically and by questionnaires, with a prospective quality of life assessment in the transverse group. Results: During a median follow-up of 12 (range 6–60) months, reflux or stenosis necessitated revision or dilatation in six patients. Irrigation with a median of 1·3 (0·8–2·0) litres of water achieved evacuation in all patients. Improvements in abdominal pain and bloating were reported by seven of the ten patients in the transverse conduit group, but benefit was found in only three of 11 in the sigmoid group. There was no significant improvement in quality of life scores. In the medium term, seven patients retained a transverse conduit compared with three with a sigmoid conduit. Conclusion: The transverse colonic conduit offers better relief from the symptoms of constipation due to rectal evacuatory dysfunction than the sigmoid conduit.