Most common type of colectomy for constipation

[Kbird4]

I am a 52 year old lady who is considering having all or part of my colon removed for severe constipation which began when I started taking medications for chronic pain/fibromyalgia about 24 years ago.

I’ve seen 2 colon surgeons who both think surgery (laproscopic) is warranted.  One would remove my entire colon and join my small bowel to my rectum.  The other one would leave 6 – 8 inches of my sigmoid colon.  Do you know which of these is most often done for colonic inertia?  Is one more effective than the other?

In addition, the one taking my entire colon would join the small bowel to the rectum at a right angle.  The other one would attach the small bowel going straight down into the sigmoid colon. Do you know which of these techniques is best?  It seems like going straight down would be but I’m not sure.
Thanks much!

[Kbird4]

Thanks for your helpful response doctor!

[DR_RTewari]

Dear Kbird.
when coloectomy is done for ulcerative colitis or FAP then total removal of colon and rectum gives a better result (but removing complete colon and rectum means ileum is to be joined with anal canal which requires a pouch construction from ielum which is difficult and has its own problem, but we dont want to leave any part of colon or retum in above said conditions so this procedure is preferred thogh difficult) but in your case i.e. inertia of colon (motility disorder) I feel leaving some part of rectum/ colon would be wise coz it will make the surgery easy/ less of fecal soiling problem lateron/ less chances of leak from anastomosis.
Best wishes
Dr Tewari (India)

[Ratnakar Kini]

Hi,
The options available are subtotal colectomy with ileorectal anastomosis and proctocolectomy with ileoanal anastomosis.
In the former the rectum and part of colon are left behind whereas in the latter rectum is also removed.
Both are equally good. But a few studies have shown that the latter is better.