Twenty-Five Years of Pathophysiology-Based Surgery of Slow-Transit Constipation: Outcomes After Segmental, Subtotal and Total Colectomy

Background: Idiopathic slow-transit constipation (STC) is a clinically significant event of chronic constipation. Total colectomy with ileorectal anastomosis is considered the standard surgical option for medically refractory STC but is associated with relevant morbidity and long-term functional impairment. This study aimed to evaluate safety and functional outcomes of partial colectomy (segmental or subtotal resection) as a potential alternative in patients with limited colonic involvement. Methods: A retrospective observational single-center study was conducted on patients with STC refractory to medical and rehabilitative treatment (1998–2021). Five-year follow-up data were collected. Results: On a cohort of 76 patients, 10 (13.2%) underwent total colectomy, 63 (82.9%) segmental, and 3 (3.9%) subtotal resections (left hemicolectomy). No perioperative mortality occurred. Overall, 30-day morbidity was 25.0%, with major complications observed in 12.1% after partial colectomy. Median hospital stay was three days longer after total colectomy. Constipation recurred in 20.3% of patients, exclusively after segmental resection, at a median follow-up of 7.7 years. Constipation severity significantly decreased postoperatively (p < 0.001), with the mean Wexner score improving from 21.5 to 6.1 (p < 0.001). Rates of diarrhea and fecal incontinence were comparable between segmental and total colectomy. Quality-of-life significantly improved in more than 75% of cases across all SF-36 domains. Conclusions: Segmental colectomy may be a safe and effective alternative to total colectomy in patients with limited STC, potentially offering durable symptom relief and favorable quality-of-life outcomes.