Abstract

Summary

To improve treatment outcomes in patients with chronic constipation associated with dolichosigma by developing a differentiated therapeutic strategy based on comprehensive assessment of the morpho-functional phenotype, connective tissue dysplasia, colonic transit, circadian regulation and neuromotor disorders.
 

Materials and Methods

The results of examination and treatment of 296 patients with chronic constipation associated with dolichosigma treated between 2016 and 2026 were analyzed. After exclusion criteria had been applied, 240 patients were included in the final analysis: 116 in the retrospective cohort and 124 in the prospective cohort. In the prospective cohort, two phenotypes were identified: a predominantly mechanical variant of chronic colostasis (n=48) and a slow-transit variant associated with signs of connective tissue dysplasia and systemic functional disorders (n=76). The diagnostic program included clinical assessment, Wexner score, colonic transit study, high-resolution anorectal manometry, SIBO testing, assessment of bowel circadian rhythm, ileocecal junction status and laboratory-metabolic abnormalities.
 

Results

Compared with the mechanical phenotype, the slow-transit phenotype was associated with a higher frequency of severe constipation according to Wexner score >15 (80.3% vs 35.4%; OR=7.42; 95% CI 3.27-16.80; p<0.001), colonic transit >72 h (69.7% vs 29.2%; OR=5.60; 95% CI 2.54-12.35; p<0.001), recurrent coprostasis, SIBO and laboratory signs of connective tissue dysplasia. In the prospective cohort, where phenotype-oriented management was used, good and excellent long-term outcomes were achieved in 83.1% of patients versus 52.6% in the retrospective cohort (OR=4.42; 95% CI 2.50-7.83; p<0.001). The rate of repeat surgery decreased from 13.8% to 5.6% (OR=0.37; 95% CI 0.15-0.93; p=0.032).
 

Conclusion

Chronic constipation associated with dolichosigma should not always be regarded as a purely mechanical consequence of sigmoid elongation. Preliminary morpho-functional phenotyping helps to define the scope of preoperative preparation, conservative correction, rehabilitation and surgery more accurately, which is accompanied by better functional outcomes and a lower risk of recurrence.
 

Keywords

chronic constipation dolichosigma slow-transit constipation connective tissue dysplasia SIBO cecum mobile morpho-functional phenotyping

Full Text

Download Article as PDF

Full article in PDF format

References

  1. Cho YS, Lee YJ, Shin JE, Jung HK, Park SY, Kang SJ, et al. 2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation. J Neurogastroenterol Motil. 2023;29(3):271-305. doi:10.5056/jnm23066.
  2. Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, et al. AGA-ACG Clinical Practice Guideline: pharmacological management of chronic idiopathic constipation. Am J Gastroenterol. 2023;118(6):936-954. doi:10.14309/ajg.0000000000002227.
  3. Alavi K, Davids JS, Fichera A, Paquette IM, Steele SR, Feingold DL, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the evaluation and management of chronic constipation. Dis Colon Rectum. 2024;67(10):1244-1257. doi:10.1097/DCR.0000000000003430.
  4. Ihara E, Manabe N, Ohkubo H, Ogasawara N, Ogino H, Kakimoto K, et al. Evidence-Based Clinical Guidelines for Chronic Constipation 2023. Digestion. 2025;106(1):62-89. doi:10.1159/000540912.
  5. Vlismas LJ, Wu W, Ho V. Idiopathic slow transit constipation: pathophysiology, diagnosis, and management. Medicina (Kaunas). 2024;60(1):108. doi:10.3390/medicina60010108.
  6. Tang X, Huang Y, Jiang T, Wu W. Pathophysiological mechanisms, diagnostic innovations, and multimodal therapeutic strategies for slow transit constipation. BMC Gastroenterol. 2025;25(1):810. doi:10.1186/s12876-025-04387-9.
  7. Shi H, Li L, Huang L, Xia W, Zhu M, Zhao Y. High-resolution anorectal manometry and balloon expulsion test outcomes in functional constipation: a comparative study. Med Sci Monit. 2024;30:e944599. doi:10.12659/MSM.944599.
  8. Perivoliotis K, Baloyiannis I, Tzovaras G. Cecorectal versus ileorectal anastomosis after colectomy for slow transit constipation: a meta-analysis. Int J Colorectal Dis. 2022;37(3):531-539. doi:10.1007/s00384-022-04093-y.
  9. Deng XM, Zhu TY, Wang GJ, Gao BL, Li RX, Wang JT. Laparoscopic total colectomy with ileorectal anastomosis and subtotal colectomy with antiperistaltic cecorectal anastomosis for slow transit constipation. Updates Surg. 2023;75(4):871-880. doi:10.1007/s13304-023-01458-y.
  10. Załęski A, Krogulska A, Pawłowska-Kamieniak A, Jankowska A, Jankowska-Wika J, Walkowiak J. Excessive laxity of connective tissue in constipated children. Prz Gastroenterol. 2022;17(1):44-48. doi:10.5114/pg.2021.104733.
  11. Ардатская МД, Буторова ЛИ, Анучкин АА, Гайворонский ИН, Павлов АИ, Паценко ОЮ. Хронический запор: современные возможности патогенетической терапии. Медицинский совет. 2024;18(8):145-153. doi:10.21518/ms2024-181.
  12. Галагудза ММ, Успенский ЮП, Фоминых ЮА, Бутко ДЮ. Патогенез нарушений моторной функции толстой кишки при функциональном запоре. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2024;34(3):24-37. doi:10.22416/1382-4376-2024-34-3-24-37.
  13. Шевченко ТИ, Швороб ДС, Абрамян АА. Морфология стенки толстой кишки на разных стадиях хронического запора. Клиническая и экспериментальная морфология. 2024;13(2):36-43. doi:10.31088/CEM2024.13.2.36-43.
  14. Серкова МЮ, Авалуева ЕБ, Ситкин СИ. Хронический запор: фокус на микробиом-модулирующей терапии пребиотиками, пробиотиками и синбиотиками. Альманах клинической медицины. 2024;52(5):280-296. doi:10.18786/2072-0505-2024-52-026.
  15. Driouch J, Abdulqader MA, Sajid S, Kapellas N, Riyal Q, Senkal M, et al. Prospective laparoscopic assessment of sigmoid elongation: association with constipation and abdominal pain. Langenbecks Arch Surg. 2026;411:114. doi:10.1007/s00423-026-04015-4.