ASCRS Ch58 - Evaluation of Constipation and Treatment of Abdominal Component

Fifty-eighth chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Garrett KA, Ogilvie JW Jr). Book pages 995–1006 (PDF pages 983–994 of raw/ASCRS Textbook 4th Ed.pdf, offset +12 — unchanged from Ch57, confirmed via the "© Springer Nature Switzerland AG 2022 <page>" copyright-line cross-check on both this chapter's first page (995 = 983 + 12) and the Ch58/Ch59 boundary (PDF page 995/book page 1007, also +12). Begins immediately at PDF page 983 with no intervening blank page.

Covers the full evaluation and abdominal-component surgical treatment of chronic constipation: Rome IV subtyping (functional constipation, IBS-C, opioid-induced constipation, functional defecation disorders), etiology/secondary causes, history/physical/diagnostic testing (transit studies and pelvic floor testing), the full medical management ladder (fiber, laxatives by class, secretagogues, 5-HT4 agonists, OIC-specific agents), and — the chapter's real center of gravity — surgical patient selection and outcomes for slow transit constipation (abdominal colectomy with IRA, anastomotic variants, the megarectum/IPAA caveat, less-invasive alternatives, and less-standard approaches).

Key concepts (chapter's own summary box)

• There are different subtypes of constipation requiring a careful history and selective diagnostic testing to elucidate.
• Most treatment algorithms of constipation begin with medical management.
• Abdominal constipation severely affecting quality of life may require surgical intervention.

Filing

• Constipation — substantially expanded (previously built only from Sabiston Ch52 - Pelvic Floor Disorders & Constipation's brief technique/medication mentions). New content: full Rome IV subtyping table (FC, IBS-C, OIC, functional defecation disorders), etiology/secondary-causes table, transit-testing technique detail (radiopaque markers, scintigraphy, wireless capsule, colonic manometry), a much deeper medical management section that resolves the page's prior "no primary trial data" gap for lubiprostone/linaclotide (adding named RCTs for these plus plecanatide, tenapanor, and prucalopride), and an extensively expanded surgical section (patient-selection factors, the Staller 2018 algorithm, the 2016 ASCRS CPG recommendation, long-term outcome data, anastomotic variants, the megarectum/IPAA caveat, TAI/ACE, and SNM/ ileostomy as less-standard approaches).

Relevance

The chapter's most clinically load-bearing contribution is arguably negative/cautionary rather than prescriptive: it repeatedly stresses that no test result (abnormal transit study, abnormal defecography/manometry) reliably predicts surgical outcome in isolation, that no standardized definition of "medically refractory constipation" exists to guide referral, and that even the ASCRS CPG's own recommendation for colectomy with IRA rests on low-quality evidence. This tempers what might otherwise read as a straightforward "test → diagnose → operate" pathway, and is a useful counterweight when counseling patients — especially combined with the frank functional trade-offs disclosed in the long-term outcome data (up to 29% moderate and 21% severe incontinence in one long-term IRA cohort).

Open items / gaps

• All content is textbook-level/secondary; 99 references total. Individual RCTs/analyses flagged in Research Priorities.md: the Johanson 2008 lubiprostone RCT, the Lembo 2011 linaclotide trials, the Miner 2017 plecanatide RCT, the Camilleri 2016 prucalopride integrated analysis (6 RCTs, 2,484 patients), and the Luthra 2018 PAMORA network meta-analysis (27 RCTs).
• No standardized definition of "medically refractory constipation" exists in the surgical literature — an explicit, field-wide evidence gap rather than a wiki-specific one.
• Chapter 59 ("Treatment of Difficult/Obstructive Defecation," Zutshi M, Oliveira LCC) begins immediately at PDF page 995 — next in the sequential ingest, offset confirmed +12 (unchanged).