Conservative versus surgical therapy for idiopathic and secondary megacolon or megarectum in adults – a retrospective multicentre controlled study

Daniel Schmitz; Emilia Meier; Steffen Axt; Gerrit Arlt; Peter Kienle; Jonas Johannink; Alfred Königsrainer; Owais Mohammad; Ralf Jakobs; Stefan Willis; Ihsan Ekin Demir; Helmut Friess; Svetlana Hetjens; Matthias Philip Ebert; Christoph Reissfelder; Georgi Vassilev

doi:10.1055/a-2360-5008

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2024; 62(11): 1913-1923
DOI: 10.1055/a-2360-5008

Originalarbeit

Conservative versus surgical therapy for idiopathic and secondary megacolon or megarectum in adults – a retrospective multicentre controlled study

Konservative versus chirurgische Therapie beim idiopathischen und sekundären Megakolon oder Megarektum im Erwachsenenalter – eine retrospektive multizentrische Kontrollstudie

Daniel Schmitz

¹Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and Sankt Hedwig-Klinik, Mannheim, Germany (Ringgold ID: RIN39850)

²Department of Gastroenterology and Infectiology, Helios Klinken Schwerin, University Campus of Medical School Hamburg, Schwerin, Germany

,

Emilia Meier

¹Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and Sankt Hedwig-Klinik, Mannheim, Germany (Ringgold ID: RIN39850)

,

Steffen Axt

³Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Tübingen, Germany (Ringgold ID: RIN27203)

,

Gerrit Arlt

⁴Department of General and Abdominal Surgery, Theresienkrankenhaus and Sankt Hedwig-Klinik, Mannheim, Germany (Ringgold ID: RIN39850)

,

Peter Kienle

⁴Department of General and Abdominal Surgery, Theresienkrankenhaus and Sankt Hedwig-Klinik, Mannheim, Germany (Ringgold ID: RIN39850)

,

Jonas Johannink

³Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Tübingen, Germany (Ringgold ID: RIN27203)

,

Alfred Königsrainer

³Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Tübingen, Germany (Ringgold ID: RIN27203)

,

Owais Mohammad

⁵Department of Gastroenterology, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen, Germany (Ringgold ID: RIN9209)

,

Ralf Jakobs

⁵Department of Gastroenterology, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen, Germany (Ringgold ID: RIN9209)

,

Stefan Willis

⁶Department of General, Abdominal and Thoracic Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany (Ringgold ID: RIN9209)

,

Ihsan Ekin Demir

⁷Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (Ringgold ID: RIN27190)

,

Helmut Friess

⁷Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (Ringgold ID: RIN27190)

,

Svetlana Hetjens

⁸Department of Medical Statistics, Biomathematics, and Information Processing, University Hospital Mannheim, Mannheim, Germany

,

Matthias Philip Ebert

⁹Department of Gastroenterology, Hepatology and Infectiology, University Hospital Mannheim, Mannheim, Germany

,

Christoph Reissfelder

¹⁰Department of Surgery, University Hospital Mannheim, Mannheim, Germany

,

Georgi Vassilev

¹⁰Department of Surgery, University Hospital Mannheim, Mannheim, Germany

› Author Affiliations

Abstract

Background Idiopathic and secondary megacolon (MC) and megarectum (MR) in adults is associated with persistent bowel dilatation and reduced intestinal motility. Little is known about the optimal treatment of this rare disease. Therefore, we retrospectively analysed long-term data from these patients in 5 community and university hospitals, focusing on conservative versus surgical treatment.

Methods Patient records from 7/2004 to 9/2021 were screened for colorectal diseases with severe constipation and persistent megacolon ≥ 9.0 cm and/or megarectum ≥ 6.5 cm. Follow up-data was collected through telephone interviews and written surveys. ClinicalTrialsgov NCT04340856.

Results Sixty-seven patients with idiopathic (n=10) and secondary (n=57) MC or MR were identified with only 20 of 67 patients (29.9%) correctly diagnosed. Mean/median age was 64/69 (range 18–93) years. Thirty-two patients were treated with laxative regimens, and 35 underwent surgery (colostomy: n=12, segmental resection, or hemicolectomy: n=10, (sub)total colectomy: n= 13) after conservative treatment attempts in 32/35 (91.4%). The mean/median follow-up was 4.2/2.7 (range 0.1–17.0) years. The readmission rate for MC-associated symptoms was significantly higher after conservative treatment than after surgical therapy at 12 (0.84 vs. 0.36 per patient, p=0.036), 24 (1.00 vs. 0.52, p=0.048) and 36 (1.13 vs. 0.58, p=0.047) months, as was the number of patients with persistent laxative dependence (28/32 (87.5%) vs. 19/33 (57.6%); p = 0.007). Therapy-associated adverse events (Clavien-Dindo classification) were documented more often in surgically treated patients (11/35, 31.4%) (p=0.025).

Conclusion Surgical treatment may be considered earlier if idiopathic or secondary MC or MR is correctly diagnosed, and conservative treatment has been attempted.

Zusammenfassung

Hintergrund Das idiopathische und sekundäre Megacolon (MC) und Megarectum (MR) ist bei Erwachsenen mit einer anhaltenden Darmdilatation und einer eingeschränkten Darmmotilität verbunden. Über die optimale Behandlung dieser seltenen Erkrankung ist wenig bekannt. Daher haben wir retrospektiv die Langzeitdaten dieser Patienten in 5 kommunalen wie universitären Krankenhäusern analysiert.

Methoden Sämtliche Patientenakten von 7/2004 bis 9/2021 wurden im Hinblick auf Erkrankungen mit schwerer Obstipation und persistierendem Megakolon ≥9,0 cm oder Megarektum ≥ 6,5 cm gescreent. Follow-up-Daten wurden in Form von Telefoninterviews und schriftlichen Befragungen erhoben. ClinicalTrialsgov NCT04340856.

Ergebnisse Siebenundsechzig Patienten mit idiopathischer (n=10) und sekundärer (n=57) MC oder MR wurden identifiziert, wobei nur 20 von 67 (29.9%) Patienten die richtige Diagnose erhalten hatten. Das mittlere/mediane Alter betrug 64/69 (18–93) Jahre. Zweiunddreißig Patienten wurden mit Abführmaßnahmen behandelt, und 35 operiert (Kolostomie: n=12, Segmentresektion oder Hemikolektomie: n=10, (sub)totale Kolektomie: n= 13) nach konservativen Therapieversuchen bei 32/53 (91,6%) der Patienten. Das mittlere/mediane Follow-up betrug 4,2/2,7 (0,1–17,0) Jahre. Die Wiederaufnahmerate wegen Megakolon-assoziierter Symptome war nach konservativer Behandlung signifikant höher als nach chirurgischer Therapie nach 12 (0,84 vs. 0,36 pro Patient, p=0,036), 24 (1,00 vs. 0,52, p=0,048) und 36 (1,13 vs. 0,58, p=0,047) Monaten, ebenso wie die Anzahl der Patienten mit anhaltender Abführmittelabhängigkeit (28/32 (87,5%) vs. 19/33 (57,6%); p = 0,007). Therapiebedingte unerwünschte Ereignisse (Clavien-Dindo-Klassifikation) wurden bei den chirurgisch behandelten Patienten häufiger dokumentiert (11/35, 31,4 %) (p=0,025).

Schlussfolgerung Eine chirurgische Therapie sollte bei richtiger Diagnosestellung eines idiopathischen oder sekundären MC or MR und konservativem Therapieversuch möglicherweise früher in Betracht gezogen werden.

Keywords

Megacolon - Laxatives - Intestinal volvulus - Colostomy - Colectomy

Schlüsselwörter

Megakolon - Abführmittel - Dickdarmvolvulus - Kolostomie - Kolektomie

Full Text

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Supplementary Material

Supplementary Material