Changes in defecation function and psychological status following total abdominal colectomy with ileorectal anastomosis in patients with slow transit constipation: an observational cohort study

Abstract Objective To assess anxiety and depression in patients with slow transit constipation (STC), changes in psychological status after surgery, and the relationship between constipation severity and psychological status. Background Constipation is one of the most prevalent gastrointestinal symptoms. Chronic constipation often coexists with anxiety and depression. Slow transit constipation (STC) is a severe subtype that may require surgery, but the effect of surgery on psychological outcomes remains unclear. Methods 63 patients with STC who underwent total abdominal colectomy with ileorectal anastomosis (TAC-IRA) were included. Defecation function, psychological status, and quality of life were assessed before surgery and 6 months after surgery. Defecation function was evaluated using the Wexner score; psychological status was assessed using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS); quality of life was assessed using the gastrointestinal quality of life index (GIQLI). Paired t-tests, McNemar’s test, and Pearson correlation analysis were used. Results Before surgery, 42.9% and 57.1% of patients had anxiety and depression, respectively. After surgery, the proportion with anxiety decreased to 23.8% ( P < 0.001), while the proportion with depression was 50.8% ( P = 0.07). Paired t-tests showed significant reductions in Wexner ( P < 0.001) and SAS ( P = 0.01) scores, and a significant increase in GIQLI ( P = 0.002); SDS scores did not change significantly ( P = 0.143). SAS score was positively correlated with Wexner score before and after surgery. SDS score was positively correlated with Wexner score after surgery but not before surgery. GIQLI score was negatively correlated with Wexner score before and after surgery. Conclusion In this observational cohort, TAC-IRA was associated with significant improvements in constipation, quality of life, and anxiety symptoms, but not depression, at 6 months. Changes in anxiety and quality of life correlated with improvements in bowel function. However, causality cannot be established because of the uncontrolled design. Study registration Chinese clinical trial registry, ChiCTR2000036473; registration date:20200823