Long-term outcomes of total colectomy for severe constipation.

AIM: Surgery for constipation is usually reserved for patients with severe and refractory symptoms because of concerns about perioperative morbidity and unpredictable functional outcomes. The aim of this paper is to identify the long-term outcomes of patients who have undergone total colectomy and ileorectal anastomosis for severe constipation. METHOD: Patients who had undergone a total colectomy and ileorectal anastomosis for severe constipation were identified from a prospectively maintained database and sent a postal survey assessing functional symptoms, patient satisfaction and the impact of symptoms on quality of life. Information regarding the surgery, perioperative complications and hospitalizations were also collected. Functional outcomes of the surgery were evaluated with the Gastrointestinal Quality of Life Index, St Marks incontinence score, Wexner continence score, obstructed defaecation syndrome score and Cleveland Clinic constipation score. RESULTS: Seventy-one questionnaires were posted and 32 (45%) patients responded. The mean time since surgery was 15.3 years (range 2.9-30.4 years) Most patients were happy with the surgery. Ongoing symptoms were common, the most frequent of these were abdominal pain, experienced by 23 patients (71.9%), and faecal incontinence, experienced by 17 patients (53%). Fourteen patients (43.8%) required subsequent hospital admission due to bowel obstruction and eight patients (25%%) had subsequent surgery for adhesions. There was an association between patient quality of life and subsequent surgeries. CONCLUSION: Most patients were happy and viewed their life as improved following total colectomy for severe constipation. This is despite a high rate of ongoing functional symptoms.

Hypoxia training: symptom replication in experienced military aircrew.

INTRODUCTION: Military aircrew are trained to recognize the signs and symptoms of hypoxia in a safe environment using a variety of methods to simulate altitude. In order to investigate the effectiveness of hypoxia training, this study compared the recall of hypoxia symptoms in military aircrew between two consecutive hypobaric chamber hypoxia training sessions conducted, on average, 4.5 yr apart. METHODS: Previously trained subjects completed a questionnaire immediately before and after they underwent refresher hypoxia training and recorded the occurrence, order, and severity of symptoms experienced. Responses from refresher training were compared with their recall of symptoms experienced during previous training. RESULTS: There was no difference in the recall of most hypoxia symptoms between training sessions. Slurred speech was recalled more frequently from previous training compared to refresher training (14 vs. 4 subjects), whereas hot/cold flushes were recalled less frequently from previous training compared to refresher training (5 vs. 17 subjects). There was a statistically significant difference in overall hypoxia score (10.3 vs. 8.3), suggesting that from memory subjects may underestimate the level of hypoxia experienced in previous training. DISCUSSION: A high level of similarity between the recall of previously experienced hypoxia symptoms and recent experience supports the effectiveness of hypoxia training. These results replicate the finding of a 'hypoxia signature' reported by a previous study. Small differences in the recall of some symptoms and in overall hypoxia score highlight the importance of drawing attention to the more subtle symptoms of early hypoxia, and of using training techniques which optimize aircrew recall.