BACKGROUND: Functional constipation is a chronic GI disorder that significantly impairs quality of life. OBJECTIVE: To evaluate the beneficial effects of transanal irrigation after 12 and 24 months of treatment in patients with functional constipation. DESIGN: Multicenter, prospective, observational study. SETTINGS: Thirteen gastroenterology centers across Italy. PATIENTS: A total of 216 adults diagnosed with functional constipation were enrolled. INTERVENTION: A transanal irrigation system was used to perform bowel irrigation. Patients completed validated questionnaires at baseline and at 1, 6, 12, and 24 months after the procedure. MAIN OUTCOME MEASURES: The primary end points were to assess improvement in patient satisfaction and quality of life related to bowel function, as well as the safety of the procedure. Secondary outcomes included constipation severity, symptom occurrence, treatment discontinuation rates, and reasons for dropout. RESULTS: Mean satisfaction scores increased from 2.9 ± 2.4 at baseline to 6.5 ± 2.0 in 1 month and remained higher through 24 months ( p < 0.001). The mean quality-of-life total score improved from 2.7 ± 0.6 to 2.0 ± 0.7 in 1 month and remained at about 1.9 thereafter ( p < 0.001). Constipation score severity decreased (Wexner score 17.9 ± 5.8 to 12.5 ± 5.2 at 1 month; maintained to 24 months; p < 0.001), and mean constipation-related symptoms declined from 3.3 to 1.0 per patient at 24 months. Of 175 patients prescribed irrigation, discontinuation occurred in 10.3% at 6 months, 9.1% at 12 months, and 6.3% at 24 months; technical difficulties were uncommon and absent at 24 months, and no serious adverse events were reported. LIMITATIONS: The nonrandomized design may have introduced bias. Outcomes were assessed using validated but subjective self-reported questionnaires, and the study population was unbalanced for sex and comorbidities, although these factors did not significantly affect the primary results. CONCLUSIONS: This study provides the first evidence to support the effectiveness and safety of long-term transanal irrigation in improving bowel function, symptoms, and quality of life in patients with functional constipation across the long term. See Video Abstract . IRRIGACIÓN TRANSANAL EN EL ESTREÑIMIENTO FUNCIONAL: RESULTADOS A LARGO PLAZO DE UN ESTUDIO NACIONAL ITALIANO: ANTECEDENTES: El estreñimiento funcional es un trastorno gastrointestinal crónico que afecta significativamente la calidad de vida. OBJETIVO: Evaluar los efectos beneficiosos de la irrigación transanal tras 12 y 24 meses de tratamiento en pacientes con estreñimiento funcional. DISEÑO: Estudio multicéntrico, prospectivo y observacional. ÁMBITO: Trece centros de gastroenterología en Italia. PACIENTES: Se incluyeron 216 adultos diagnosticados de estreñimiento funcional. INTERVENCIÓN: Se realizó irrigación transanal mediante un sistema de irrigación transanal. Los pacientes completaron cuestionarios validados al inicio del estudio y a los 1, 6, 12 y 24 meses. PRINCIPALES MEDIDAS DE RESULTADO: Los objetivos primarios fueron evaluar la mejora en la satisfacción del paciente y la calidad de vida relacionada con la función intestinal, así como la seguridad del procedimiento. Los objetivos secundarios incluyeron la gravedad del estreñimiento, la aparición de síntomas, las tasas de abandono del tratamiento y los motivos de abandono. RESULTADOS: La puntuación de satisfacción aumentó de 2,9 ± 2,4 al inicio a 6,5 ± 2,0 al mes y se mantuvo más alta durante 24 meses (p < 0,001). La puntuación total de calidad de vida mejoró de 2,7 ± 0,6 a 2,0 ± 0,7 al mes y alrededor de 1,9 a partir de entonces (p < 0,001). La gravedad de la puntuación de estreñimiento disminuyó (puntuación de Wexner de 17,9 ± 5,8 a 12,5 ± 5,2 al mes; se mantuvo hasta los 24 meses; p < 0,001), y los síntomas relacionados con el estreñimiento promedio disminuyeron de 3,3 a 1,0 por paciente a los 24 meses. De 175 pacientes a los que se les prescribió irrigación, la interrupción ocurrió en el 10,3% a los 6 meses, el 9,1% a los 12 y el 6,3% a los 24; Las dificultades técnicas fueron poco frecuentes y no se presentaron a los 24 meses, y no se notificaron eventos adversos graves. LIMITACIONES: El diseño no aleatorizado podría haber introducido sesgos. Los resultados se evaluaron mediante cuestionarios autoadministrados validados pero subjetivos, y la población del estudio no estaba equilibrada en cuanto a sexo y comorbilidades, aunque estos factores no afectaron significativamente los resultados principales. CONCLUSIONES: Este estudio proporciona la primera evidencia que respalda la eficacia y seguridad de la irrigación transanal a largo plazo para mejorar la función intestinal, los síntomas y la calidad de vida en pacientes con estreñimiento funcional a largo plazo. (AI-generated translation )

Background: Idiopathic slow-transit constipation (STC) is a clinically significant event of chronic constipation. Total colectomy with ileorectal anastomosis is considered the standard surgical option for medically refractory STC but is associated with relevant morbidity and long-term functional impairment. This study aimed to evaluate safety and functional outcomes of partial colectomy (segmental or subtotal resection) as a potential alternative in patients with limited colonic involvement. Methods: A retrospective observational single-center study was conducted on patients with STC refractory to medical and rehabilitative treatment (1998–2021). Five-year follow-up data were collected. Results: On a cohort of 76 patients, 10 (13.2%) underwent total colectomy, 63 (82.9%) segmental, and 3 (3.9%) subtotal resections (left hemicolectomy). No perioperative mortality occurred. Overall, 30-day morbidity was 25.0%, with major complications observed in 12.1% after partial colectomy. Median hospital stay was three days longer after total colectomy. Constipation recurred in 20.3% of patients, exclusively after segmental resection, at a median follow-up of 7.7 years. Constipation severity significantly decreased postoperatively (p < 0.001), with the mean Wexner score improving from 21.5 to 6.1 (p < 0.001). Rates of diarrhea and fecal incontinence were comparable between segmental and total colectomy. Quality-of-life significantly improved in more than 75% of cases across all SF-36 domains. Conclusions: Segmental colectomy may be a safe and effective alternative to total colectomy in patients with limited STC, potentially offering durable symptom relief and favorable quality-of-life outcomes.