Until recently, the surgical management of idiopathic slow-transit constipation had remained unchanged since the condition was jirst described by Arbuthnot Lane in 1908. Although colectomy and ileorectal anastomosis is a successful treatment for the majority of patients, symptoms persist or are worse in some cases following such surgery. The previously inaccessible colon is now an area of interest in both health and disease; recent observations on aetiology, clinical investigation, neuropathology and surgical outcome lead us to question the rationale of colectomy for all patients with severe constipation.
At the beginning of this century Arbuthnot reported in a series of communications to the British Medical Journal thi: results of colectomy and ileorectal anastomosis for severe constipation. He identified a group of patients, predominantly women of child-bearing age or younger, with severe constipation whose symptoms could be improved dramatically by removal of the colon. He also observed that the colon of these women, although macroscopically normal, was nonfunctional. The syndrome became known as Arbuthnot Lane's disease. In the absence of a pathognomonic test we will never know whether the disease he treated (with some success) is the same as that which we now call idiopathic slow-transit constipation (ISTC). Equally, in the absence of histology that identifies a pathological abnormality, we d o not know whether the condition that we treat 80 years on, with no greater a success rate, is Arbuthnot Lane's d i ~e a s e ~. ~.
ISTC is currently defined as a disorder of normal colon propulsion that results in severe constipation. By convention, the condition excludes megarectum and megacolon.