PURPOSE: Despite a good percentage of success, mainly related to the amelioration of patient selection, surgery for slow transit constipation still presents failures and late complications, often unpredictable, and sometimes related to technical variants. The aim of the study is to critically analyze late surgical complications of subtotal colectomy with caeco-rectal anastomosis (SCCRA), examining the peculiar risks of the procedure and possible prevention measures. METHODS: Follow-up data of 43 compliant patients submitted to SCCRA at our Institution were reviewed. Patients undergoing further surgery for a complication clearly related to SCCRA at our centre were included. RESULTS: We identified three late surgical complications (7%): a caecal distension, an ileo-caecal volvulus and an ileal volvulus. all patients were successfully treated. an evident predisposing condition was found only in the first case. CONCLUSIONS: Peculiar long term complications related to the presence of a dysfunctional or mobile caecal stump may be prevented by careful patient selection and surgical technique.