Clinical efficacy of subtotal colectomy-ileosigmoidal anastomosis in treatment of slow transit constipation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xiaowei ¹ ,  MA Zhennan ¹ , SUN Wei ¹ , JIANG Yangshen ¹ , LI Wei ¹ , JIA Yi ¹ , YANG Xuan ² , XU Zhiqiang ¹ , MA Shuai ¹ , SONG Caili ¹

1. Department of General Surgery, Affiliated Xinhua Hospital of Dalian University, Dalian, Liaoning 116021, P. R. China;
2. Liaoning Electric Center Hospital, Shenyang 110000, P. R. China;

Corresponding author：

MA Zhennan, Email: mazhennan8888@163.com

Keywords：

slow transit constipation; subtotal colectomy; ileosigmoidal anastomosis; ileorectal anastomosis

DOI：

10.7507/1007-9424.201808021

Video：

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Objective To investigate efficacy of total colectomy-ileorectal anastomosis (IRA) and subtotal colectomy-ileosigmoidal anastomosis (ISA) in treatment of patients with slow transit constipation (STC).Methods The clinical data of 45 patients with STC underwent operation from January 2008 to January 2015 were analyzed retrospectively. These patients were divided into an IRA group and ISA group according to the operation method, there were 23 cases in the IRA group and 22 cases in the ISA group. The operative time, intraoperative blood loss, postoperative hospitalization, use of antidiarrheal drugs, and complications rate in both groups were compared. All the patients were followed up at the 3th, 6th, 12th, and 24th month after the operation, the defecation frequency, Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score in two groups were evaluated.Results There were no significantly statistical differences between the two groups in the operation time, intraoperative blood loss, and postoperative complications rate (P>0.05). In the perioperative period, compared with the IRA group, the ISA group had a shorter postoperative hospitalization and a relatively lower proportion of antidiarrheal drugs, the differences were statistically significant between the two groups (P<0.05). On the postoperative 3th, 6th, and 12th month, the frequency of defecation in the IRA group was significantly higher than that in the ISA group (P<0.05). The Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score had no statistical differences between the two groups (P>0.05).Conclusions ISA and IRA are safe and effective in treatment of STC, it might be selected according to patient’s conditions. On premise of strictly grasping indications, ISA has more obvious advantages.

Citation： ZHANG Xiaowei, MA Zhennan, SUN Wei, JIANG Yangshen, LI Wei, JIA Yi, YANG Xuan, XU Zhiqiang, MA Shuai, SONG Caili. Clinical efficacy of subtotal colectomy-ileosigmoidal anastomosis in treatment of slow transit constipation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1469-1475. doi: 10.7507/1007-9424.201808021 Copy

1.	魏东. 慢传输型便秘外科治疗进展. 世界华人消化杂志, 2017, 25(16): 1438-1445.
2.	Bharucha AE, Phillips SF. Slow transit constipation. Gastroenterol Clin North Am, 2001, 30: 77-79.
3.	Dinning PG, Hunt L, Patton V, et al. Treatment efficacy of sacral nerve stimulation in slow transit constipation: a two-phase, double-blind randomized controlled crossover study. Am J Gastroenterol, 2015, 110(5): 733-740.
4.	魏东. 慢传输型便秘外科手术方法的治疗进展. 中华胃肠外科杂志, 2018, 21(3): 357-360.
5.	刘宝华. 结肠慢传输性便秘外科治疗国内外进展. 中国普外基础与临床杂志, 2007, 14(6): 630-631.
6.	谢尚奎, 彭慧, 罗俊, 等. 结肠次全切除、结肠直肠低位吻合治疗合并出口梗阻的结肠慢传输型便秘. 实用医学杂志, 2016, 32(15): 2584-2585.
7.	Marples G. Diagnosis and management of slow transit constipation in adults. Nurs Stand, 2011, 26(8): 41-48.
8.	黄忠诚. 慢传输型便秘手术的规范与实施. 中华胃肠外科杂志, 2016, 19(12): 1338-1341.
9.	Marchesi F, Percalli L, Pinna F, et al. Laparoscopic subtotal colectomy with anti- peristaltic cecorectal anastomosis: a new step in the treatment of slow transit constipation. Surg Endosc, 2012, 26(6): 1528-1533.
10.	Fu T, Zhao S, Li F, et al. Single-incision laparoscopic subtotal colectomy with cecorectal anastomosis for slow transit constipation. Tech Coloproctol, 2016, 20(2): 135-137.
11.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
12.	Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum, 1996, 39(6): 681-685.
13.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
14.	Eypasch E1, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg, 1995, 82(2): 216-222.
15.	Li F, Fu T, Tong W, et al. Effect of different surgical options on curative effect, nutrition, and health status of patients with slow transit constipation. Int J Colorectal Dis, 2014, 29(12): 1551-1556.
16.	Lane WA. Remarks on the results of the operative treatment of chronic constipation. Br Med J, 1908, 1(2455): 126-130.
17.	McCoy JA, Beck DE. Surgical management of colonic inertia. Clin Colon Rectal Surg, 2012, 25(1): 20-23.
18.	刘宝华. 便秘外科手术治疗. 临床消化病杂志, 2013, 25(4): 218-221.
19.	傅传刚, 高显华. 便秘外科治疗的争议和共识. 中国实用外科杂志, 2012, 32(1): 60-62.
20.	Vergara-Fernandez O, Mejía-Ovalle R, Salgado-Nesme N, et al. Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia. Surg Today, 2014, 44(1): 34-38.
21.	Reshef A, Alves-Ferreira P, Zutshi M, et al. Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation. Int J Colorectal Dis, 2013, 28(6): 841-847.
22.	王文航, 魏东, 张剑锋, 等. 直肠保留长度对腹腔镜结肠全切除回直肠吻合术治疗慢传输型便秘疗效的影响. 临床外科杂志, 2017, 25(4): 269-271.
23.	谢尚奎, 任东林, 鲜振宇, 等. 全结肠切除联合全直肠保留治疗结肠慢传输型便秘. 广东医学, 2015, 36(6): 873-874.
24.	Wei D, Cai J, Yang Y, et al. A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs . long colonic reservoir. BMC Gastroenterol, 2015, 15: 30.
25.	黄兴, 刘祺, 肖志刚, 等. 低位直肠癌术后吻合口位置与肛门功能关系的研究. 中国肿瘤临床, 2013, 40(10): 592-595.
26.	Pinedo G, Zarate AJ, Garcia E, et al. Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc, 2009, 23(1): 62-65.
27.	Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg, 1999, 230: 627-638.
28.	Jiang CQ, Qian Q, Liu ZS, et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Colorectal Dis, 2008, 23(12): 1251-1256.

1. 魏东. 慢传输型便秘外科治疗进展. 世界华人消化杂志, 2017, 25(16): 1438-1445.
2. Bharucha AE, Phillips SF. Slow transit constipation. Gastroenterol Clin North Am, 2001, 30: 77-79.
3. Dinning PG, Hunt L, Patton V, et al. Treatment efficacy of sacral nerve stimulation in slow transit constipation: a two-phase, double-blind randomized controlled crossover study. Am J Gastroenterol, 2015, 110(5): 733-740.
4. 魏东. 慢传输型便秘外科手术方法的治疗进展. 中华胃肠外科杂志, 2018, 21(3): 357-360.
5. 刘宝华. 结肠慢传输性便秘外科治疗国内外进展. 中国普外基础与临床杂志, 2007, 14(6): 630-631.
6. 谢尚奎, 彭慧, 罗俊, 等. 结肠次全切除、结肠直肠低位吻合治疗合并出口梗阻的结肠慢传输型便秘. 实用医学杂志, 2016, 32(15): 2584-2585.
7. Marples G. Diagnosis and management of slow transit constipation in adults. Nurs Stand, 2011, 26(8): 41-48.
8. 黄忠诚. 慢传输型便秘手术的规范与实施. 中华胃肠外科杂志, 2016, 19(12): 1338-1341.
9. Marchesi F, Percalli L, Pinna F, et al. Laparoscopic subtotal colectomy with anti- peristaltic cecorectal anastomosis: a new step in the treatment of slow transit constipation. Surg Endosc, 2012, 26(6): 1528-1533.
10. Fu T, Zhao S, Li F, et al. Single-incision laparoscopic subtotal colectomy with cecorectal anastomosis for slow transit constipation. Tech Coloproctol, 2016, 20(2): 135-137.
11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
12. Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum, 1996, 39(6): 681-685.
13. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
14. Eypasch E1, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg, 1995, 82(2): 216-222.
15. Li F, Fu T, Tong W, et al. Effect of different surgical options on curative effect, nutrition, and health status of patients with slow transit constipation. Int J Colorectal Dis, 2014, 29(12): 1551-1556.
16. Lane WA. Remarks on the results of the operative treatment of chronic constipation. Br Med J, 1908, 1(2455): 126-130.
17. McCoy JA, Beck DE. Surgical management of colonic inertia. Clin Colon Rectal Surg, 2012, 25(1): 20-23.
18. 刘宝华. 便秘外科手术治疗. 临床消化病杂志, 2013, 25(4): 218-221.
19. 傅传刚, 高显华. 便秘外科治疗的争议和共识. 中国实用外科杂志, 2012, 32(1): 60-62.
20. Vergara-Fernandez O, Mejía-Ovalle R, Salgado-Nesme N, et al. Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia. Surg Today, 2014, 44(1): 34-38.
21. Reshef A, Alves-Ferreira P, Zutshi M, et al. Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation. Int J Colorectal Dis, 2013, 28(6): 841-847.
22. 王文航, 魏东, 张剑锋, 等. 直肠保留长度对腹腔镜结肠全切除回直肠吻合术治疗慢传输型便秘疗效的影响. 临床外科杂志, 2017, 25(4): 269-271.
23. 谢尚奎, 任东林, 鲜振宇, 等. 全结肠切除联合全直肠保留治疗结肠慢传输型便秘. 广东医学, 2015, 36(6): 873-874.
24. Wei D, Cai J, Yang Y, et al. A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs . long colonic reservoir. BMC Gastroenterol, 2015, 15: 30.
25. 黄兴, 刘祺, 肖志刚, 等. 低位直肠癌术后吻合口位置与肛门功能关系的研究. 中国肿瘤临床, 2013, 40(10): 592-595.
26. Pinedo G, Zarate AJ, Garcia E, et al. Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc, 2009, 23(1): 62-65.
27. Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg, 1999, 230: 627-638.
28. Jiang CQ, Qian Q, Liu ZS, et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Colorectal Dis, 2008, 23(12): 1251-1256.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficacy of subtotal colectomy-ileosigmoidal anastomosis in treatment of slow transit constipation

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