Anorectal manovolumetry in the decision making before surgery for slow transit constipation

Comparing the short-term clinical outcomes and therapeutic effects of different colectomies in patients with refractory slow-transit constipation in eastern countries: a network meta-analysis

Surgical treatment has been widely used in patients with refractory slow transit constipation (RSTC). The aim of this network meta-analysis (NMA) was to compare the effects of different colectomies on short-term postoperative complications and quality of life in patients with RSTC. Electronic literature searches were performed in the PubMed, Web of Science, EMBASE, WANFANG DATA, and Cochrane Central Register of controlled trials databases and were searched up to December 2022. Selected to compare the short-term clinical outcomes and quality of life of the treatment of RSTC. A random-effects Bayesian NMA was conducted to assess and rank the effectiveness of different surgical modalities. This study included a total of six non-randomized controlled trials involving 336 subjects. It was found that subtotal colectomy with cecorectal anastomosis (CRA) demonstrated superior effectiveness in several aspects, including reduced hospital stay (MD 0.06; 95% CI [0.02, 1.96]), shorter operative time (MD 4.75; 95% CI [0.28, 14.07]), lower constipation index (MD 0.61; 95% CI [0.04, 1.71]), improved quality of life (MD 4.42; 95% CI [0.48, 4.42]). Additionally, in terms of short-term clinical outcomes, subtotal colectomy with ileosigmoidal anastomosis (SC-ISA) procedure ranked the highest in reducing small bowel obstruction (OR 0.24; 95% CI [0.02, 0.49]), alleviating abdominal pain (OR 0.53; 95% CI [0.05, 1.14]), minimizing abdominal distension (OR 0.33; 95% CI [0.02, 0.65]), and reducing incision infection rates (OR 0.17; 95% CI [0.01, 0.33]). Furthermore, SC-ISA ranked as the best approach in terms of patient satisfaction (OR 0.66; 95% CI [0.02, 1.46]). Based on our research findings, we recommend that CRA be considered as the preferred treatment approach for patients diagnosed with RSTC.

Functional constipation: implications for nursing interventions

AIMS

To verify the correlation between anorectal function and psychological conditions of depression/anxiety in patients with functional constipation. The aim of this study is to explore why people with depression/anxiety have higher incidence of functional constipation and recommend innovative interventions to advance patient care of functional constipation.

DESIGN

A prospective correlational design.

METHODS

Anorectal manometry was performed on functional constipation patients (n=70) through the Medtronic Synectics PC Polygraf, while the psychological condition was tested by Self-Rating Anxiety Scale and Self-Rating Depression Scale. Twenty normal controls were also studied.

RESULTS

Compared with controls, (1) functional constipation patients displayed higher squeezing pressure, defaecation thresholds and maximal volume of tolerance (p<0·01), and there was no significant difference in anorectal resting pressure, defaecating pressure, minimum relaxation volume and first sensation (p>0·05). (2) Functional constipation patients showed higher depression/anxiety scores (p<0·01). (3) The anorectal squeezing pressure was negatively correlated with anxiety and depression scores, while the first sensation and maximal volume of tolerance was positively correlated with depression score (p<0·05).

CONCLUSIONS

Abnormal anorectal function correlates to depression/anxiety levels indicating that depression/anxiety may contributes to functional constipation. The possible pathology is via brain-gut axis.

RELEVANCE TO CLINICAL PRACTICE

The study indicates that nurses should pay attention to the patients' psychological needs, especially to those interested in seeing the physician and doing unnecessary examinations repeatedly to find any organic disease. Integrated nursing intervention should be applied to improve patients' psychological adaptation and boost the functional constipation therapeutic effect.

Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report

BACKGROUND AND AIMS

Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is recommended widely for the patients with severe, refractory slow transit constipation (STC). Subtotal colectomy with end-to-end antiperistaltic cecorectal anastomosis (Sarli procedure), an alternative for STC, has been paid particular attention. The purpose of this study was to retrospectively compare alterations of clinical functions and qualities of life between TAC-IRA and Sarli procedure.

METHODS

Seventeen patients with STC who underwent Sarli procedure and 20 patients with STC who underwent TAC-IRA were chosen for this study. Patient characteristics, operative data, postoperative data, alterations of clinical function, and quality of life were compared. The gastrointestinal quality of life index (GIQLI) survey was used to evaluate postoperative qualities of life.

RESULTS

At the mean 4-year follow-up (range 2-6 years), the frequency of daily bowel movement in the Sarli group was significantly less than that in the TAC-IRA group (2.4 +/- 0.9 vs. 3.4 +/- 0.8; P = 0.0014), and the Wexner continence scores were significantly lower in the Sarli group compared to the TAC-IRA group (4.3 +/- 1.8 vs. 5.8 +/- 1.9; P = 0.0223). However, the GIQLI score in Sarli group was higher than the TAC-IRA group (119.8 +/- 7.5 vs. 111.1 +/- 12.0, P = 0.0455). Post subtotal colectomy barium enema showed a sign of "reservoir" at the residual ascending colon and cecum.

CONCLUSIONS

Compared to the TAC-IRA, subtotal colectomy with end-to-end antiperistaltic cecoproctostomy for appropriately selected patients with STC resulted in relief of constipation, satisfactory functional outcome, and improved qualities of life.

Anorectal physiologic evaluation of constipation

Chronic constipation is a widespread problem which affects approximately 63 million people in North America alone. Although the majority of patients respond to changes in dietary fiber and water intake, as well as the judicious use of laxatives, a small portion will not and as a result, will be evaluated by gastroenterologists and colorectal surgeons. These patients most frequently have slow transit constipation, pelvic floor dysfunction, or some combination of the two. The physiologic evaluation of these patients comprises colonic transit studies, anorectal manometry, cinedefecography, electromyography, and pudendal nerve terminal motor latency testing. In this article, the authors describe the physiologic basis for these studies and review the techniques used in diagnosing these conditions.