Long-term results of subtotal colectomy with cecorectal anastomosis for isolated colonic inertia

Surgery for chronic idiopathic constipation: pediatric and adult patients - a systematic review

BACKGROUND

Chronic idiopathic constipation (CIC) is a substantial problem in pediatric and adult patients with similar symptoms and workup; however, surgical management of these populations differs. We systematically reviewed the trends and outcomes in the surgical management of CIC in pediatric and adult populations.

METHODS

A literature search was performed using Ovid MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov between January 1, 1995 and June 26, 2020. Clinical trials and retrospective and prospective studies of patients of any age with a diagnosis of CIC with data of at least 1 outcome of interest were selected. The interventions included surgical resection for constipation or antegrade continence enema (ACE) procedures. The outcome measures included bowel movement frequency, abdominal pain, laxative use, satisfaction, complications, and reinterventions.

RESULTS

Adult patients were most likely to undergo resection (94%), whereas pediatric patients were more likely to undergo ACE procedures (96%) as their primary surgery. Both ACE procedures and resections were noted to improve symptoms of CIC; however, ACE procedures were associated with higher complication and reintervention rates.

CONCLUSION

Surgical management of CIC in pediatric and adult patients differs with pediatric patients receiving ACE procedures and adults undergoing resections. The evaluation of resections and long-term ACE data in pediatric patients should be performed to inform patients and physicians whether an ACE is an appropriate procedure despite high complication and reintervention rates or whether resections should be considered as an initial approach for CIC.

Subtotal colectomy with antiperistaltic cecosigmoidal anastomosis may be another suitable option for slow transit constipation: Experiences from Chinese people

The objective of this paper is to demonstrate, considering the experiences from Chinese people, if slow transit constipation (STC) can be accurately diagnosed, choosing patients qualifying for surgery, subtotal colectomy with antiperistaltic cecosigmoidal anastomosis (STC-Anti-CSA) may come with more acceptable short and long-term outcomes.A retrospective study was performed at a department of colorectal and anal surgery. A cohort of 29 patients were coming with up to 5 years' follow-up care, who were in a diverse range of age, BMI, laxative medicine histories, including both males and females. Pre-surgery work-up strictly followed a protocol designed to rule out the patients who were not suitable for surgery treatments. Classification of STC was followed after diagnosis. STC-Anti-CSA was performed in all cases. The operative time, blood loss, average post-operative length of stay (LOS), frequency of BMs, stool consistency and patients satisfaction, by using Wexner constipation score (WCS), numerical rating scale (NRS), and abdominal bloating score (ABS), over the study period were recorded.In this study, there were 14 males and 15 females, with mean age 51, and BMI from 20.14 to 31.62 kg/m. The period of laxative medicine history was 4.8 years (2-13 years). The mean operative time was 152 ± 34 min, and the mean perioperative blood loss was 123 ± 51 mL. Average post-operative LOS (LOS) was 8 days. There were no severe post-operative complications, peri-operative mortality, anastomotic leaks, or revisions of the original surgery. Initial post-operative BMs averaged 6 times/day. During the period of 1 month to 12 months follow-up care, BMs fell down to 2 or 3 times/day. By the 1st to 3rd year follow-up care, BMs averaged 5 to 7 times/week. However, from the 4th year to 5th year, constipations recurred somehow. However, most patients were satisfied with their bowel patterns.STC-Anti-CSA can receive acceptable postoperative outcomes as long as the patients can be accurately diagnosed and classified as severe STC. Among the surgical procedures for STC, this procedure may be another suitable option, especially for Chinese people.

Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy for the treatment of slow transit constipation in an aged population: A retrospective control study

AIM

To compare the efficacy, improved quality of life, and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) for the treatment of slow transit constipation.

METHODS

Between October 2010 and October 2014, aged patients with slow transit constipation who were hospitalized and underwent laparoscopic surgery in our institute were divided into two groups: the bypass group, 15 patients underwent SCBAC, and the bypass plus colostomy group, 14 patients underwent SCBCAC. The following preoperative and postoperative clinical data were collected: gender, age, body mass index, operative time, first flatus time, length of hospital stay, bowel movements (BMs), Wexner fecal incontinence scale, Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI), numerical rating scale for pain intensity (NRS), abdominal bloating score (ABS), and Clavien-Dindo classification of surgical complications (CD) before surgery and at 3, 6, 12, and 24 mo after surgery.

RESULTS

All patients successfully underwent laparoscopic surgery without open surgery conversion or surgery-related death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group (P = 0.007). No significant differences were observed in first flatus time, length of hospital stay, or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At 3, 6, and 12 mo after surgery, the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at 3, 6, 12, and 24 mo after surgery in both groups significantly improved compared with the preoperative conditions (P < 0.05), except NRS at 3, 6 mo after surgery in both groups, ABS at 12, 24 mo after surgery and NRS at 12, 24 mo after surgery in the bypass group. WCS, GIQLI, NRS, and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at 3, 6, 12, and 24 mo after surgery (P < 0.05) except WCS, NRS at 3, 6 mo after surgery and ABS at 3 mo after surgery. At 1 year after surgery, a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group (P = 0.007).

CONCLUSION

Laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in an aged population.

慢传输型便秘外科治疗进展

近年来, 慢性便秘呈缓慢上升趋势, 慢传输型便秘(slow transit constipation, STC)是慢性便秘最常见的一种类型, 外科治疗是STC治疗的重要手段. 由于目前对于STC的发病原因及发病机制尚未完全明确, 及术前缺乏精确定位病变结肠的检查方法, 导致治疗STC手术方法的多样性. 近三十年来, 随着医学技术的不断进步, STC的外科治疗不断发展, 手术方法不断创新; 手术方法经历了从简单到复杂再到个体化选择, 从单一手术方法到多种手术方法选择, 从经腹开放手术到腹腔镜微创手术. 本文从STC的术式产生和发展过程来阐述STC外科治疗疗效和进展.

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

Background

To observe and compare the short term results and functional recovery of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSCACRA) in the treatment of Adult slow transit constipation (STC) with two different reservoir length: short colonic reservoir and long colonic reservoir.

Methods

All STC patients treated with LSCACRA between April 2007 and December 2011 at our institution were followed up. Patients with 2 cm to 3 cm ascending colon preserved above the ileocecal junction were designated as observation group, whereas those preserved by 10 cm to 15 cm were classified as control group. 41 cases in the observation group and 40 cases in the control group were enrolled. Preoperative and outcome parameters of patients were collected, including gender, age, body mass index, operative time , blood loss, first flatus time, hospital stay, postoperative complications, Wexner constipation scale(WCS), Wexner incontinence scale, gastrointestinal quality of life index(GIQLI), abdominal pain intensity scale(APIS), abdominal pain frequency scale(APFS) and abdominal bloating scale(ABS).

Results

Laparoscopic surgeries were successfully carried out for all patients, without any case transferred to laparotomy or death related to surgery. The operative time, blood loss, first flatus time, and days of hospital stay of the two groups did not show significant differences. We found no significant differences on complications (Clavien–Dindo grade > I) between the two groups. No patient exhibited anastomotic leak. No fecal incontinence occurred in both groups. On the 3^rd, 6^th and 12^th month after operation, the parameters of both groups significantly improved compared with the preoperative conditions (P < 0.05) except the APIS at 3^rd and 6^th month in control group. On the 3^rd, 6^th and 12^th month after operation, the Functional Recovery outcomes of WCS、GIQLI、APIS、APFS and ABS in the observation group were superior to those in the control group (P < 0.05).

Conclusion

LSCACRA has a significant effect in the treatment of STC in adult. Postoperative outcomes can be optimized by shortening the length of the preserved ascending colon above the ileocecal junction, which promise better life quality of patients. Trial registration: Chinese Clinical Trial Registry ChiCTR-OPC-14005280, 2014-09-29.

Electronic supplementary material

The online version of this article (doi:10.1186/s12876-015-0257-7) contains supplementary material, which is available to authorized users.

Long-term follow-up of the Jinling procedure for combined slow-transit constipation and obstructive defecation

BACKGROUND

Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial.

OBJECTIVE

The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up.

DESIGN

The study is a retrospective review of prospectively gathered data in a patient registry database.

SETTINGS

This investigation was conducted at a tertiary-care gastroenterology surgical center in China.

PATIENTS

The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007.

INTERVENTION

The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation.

MAIN OUTCOME MEASURES

We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up.

RESULTS

A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01).

LIMITATIONS

This study did not include a comparison group.

CONCLUSIONS

Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.

Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation

BACKGROUND

Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) has proved to be an effective alternative to total colectomy for the treatment of severe slow-transit constipation. The laparoscopic approach has made this procedure even more attractive. This is the first controlled trial on laparoscopic SCCRA. The study compares the laparoscopic and the open approach.

METHODS

Since 2001, all SCCRAs have been performed laparoscopically at our institution. Only severely symptomatic patients are offered surgery, after stringent patient selection. Laparoscopic SCCRA was performed following the same steps that we first described for the open approach, by utilizing a five-trocar technique. Outcome parameters were prospectively collected every 3 and 6 months. Wexner constipation and incontinence scales (WCS, WI) and gastrointestinal quality of life index (GIQLI) were adopted for functional results. We conducted a case-control study of 15 consecutive patients who underwent laparoscopic SCCRA (VL) and 15 patients previously operated on by the open approach (Op) to compare postoperative and functional outcomes.

RESULTS

The VL group had better postoperative outcomes (pain, ileus) while complication rates were similar. Resolution of constipation was impressive in both groups, with no significant difference at follow-up. The VL group presented with a higher number of bowel movements at 3 months (3.8 vs. 2.8, p = 0.039), resulting in a significantly higher incontinence rate at 3 months (WI 6.4 vs. 2.73, p = 0.004), although the difference was no longer significant at 1-year follow-up. The quality of life was good for both groups; the VL group showed a significant improvement at 1-year follow-up (64.18 vs. 114.79, p < 0.01).

CONCLUSIONS

Laparoscopic SCCRA confirmed the good functional results of the open approach, with no increase in morbidity rate and a faster postoperative recovery. An early higher incontinence rate did not affect quality of life.

Surgical treatment for constipation in children and adults

Functional constipation is one of the most common gastrointestinal disorders. In both children and adults, most patients are managed conservatively with good results. In this review, we focus on the surgical approach to constipation. Patients who lack the capacity to consistently have voluntary bowel movements may need mechanical emptying of the colon through an enema program; for them, surgery to allow for antegrade enemas, (via the appendix or using a button device) is useful. Those patients with severe constipation not responsive to intense medical treatment may be candidates for other surgical interventions, such as resection of the dysfunctional colonic segment (rectosigmoid or whole colon), or plication, -pexy, and STARR techniques for evacuatory disorders secondary to obstructive anatomical features. Permanent stomas are an option of last resort.

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.