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

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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.	魏東. 慢傳輸型便秘外科治療進展. 世界華人消化雜志, 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.	魏東. 慢傳輸型便秘外科手術方法的治療進展. 中華胃腸外科雜志, 2018, 21(3): 357-360.
5.	劉寶華. 結腸慢傳輸性便秘外科治療國內外進展. 中國普外基礎與臨床雜志, 2007, 14(6): 630-631.
6.	謝尚奎, 彭慧, 羅俊, 等. 結腸次全切除、結腸直腸低位吻合治療合并出口梗阻的結腸慢傳輸型便秘. 實用醫學雜志, 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.	黃忠誠. 慢傳輸型便秘手術的規范與實施. 中華胃腸外科雜志, 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.	劉寶華. 便秘外科手術治療. 臨床消化病雜志, 2013, 25(4): 218-221.
19.	傅傳剛, 高顯華. 便秘外科治療的爭議和共識. 中國實用外科雜志, 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, 魏東, 張劍鋒, 等. 直腸保留長度對腹腔鏡結腸全切除回直腸吻合術治療慢傳輸型便秘療效的影響. 臨床外科雜志, 2017, 25(4): 269-271.
23.	謝尚奎, 任東林, 鮮振宇, 等. 全結腸切除聯合全直腸保留治療結腸慢傳輸型便秘. 廣東醫學, 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.	黃興, 劉祺, 肖志剛, 等. 低位直腸癌術后吻合口位置與肛門功能關系的研究. 中國腫瘤臨床, 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. 魏東. 慢傳輸型便秘外科治療進展. 世界華人消化雜志, 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. 魏東. 慢傳輸型便秘外科手術方法的治療進展. 中華胃腸外科雜志, 2018, 21(3): 357-360.
5. 劉寶華. 結腸慢傳輸性便秘外科治療國內外進展. 中國普外基礎與臨床雜志, 2007, 14(6): 630-631.
6. 謝尚奎, 彭慧, 羅俊, 等. 結腸次全切除、結腸直腸低位吻合治療合并出口梗阻的結腸慢傳輸型便秘. 實用醫學雜志, 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. 黃忠誠. 慢傳輸型便秘手術的規范與實施. 中華胃腸外科雜志, 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. 劉寶華. 便秘外科手術治療. 臨床消化病雜志, 2013, 25(4): 218-221.
19. 傅傳剛, 高顯華. 便秘外科治療的爭議和共識. 中國實用外科雜志, 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, 魏東, 張劍鋒, 等. 直腸保留長度對腹腔鏡結腸全切除回直腸吻合術治療慢傳輸型便秘療效的影響. 臨床外科雜志, 2017, 25(4): 269-271.
23. 謝尚奎, 任東林, 鮮振宇, 等. 全結腸切除聯合全直腸保留治療結腸慢傳輸型便秘. 廣東醫學, 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. 黃興, 劉祺, 肖志剛, 等. 低位直腸癌術后吻合口位置與肛門功能關系的研究. 中國腫瘤臨床, 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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