Comparison of ileocecal-preserving laparoscopic subtotal colectomy, antegrade peristaltic ascending colorectal anastomosis with antiperistaltic cecorectal anastomosis for the treatment of severe slow transit constipation
10.3760/cma.j.cn113855-20230323-00144
- VernacularTitle:保留回盲部的腹腔镜下结肠次全切除、顺蠕动升结肠直肠吻合术与逆蠕动盲肠直肠吻合术治疗重度慢传输型便秘疗效的比较
- Author:
Xiaoyi ZHU
1
;
Jianjiang LIN
;
Zhan SHEN
;
Hang RUAN
Author Information
1. 树兰（杭州）医院结直肠肛门外科，杭州 310000
- Keywords:
Constipation;
Anastomosis,surgical;
Colectomy;
Laparoscopy
- From:
Chinese Journal of General Surgery
2024;39(2):115-120
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy of ileocecal-preserving laparoscopic subtotal colectomy, antegrade peristaltic ascending colorectal anastomosis with antiperistalsis cecorectal anastomosis in the treatment of severe slow transit constipation.Methods:The clinical data of 42 patients with severe slow transit constipation undergoing surgery in Shulan (Hangzhou) Hospital from Jan 2016 to Oct 2021 were retrospectively analyzed. All 42 patients underwent ileocecal-preserving laparoscopic subtotal colectomy. Among them, 25 patients underwent antegrade peristaltic anastomosis of ascending colon and rectum, 17 patients underwent antiperistaltic anastomosis of cecum and rectum.Results:There was no significant difference in the operation time and hospitalization time between the two groups ( t=-0.464, P=0.645; t=0.010, P=0.992); Wexner constipation scores in both groups were significantly reduced at 6 and 12 months after surgery. There was no significant difference in the Wexner constipation scores ( t=-1.181, P=0.240; t=-1.717, P=0.090), the number of bowel movenents per day ( t=0.179, P=0.860; t=0.545, P=0.590) and stool shapes scores ( t=-0.316, P=0.750; t=0.447, P=0.660) between the two groups at 6 and 12 months after surgery. Gastrointestinal quality of life index scores in the antegrade peristaltic anastomosis group were significantly higher than those in the antiperistalsis anastomosis group at 6 and 12 months after surgery ( t=4.329, P<0.05; t=3.988, P<0.05), while abdominal pain scores were significantly lower than those in the antiperistalsis anastomosis group ( t=-4.386, P<0.05; t=-5.740, P<0.05). Conclusions:For patients with severe slow transit constipation, ileocecal-preserving laparoscopic subtotal colectomy has good surgical safety and near-to-medium-term clinical efficacy, whether it is antegrade peristaltic ascending colorectal anastomosis (the stump of the ascending colon is turned from front to back) or antiperistalsis cecorectal anastomosis. The antegrade peristaltic ascending colorectal anastomosis has lower abdominal pain score and better gastrointestinal quality of life than antiperistalsis cecorectal anastomosis, which should be recommended first. During the operation, the ileocolic mesentery should be fully separated to the root of mesentery and the ileocecal part should be turned from front to back to avoid the occurrence of mesenteric vascular torsion and small intestinal obstruction.
