Chronic Disease ; Constipation ; surgery ; Humans

Colon ; physiopathology ; Constipation ; etiology ; surgery ; Humans

The treatment of constipation is to alleviate the symptoms and improve quality of life. If complications occur after surgery, it will bring more pain to the patients.The requirement of constipation surgery is higher than that of malignant tumor. The efficacy of constipation surgery depends on accurate diagnosis and reasonable operation method.Laparoscopic technique is preferred with small trauma, quick recovery and satisfactory cosmetic outcomes.
Constipation ; surgery ; Humans ; Laparoscopy ; Quality of Life

Operation is one of the important methods for the treatment of chronic constipation, while the perioperative management is an important part of the operation. This consensus aims to improve the understanding of chronic constipation surgery among Chinese colorectal and anal surgeons and to provide instructions for the perioperative management. This consensus provides detailed recommendations for preoperative assessment, preoperative preparation, the choice of procedures, postoperative management and follow-up. The consensus is intended to reduce complications and improve efficacy.
China ; Consensus ; Constipation/surgery* ; Humans ; Postoperative Period

Adult ; Anastomosis, Surgical ; Constipation/surgery* ; Humans ; Megacolon/surgery* ; Proctocolectomy, Restorative

Refractory constipations are mostly mixed constipations. Surgery is only reserved as the last option when conservative treatments have failed. Colectomy or stapbed transanal rectal resection (STARR) represents the procedure of choice in patients with pure slow transmit constipation (STC) or obstructive defecation syndrome (ODS). However, its clinical outcome is unsatisfactory. Jinling procedure, a new surgical innovation for mixed constipation, aims to correct the coexistence of STC and ODS in severe refractory constipation. It combines subtotal colectomy and side to side cecorectal anastomosis, which shows a promising clinical outcome in over 500 refractory constipation patients. In our department, there is no significant difference in operation time, mortality and complications between the laparoscopic assisted and open Jinling procedures. Jinling procedure is also appropriate for secondary Hirschsprung's disease. Stoma is described in the treatment of some adult constipation patients, which has not been supported by the evidence-based medicine at present. Anastomosis leakage is a severe complication after constipation surgery. Fecal diversion is indicated once it happened. Colon irrigation may be used in patients who failed after surgery or children who refused definitive operation. It has showed a good short-term functional recovery but becomes invalid after a long-term follow-up.
Adult ; Colectomy ; Constipation ; surgery ; Defecation ; Humans ; Laparoscopy ; Treatment Outcome

In recent years, advancements have been made in both basic and surgical research of slow-transit constipation (STC). However, compelling references for surgeons in the clinical practice of STC have been lacking, particularly on preoperative evaluation and the choice of surgical procedures. In order to further standardize the diagnosis, assessment and surgical management of STC, Chinese Medical Doctor Association Anorectal Doctor Branch and its Functional Diseases Committee selected relevant experts in the field of STC surgery in China to form the Editorial and Review Committee of the Expert Consensus on Diagnosis, Evaluation and Surgical Management of STC in China. By meticulously reviewing relevant literature from both domestic and international sources and integrating the clinical expertise of the panel of experts, the committee has formulated 20 recommendations. These recommendations aim to establish standardized processes for surgical diagnosis and treatment of STC, ultimately elevating the overall diagnostic and therapeutic standards for STC across China.
Humans ; Consensus ; Gastrointestinal Transit ; Constipation/surgery* ; Colectomy ; China

OBJECTIVETo study the feasibility of subtotal colectomy with cecorectal end-side anastomosis for slow transit constipation.

METHODSRetrospective analysis was performed on 23 patients with colon slow transit constipation treated by subtotal colectomy with cecorectal end-side anastomosis in our department from March 2006 to April 2013. The main measure outcome was the curative effect on constipation by this type of surgery.

RESULTSTwenty-three patients were successfully treated. Anastomotic leakage occurred in one case, and urinary retention in 1 case, while no anastomotic stricture, abdominal bleeding, abdominal hernia, incontinence and other complications occurred. During follow-up of 2 months to 7 years, defecation frequency was 1-4 times a day with no need of antidiarrheal agents. Each time of defecation was less than 5 min. All the patients had no recurrence of constipation.

CONCLUSIONSubtotal colectomy with cecorectal end-side anastomosis can be used to treat colon slow transit constipation, while accurate preoperative evaluation and strict indications for the surgery is the key to success.

Anastomosis, Surgical ; Cecum ; surgery ; Colectomy ; Colon ; surgery ; Constipation ; surgery ; Defecation ; Humans ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo propose a novel surgical procedure for refractory constipation, namely Jinling procedure, and to explore its safety and efficacy through long-term follow-up.

METHODSA total of 614 patients with refractory constipation were admitted to the Department of General Surgery between February 2000 and June 2011. Five hundred and fifty-four patients received Jinling procedure and were included in this study. The general clinical data, complications after Jinling procedure, gastrointestinal quality of life index (GIQLI), Wexner constipation scale and satisfaction rate during follow-up were collected.

RESULTSNo operation-associated death occurred. Increased bowel movement frequency was observed during the perioperative period. Temporary difficulty in urination occurred in 24.5% of the patients. Other complications included small bowel obstruction (9.6%), anastomotic bleeding (8.1%), anastomotic leakage (3.1%), sexual dysfunction (3.1%), and wound infection (3.1%). Most postoperative complications were managed conservatively. The most recent follow-up was on August 2011, and the follow-up rate was 100%, 88.8%, 75.1%, 56.3% at 3, 6, 12, and 24 months after surgery. GIQLI temporarily increased from 78.1±9.4 preoperatively to 92.0±9.5 at 3 months follow-up, but continued to decrease during the follow-up at the 6 months (48.4±14.1), 12 months (21.0±4.3), and 24 months (20.0±3.4). Wexner constipation scale decreased from 19.9±4.3 preoperatively to 8.4±2.1 at 3 months follow-up (P<0.01). The low Wexner scale sustained until 24 months after operation. The satisfaction rate at the 3, 6,12 and 24 months follow-up was 78.1%, 91.1%, 94.2% and 94.6%, respectively.

CONCLUSIONJinling procedure provides refractory constipation patients with a novel, safe and effective surgical option.

Constipation ; surgery ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; surgery ; Quality of Life ; Treatment Outcome

OBJECTIVETo evaluate the anatomy and functional changes of pelvis before and after Jinling procedure (subtotal colectomy and side-to-side colorectal anastomosis) using defecography.

METHODSFifty patients with refractory mixed constipation received Jinling procedure in the Jinling Hospital between March 2009 and December 2010 and were included in this prospective study. The defecography was performed at one week before surgery and 6 months after Jinling procedure. Longo outlet obstructed score, Wexner constipation score and Wexner incontinence score were also recorded before and after the procedure.

RESULTSAfter 6 months follow-up, defecography showed that anterior rectocele, prolapse, intussusception, and descending perineum were significantly improved (P<0.01). Anterior rectoceles were significantly reduced in depth from 22.0±1.8 mm to 2.4±0.4 mm (P<0.01). Intussusception decreased from 1.9±0.4 cm to 0.4±0.5 cm (P<0.01). Compared with preoperative score, Longo score and Wexner constipation score were significantly improved from 17.6±3.8 to 5.3±2.0 and from 19.5±4.8 to 5.5±2.4, respectively (P<0.01).

CONCLUSIONSJinling procedure can correct the anatomy and functional pelvic disorders in mixed constipation. Clinical improvement of obstructed defecation syndrome after Jinling procedure correlates well with morphologic correction of the rectal redundancy.

Anastomosis, Surgical ; Colectomy ; Constipation ; surgery ; Defecation ; Defecography ; Female ; Humans ; Prospective Studies ; Rectocele ; Treatment Outcome