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 investigate the safety and feasibility of 3D laparoscopic surgery via transrectal extraction of specimens without abdominal incision in the treatment of slow transit constipation (STC).

METHODSFrom May 2015 to January 2017, 8 STC patients (6 females and 2 males) with informed consent were selected to receive subtotal colectomy with 3D laparoscopy as the no-incision incision group, in which the initial part of ascending colon and rectum were end-to-end anastomosed directly after extraction of the specimen through the rectum. Twelve STC patients (9 females and 3 males) undergoing traditional subtotal colectomy with 3D laparoscopy were selected as the traditional group by case matching method (gender, age, BMI, the difference of receiving operation time less than 12 months, same surgeon team). Perioperative parameters (operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay, complications, postoperative pain score and additional pain management), inflammation index at postoperative day 1 and day 3 (leukocyte, procalcitonin, interleukin 6, C-reactive protein), postoperative peritoneal infection, wound healing, short-term and long-term efficacy, patient satisfaction evaluation (subjective hundred-mark system) at postoperative one year were compared between two groups.

RESULTSThere were no significant differences between two groups in operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay and morbidity of complication (all P>0.05). Significantly lower pain scores at postoperative 6-hour (median 3.0 vs. 4.5, U=23.0, P=0.042), lower ratio of additional analgesic at postoperative day 1(1/8 vs. 7/12, P=0.040) were found in the no-incision group. Leukocyte level at postoperative day 1 was significantly lower in the no-incision group [(11.0±3.5)×10/L vs. (14.7±3.6)×10/L, t=-2.281, P=0.035]. C-reactive protein concentration at postoperative day 3 was not significantly different between two groups but with different trend [median 78.1(0.1 to 154.0) mg/L vs. 22.0 (7.0 to 55.9) mg/L,U=33.0, P=0.047]. There were no significant differences of interleukin-6 and procalcitonin between two groups(all P>0.05). All the patients had follow-up for 14-31 months. Subjective effectiveness score was 90±9 in the no-incision group and 94±6 in the traditional group without significant difference(t=-1.099, P=0.286). No long-term complications associated with abdominal infection was observed in the no-incision group.

CONCLUSION3D laparoscopic subtotal colectomy via transrectal extraction of specimens without abdominal incision in the treatment of STC has similar short-term and long-term efficacies compared with traditional laparoscopic assisted surgery, and does not increase the probability of abdominal contamination.

Colectomy ; methods ; Constipation ; surgery ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Rectum ; Treatment Outcome