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

作者：Wei, Dong^*; Cai, Jian; Yang, Yang; Zhao, Ting; Zhang, Hui; Zhang, Changshan; Zhang, Yuanyao; Zhang, Jianfeng; Cai, Fengbo

来源：BMC Gastroenterology, 2015, 15(1): 30.

DOI：10.1186/s12876-015-0257-7

• Slow Transit Constipation (STC)
• Laparoscopic subtotal colectomy
• Antiperistaltic cecorectal anastomosis
• Quality of life

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 3rd, 6th and 12th month after operation, the parameters of both groups significantly improved compared with the preoperative conditions (P < 0.05) except the APIS at 3rd and 6th month in control group. On the 3rd, 6th and 12th 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.

• 单位
  中国人民解放军第二军医大学; 中国人民解放军第150中心医院