BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluat...BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.展开更多
Background:Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation(STC),despite the increase in the number of cases.This st...Background:Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation(STC),despite the increase in the number of cases.This study aimed to analyse the long-termsurgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis(SC-ACRA)vs total colectomy with ileorectal anastomosis(TC-IRA)for severe STC.Methods:Between January 2005 and January 2015,we retrospectively collected clinical data of 55 patients who underwent TC-IRA(n=35)or SC-ACRA(n=20)for severe STC at our institution.The post-operative functional outcomes between the two groups were compared.Results:There were no significant differences in age(P=0.655),sex(P=0.234),period of constipation(P=0.105)and defecation frequency(P=0.698)between the TC-IRA and SC-ACRA groups.During a median follow-up period of 72 months(range,12–120 months),there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day[3(1/6–7)vs 3(1/6–5),P=0.578],Cleveland Clinic Florida Constipation Score[2(0–20)vs 2(0–19),P=0.454],Cleveland Clinic Incontinence Score[0(0–5)vs 0(0–2),P=0.333]and Gastrointestinal Quality of Life Index[122(81–132)vs 120(80–132),P=0.661].Moreover,there was no significant difference in the incidence of postoperative complications between the two groups(37.1%vs 25.0%,P=0.285).Conclusions:Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC,with similar long-termoutcomes.展开更多
Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy impr...Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.展开更多
基金Supported by the National Natural Science Foundation of China,No.81270461,No.81570483 and No.81770541.
文摘BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.
基金funded by grants from the National Natural Science Foundation of China[No.81570492 to C.Q.J.]the National Natural Science Foundation of China[No.81500505 to W.C.L.]the Natural Science Foundation of Hubei Province[No.2015CFB636 to W.C.L.].
文摘Background:Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation(STC),despite the increase in the number of cases.This study aimed to analyse the long-termsurgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis(SC-ACRA)vs total colectomy with ileorectal anastomosis(TC-IRA)for severe STC.Methods:Between January 2005 and January 2015,we retrospectively collected clinical data of 55 patients who underwent TC-IRA(n=35)or SC-ACRA(n=20)for severe STC at our institution.The post-operative functional outcomes between the two groups were compared.Results:There were no significant differences in age(P=0.655),sex(P=0.234),period of constipation(P=0.105)and defecation frequency(P=0.698)between the TC-IRA and SC-ACRA groups.During a median follow-up period of 72 months(range,12–120 months),there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day[3(1/6–7)vs 3(1/6–5),P=0.578],Cleveland Clinic Florida Constipation Score[2(0–20)vs 2(0–19),P=0.454],Cleveland Clinic Incontinence Score[0(0–5)vs 0(0–2),P=0.333]and Gastrointestinal Quality of Life Index[122(81–132)vs 120(80–132),P=0.661].Moreover,there was no significant difference in the incidence of postoperative complications between the two groups(37.1%vs 25.0%,P=0.285).Conclusions:Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC,with similar long-termoutcomes.
基金This study was supported by the National Science Foundation of China[No.81700751]the Scientific Research Foundation for the Returned Overseas Chinese Scholars[No.2110000021].
文摘Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.
