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

Dong Wei, Jian Cai, Yang Yang, Ting Zhao, Hui Zhang, Changshan Zhang, Yuanyao Zhang, Jianfeng Zhang, Fengbo Cai, Dong Wei, Jian Cai, Yang Yang, Ting Zhao, Hui Zhang, Changshan Zhang, Yuanyao Zhang, Jianfeng Zhang, Fengbo Cai

Abstract

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

Trial registration: Chinese Clinical Trial Registry ChiCTR-OPC-14005280, 2014-09-29.

Figures

Figure 1
Figure 1
Resection area of observation group. The shadow is resection area.
Figure 2
Figure 2
Post-operational schematic diagram of observation group.
Figure 3
Figure 3
Resection area of control group. The shadow is resection area.
Figure 4
Figure 4
Post-operational schematic diagram of control group.
Figure 5
Figure 5
WCS Scores. X-axis: scores of WCS; Y-axis: time points pre- and post-operation. ●: mean of WCS in control group;○: mean of WCS in observation group;┊: 95% Confidence interval of WCS in control group;│: 95% Confidence interval of WCS in observation group.
Figure 6
Figure 6
GIQLI Scores. X-axis: scores of GIQLI; Y-axis: time points pre- and post-operation. ●: mean of GIQLI in control group;○: mean of GIQLI in observation group; ┊: 95% Confidence interval of GIQLI in control group;│: 95% Confidence interval of GIQLI in observation group.
Figure 7
Figure 7
ABS, APIS and APFS Scores. X-axis: scores of ABS, APIS and APFS; Y-axis: time points pre- and post-operation. ●: mean of ABS in control group;○: mean of ABS in observation group; ▲: mean of APFS in control group;△: mean of APFS in observation group; ▼: mean of APIS in control group;▽: mean of APIS in observation group; ┊: 95% Confidence interval of each index in control group;│: 95% Confidence interval of each index in observation group.
Figure 8
Figure 8
The barium enema. Note:large amount of barium has dried in block and remained in cecum and colon. Intestine has been emptied and rectum was basically emptied.

References

    1. Stewart WF, Liberman JN, Sandler RS, Woods MS, Stemhagen A, Chee E, et al. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol. 1999;94(12):3530–40. doi: 10.1111/j.1572-0241.1999.01642.x.
    1. Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg. 1999;230(5):627–38. doi: 10.1097/00000658-199911000-00004.
    1. Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, Wexner SD. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum. 2001;44(2):179–83. doi: 10.1007/BF02234290.
    1. Ternent CA, Bastawrous AL, Morin NA, Ellis CN, Hyman NH, Buie WD, et al. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum. 2007;50(12):2013–22. doi: 10.1007/s10350-007-9000-y.
    1. Lubowski DZ, Chen FC, Kennedy ML, King DW. Results of colectomy for severe slow transit constipation. Dis Colon Rectum. 1996;39(1):23–9. doi: 10.1007/BF02048263.
    1. FitzHarris GP, Garcia-Aguilar J, Parker SC, Bullard KM, Madoff RD, Goldberg SM, et al. Quality of life after subtotal colectomy for slow-transit constipation: both quality and quantity count. Dis Colon Rectum. 2003;46(4):433–40. doi: 10.1007/s10350-004-6576-3.
    1. Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Efron J, et al. Quality of life after colectomy for colonic inertia. Techniques Coloproctol. 2005;9(2):133–7. doi: 10.1007/s10151-005-0211-8.
    1. Sarli L, Costi R, Sarli D, Roncoroni L. Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation. Dis Colon Rectum. 2001;44(10):1514–20. doi: 10.1007/BF02234608.
    1. Marchesi F, Sarli L, Percalli L, Sansebastiano GE, Veronesi L, Di Mauro D, et al. Subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of slow-transit constipation: long-term impact on quality of life. World J Surg. 2007;31(8):1658–64. doi: 10.1007/s00268-007-9111-6.
    1. Iannelli A, Piche T, Dainese R, Fabiani P, Tran A, Mouiel J, et al. Long-term results of subtotal colectomy with cecorectal anastomosis for isolated colonic inertia. World J Gastroenterol. 2007;13(18):2590–5. doi: 10.3748/wjg.v13.i18.2590.
    1. Levitan R, Fordtran JS, Burrows BA, Ingelfinger FJ. Water and salt absorption in the human colon. J Clin Invest. 1962;41:1754–9. doi: 10.1172/JCI104634.
    1. Todd IP. Constipation: results of surgical treatment. British J Surg. 1985;72(Suppl):S12–3. doi: 10.1002/bjs.1800721309.
    1. Yoshioka K, Keighley MR. Clinical results of colectomy for severe constipation. British J Surg. 1989;76(6):600–4. doi: 10.1002/bjs.1800760625.
    1. Lillehei RC, Wangensteen OH. Bowel function after colectomy for cancer, polyps, and diverticulitis. J Am Med Assoc. 1955;159(3):163–70. doi: 10.1001/jama.1955.02960200009003.
    1. Perrier G, Peillon C, Testart J. [Modifications of the Deloyers procedure in order to perform a cecal-rectal anastomosis without torsion of the vascular pedicle] Ann Chir. 1999;53(3):254.
    1. Deloyers L. [Suspension of the right colon permits without exception preservation of the anal sphincter after extensive colectomy of the transverse and left colon (including rectum). technic -indications- immediate and late results] Lyon Chir. 1964;60:404–13.
    1. Zinzindohoue F. [Difficult colo-colonic or colo-rectal anastomoses: trans-mesenteric anastomoses and anastomoses with right colonic inversion] Ann Chir. 1998;52(6):571–3.
    1. Ryan JA, Jr, Oakley WC. Cecoproctostomy. Am J Surg. 1985;149(5):636–9. doi: 10.1016/S0002-9610(85)80145-8.
    1. Sarli L, Costi R, Iusco D, Roncoroni L. Long-term results of subtotal colectomy with antiperistaltic cecoproctostomy. Surg Today. 2003;33(11):823–7. doi: 10.1007/s00595-003-2611-6.
    1. Marchesi F, Percalli L, Pinna F, Cecchini S, Ricco M, Roncoroni L. Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation. Surg Endosc. 2012;26(6):1528–33. doi: 10.1007/s00464-011-2092-4.
    1. Jiang CQ, Qian Q, Liu ZS, Bangoura G, Zheng KY, Wu YH. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Color Dis. 2008;23(12):1251–6. doi: 10.1007/s00384-008-0552-7.
    1. Iannelli A, Fabiani P, Mouiel J, Gugenheim J. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation. Surg Endosc. 2006;20(1):171–3. doi: 10.1007/s00464-005-0099-4.
    1. Sarli L, Iusco D, Costi R, Roncoroni L. Laparoscopically assisted subtotal colectomy with antiperistaltic cecorectal anastomosis. Surg Endosc. 2002;16(10):1493. doi: 10.1007/s00464-002-4517-6.
    1. Sarli L, Iusco D, Violi V, Roncoroni L. Subtotal colectomy with antiperistaltic cecorectal anastomosis. Techniques Coloproctol. 2002;6(1):23–6. doi: 10.1007/s101510200004.
    1. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97. doi: 10.1007/BF02050307.
    1. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39(6):681–5. doi: 10.1007/BF02056950.
    1. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, et al. Gastrointestinal quality of life index: development, validation and application of a new instrument. British J Surg. 1995;82(2):216–22. doi: 10.1002/bjs.1800820229.
    1. Costi R, Roncoroni L, Violi V, Sarli L. Subtotal colectomy with antiperistaltic cecoproctostomy for slow-transit constipation: concerning the paper: Jiang et al. (2008) Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow-transit constipation-from Chinese report. Int J Colorectal Dis 23:1251–1256. Int J Color Dis. 2009;24(9):1117–8. doi: 10.1007/s00384-009-0668-4.
    1. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37(4):378–81. doi: 10.1136/ard.37.4.378.
    1. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. doi: 10.1097/SLA.0b013e3181b13ca2.

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