Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis

• Published in: The American journal of surgery Vol. 195; no. 1; pp. 73 - 77
• Main Authors: Feng, Ye, M.D, Jianjiang, Lin, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier; Elsevier Limited
• Subjects: Abdomen; Adult; Aged; Anastomosis, Surgical; Biological and medical sciences; Cecorectal anastomosis; Cecum - surgery; Colectomy - methods; Colon; Colon, Sigmoid - surgery; Colorectal surgery; Constipation; Constipation - physiopathology; Constipation - surgery; Diarrhea; Female; Gastrointestinal Transit; General aspects; Hospitalization; Hospitals; Humans; Ileosigmoidal anastomosis; Ileum - surgery; Laxatives; Male; Medical sciences; Medical treatment; Middle Aged; Mortality; Pain; Patient satisfaction; Rectum - surgery; Retrospective Studies; Slow-transit constipation; Stomach, duodenum, intestine, rectum, anus; Studies; Subtotal colectomy; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; China; Subtotal colectomy; Ileosigmoidal anastomosis; Slow-transit constipation; Cecorectal anastomosis; Prognosis; Anastomosis; Colectomy; Medicine; Treatment; Surgery; Digestive diseases; Intestinal disease; Evolution; Colon; Constipation
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.02.015

Abstract Background Some patients with severe slow-transit constipation may benefit from subtotal colectomy, but there is no consensus on standard operative mode. The aim of the study was to compare the functional outcomes of subtotal colectomy with cecorectal anastomosis (CRA) with those of subtotal colectomy with ileosigmoidal anastomosis (ISA) in patients with severe slow-transit constipation. Methods Records of 79 patients who received preoperative investigation to confirm slow transit at our institution from 1989 to 2004 and subsequently received colectomy with CRA (n = 34) or colectomy with ISA (n = 45) were reviewed. The mean follow-up was 2 years (range 1–15). Results Postoperative defecation frequency increased and symptoms such as bloating and abdominal pain decreased in both groups. More CRA patients than ISA patients experienced persistent constipation and continued using laxatives or enemas at the 12-month follow-up. More ISA patients (93.3%) than CRA patients (73.5%) were satisfied with the procedure, whereas some patients in both groups complained of excessively high stool frequency and fecal incontinence. Conclusion Both CRA and ISA procedures increase the number of bowel movements; however, ISA results in higher defecation frequency, less use of laxatives and enemas, and higher patient satisfaction.