Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Preservation of superior rectal artery in laparoscopically assisted subtotal colectomy with ileorectal anastomosis for slow transit constipation
Chien-Wei Wu, Ta-Wei Pu, Jung-Cheng Kang, Cheng-Wen Hsiao, Chao-Yang Chen, Je-Ming Hu, Kuan-Hsun Lin, Tzu-Chiao Lin
Chien-Wei Wu, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Ta-Wei Pu, Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan
Jung-Cheng Kang, Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 10556, Taiwan
Cheng-Wen Hsiao, Tzu-Chiao Lin, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Chao-Yang Chen, Je-Ming Hu, Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Kuan-Hsun Lin, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Author contributions: Wu CW is the first author of the above case report; Wu CW wrote the observational study and completed the literature review; Pu TW is an attending surgeon; Hsiao CW, Chen CY, Hu JM, Lin TC, Lin KH and Kang JC are our surgical team; Pu TW performed the final editing and preparation of the paper for approval; all authors have read and approved the final manuscript.
Institutional review board statement: This study protocol was reviewed and approved by the Institutional Review Board of the Taiwan Adventist Hospital (TAHIRB No.: 105-E-10). It was conducted in compliance with the Helsinki Declaration.
Informed consent statement: Written informed consent was waived.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ta-Wei Pu, MD, Attending Doctor, Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, No. 131 Jiankang Road, Songshan District, Taipei 10581, Taiwan. tawei0131@gmail.com
Received: November 11, 2020
Peer-review started: November 11, 2020
First decision: November 23, 2020
Revised: December 8, 2020
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: June 14, 2021
BACKGROUND
Slow transit constipation (STC) has traditionally been considered as a functional disorder. However, evidence is accumulating that suggests that most of the motility alterations in STC might be of a neuropathic etiology. If the patient does not meet the diagnosis of pelvic outlet obstruction and poorly response to conservative treatment, surgical intervention with subtotal colectomy may be effective. The most unwanted complication of the procedure is anastomotic leakage, however, preservation of the superior rectal artery (SRA) may reduce its incidence.
AIM
To evaluate the preservation of the SRA in laparoscopically assisted subtotal colectomy with ileorectal anastomosis in STC patients.
METHODS
This was a single-center retrospective observational study. STC was diagnosed after a series of examinations which included a colonic transit test, anal manometry, a balloon expulsion test, and a barium enema. Eligible patients underwent laparoscopically assisted total colectomy with ileorectal anastomosis and were examined between January 2016 and January 2018. The operation time, blood loss, time to first flatus, length of hospital days, and incidence of minor or major complications were recorded.
RESULTS
A total of 32 patients (mean age, 42.6 years) who had received laparoscopic assisted subtotal colectomy with ileorectal artery anastomosis and preservation of the SRA. All patients were diagnosed with STC after a series of examinations. The mean operative time was 151 min and the mean blood loss was 119 mL. The mean day of first time to flatus was 3.0 d, and the mean hospital stay was 10.6 d. There were no any patients conversions to laparotomy. Post-operative minor complications including 1 wound infection and 1 case of ileus. There was no surgical mortality. No anastomosis leakage was noted in any of the patients.
CONCLUSION
Laparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the SRA can significantly improve bowel function with careful patient selection. Sparing the SRA may protect against anastomosis leakage.
Core Tip: Slow transit constipation (STC) has traditionally been considered as a functional disorder. Surgical intervention with subtotal colectomy may be effective for STC. Laparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the superior rectal artery is tolerated and can have an excellent surgical outcome in reduce anastomosis leakage with significant improvement in bowel function under careful patient enrollment criteria.
