Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2491
Peer-review started: March 16, 2018
First decision: March 30, 2018
Revised: April 5, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: June 21, 2018
Constipation affects more than 30% of the aged population and seriously alters the life quality of patients. In terms of treatments for constipation, surgical treatment is a common approach for treatment of intractable slow transit constipation, especially for those with poor responses to conservative treatment. This study offers a better procedure for the treatment of slow transit constipation in an aged population.
Although the current surgical methods have good efficacy in the treatment of slow transit constipation, they are not suitable for aged patients or patients in poor physical condition because of the large wound produced and the length of the operation; these patients need non-surgical treatments. After long-term treatment with oral laxative agents, patients become nonresponsive to these agents and have to undergo enema administration periodically to alleviate their constipation. Some patients cannot tolerate the suffering of constipation and have to choose ileostomy.
The main aim of this study is to compare the efficacy, improved quality of life, and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) for the treatment of slow transit constipation.
Aged patients between October 2010 and October 2014, who had slow transit constipation, were hospitalized and underwent laparoscopic surgery in our institute and were divided into two groups: the bypass group and the bypass plus colostomy group. The following preoperative and postoperative clinical data were collected: gender, age, body mass index, operative time, first flatus time, length of hospital stay, bowel movements (BMs), Wexner fecal incontinence scale, Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI), numerical rating scale for pain intensity (NRS), abdominal bloating score (ABS), and Clavien-Dindo classification of surgical complications (CD) before surgery and at 3, 6, 12, and 24 mo after surgery.
All patients successfully underwent laparoscopic surgery without open surgery conversion or surgery-related death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group. No significant differences were observed in first flatus time, length of hospital stay, or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At month 3, 6, and 12 after surgery, the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at month 3, 6, 12, and 24 after surgery in both groups significantly improved compared with the preoperative conditions, except for NRS at month 3 and 6 after surgery in both groups, ABS at month 12 and 24 after surgery, and NRS at month 12 and 24 after surgery in the bypass group. WCS, GIQLI, NRS, and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at month 3, 6, 12, and 24 after surgery except WCS, NRS at month 3, 6 after surgery and ABS at month 3 after surgery. At 1 year after surgery, a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group.
We draw a conclusion from this study that laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can improve the prognosis significantly. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in the aged population.
This work is a retrospective single-center study. We will further develop a multicenter randomized controlled study. Meanwhile, we will expand the sample size and continue long-term follow-up to evaluate further efficacy of the subtotal colonic bypass plus colostomy.