A Novel Surgical Approach to Slow-Transit Constipation: Report of Two Cases

Abstract

We report two cases of slow-transit constipation diagnosed after a thorough investigation with two colonic transit tests showing slow-transit constipation, a normal anorectal manometry, balloon expulsion test, small-bowel follow-through, defecography, laboratory and psychologic tests. The patients rejected standard surgical treatment (total colectomy + ileorectal anastomosis). A colonic bypass with an ileorectal anastomosis, leaving the colon in situ, was offered and accepted by the two patients. This was performed laparoscopically liberating the cecum and terminal ileum, transecting the terminal ileum through a small suprapubic incision, and anastomosing the terminal ileum to the rectosigmoid junction intracorporeally. The total surgical time was 50 and 60 minutes, respectively. Both patients made uneventful recoveries and were discharged on the fourth postoperative day. They have completed four and two months of close follow-up and at present have one to four bowel movements per day with mild abdominal distension and pain. To our knowledge this is the first report of colonic bypass for the treatment of slow-transit constipation.

Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation

“…Despite recent reports of more conservative approaches [3,4], ablative procedures remain the most effective and reliable ones for STC treatment. Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) seems to provide a valid alternative to total colectomy with ileorectal anastomosis (IRA), the most widely adopted procedure for slow-transit constipation, with potentially less functional impairment [5][6][7][8][9].…”

“…On the other hand, any attempts at even more conservative resections, such as segmental resections or colonic bypass [3,4,15,16], have given rise to considerable concerns regarding overall effectiveness and stability of long-term results. Therefore, rather than a variation in technique, the following step in our experience has been the standardization and the validation of a minimally invasive approach for SCCRA.…”

“…Despite recent reports of more conservative approaches [3,4], ablative procedures remain the most effective and reliable ones for STC treatment. Subtotal colectomy with Presented at the 19th EAES Congress, June 15-18,…”

“…This is particularly true for outlet obstruction constipation, where surgical procedures have increased worldwide thanks to a more precise diagnostic definition as well as to the development of surgical devices [2]. However, the surgical treatment of severe slow-transit constipation (STC) (colonic inertia) has not gained such a great popularity because of the relative rarity of the syndrome and the difficulty and risks of the procedures involved.Despite recent reports of more conservative approaches [3,4], ablative procedures remain the most effective and reliable ones for STC treatment. Subtotal colectomy with Presented at the 19th EAES Congress, June 15-18,…”

Treatment of severe childhood constipation with restorative proctocolectomy: the surgeon's view

“…Segmental resection has been described either as direct anastomosis or with an ileorectal bypass with very variable results 6–8. Resection of an isolated megasigmoid has the best prognosis, but neither Jaffray nor I have had a simple isolated megasigmoid with a normal-sized rectum distally.…”