Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation

Abstract

BackgroundFew studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC.MethodsBetween January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared.ResultsThere were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285).ConclusionsOur findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.

Role of gut microbiota in functional constipation

“…may improve FC symptoms by promoting colon secretion and enhancing gastrointestinal motility [ 9 ]. Other treatment options with evidence for efficacy include biofeedback therapy [ 13 ], transanal irrigation [ 14 ], surgical interventions [ 15 , 16 ], and neuromodulation [ 14 ]. Despite all these intervention options, 40% of pediatric [ 17 ] and more than half of adult FC patients [ 18–20 ] are dissatisfied with the treatments due to the lack of efficacy and adverse effects.…”

Evaluation of Constipation and Treatment of Abdominal Component

“…If they are, surgery should be cautiously entertained but not abandoned [13]. Recent retrospective surgical series have consistently identified preoperative abdominal pain and bloating, via SF-36 questionnaires, Wexner Constipation Scores, or Gastrointestinal Quality of Life scores to be present in preoperative patients [69][70][71]. In each of these series, symptoms were significantly improved postsurgery.…”

“…Despite reporting satisfactory results, there are few comparative studies looking at these technical variations. Xie et al compared 20 patients who had abdominal colectomy with antiperistaltic cecorectal anastomosis to 35 who had standard ileorectal anastomosis and found no difference in postoperative outcomes including Wexner Constipation scores, Cleveland Clinic Incontinence and Constipation scores, as well as Gastrointestinal Quality of Life scores [71].…”

Laparoscopic subtotal colectomy with antiperistaltic caecorectal anastomosis in severe slow transit constipation — a video vignette

“…However, the best surgical procedure for STC has been debated for decades: the complexity of patients and disease, along with the difficulty of expressing or quantifying symptoms, makes a comparative study hard to perform. A recent series by Xie et al found no differences between antiperistaltic caecorectal anastomosis (SCCRA) and total colectomy with ileorectal anastomosis in terms of postoperative quality of life and incidence of complications [3]. Nevertheless, Patton et al [1] reported a significant deterioration in continence after total colectomy with ileorectal anastomosis on long‐term follow‐up.…”