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Deng XM, Zhu TY, Wang GJ, Gao BL, Li RX, Wang JT. Laparoscopic total colectomy with ileorectal anastomosis and subtotal colectomy with antiperistaltic cecorectal anastomosis for slow transit constipation. Updates Surg 2023:10.1007/s13304-023-01458-y. [PMID: 36914915 DOI: 10.1007/s13304-023-01458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/09/2023] [Indexed: 03/14/2023]
Abstract
To investigate the clinical efficacy of laparoscopic total colectomy with ileorectal anastomosis (TC-IRA) and laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (SC-ACRA) on adults with slow transit constipation (STC). One hundred and three patients with STC were assigned to the TC-IRA group (n = 53) and the SC-ACRA group (n = 50). The clinical data were analyzed. The surgery was successful in all patients (100%). Significantly (P = 0.03) more patients took anti-laxatives during hospitalization in the TC-IRA than the SC-ACRA group (39.62% vs. 20.00%). Abdominal pain and distension was present in 33.96% and 32.00% patients in the TC-IRA and SC-ACRA group, respectively, which decreased insignificantly (P > 0.05) to 18.87% and 18.00% 24 months after surgery, respectively. The postoperative Wexner and gastrointestinal quality of life (GIQLI) scores were not significantly different (P > 0.05) at all times after surgery in both groups. The defecation frequency decreased in both groups, and the average defecation frequency was significantly (P < 0.05) higher in the TC-IRA than the SC-ACRA group (3.91 ± 1.23 vs. 3.14 ± 1.15 times/day) at 3 months. Three months after surgery, significantly (P < 0.05) fewer patients were satisfied with defecation frequency in the TC-IRA than the SC-ACRA group (29 vs. 37 patients), whereas the number of patients who were willing to choose the same procedure again was not significantly (P > 0.05) different between the two groups. The WIS score of patients was significantly (P = 0.035) higher in the TC-IRA than the SC-ACRA group (6 vs. 5) 3 months later. TC-IRA and SC-ACRA are both safe and effective for adult slow transit constipation, and can significantly improve the quality of life of patients. Even though SC-ACRA has better early defecation frequency, postoperative antidiarrheal application and satisfaction, the long-term follow-up effects are similar.
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Affiliation(s)
- Xiu-Mei Deng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
| | - Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
| | - Bu-Lang Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
| | - Rui-Xin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
| | - Jing-Tao Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China
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Knowles CH, Grossi U, Chapman M, Mason J. Surgery for constipation: systematic review and practice recommendations: Results I: Colonic resection. Colorectal Dis 2017; 19 Suppl 3:17-36. [PMID: 28960923 DOI: 10.1111/codi.13779] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the outcomes of colectomy in adults with chronic constipation (CC). METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements (SES) with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Forty articles were identified, providing data on outcomes in 2045 patients. Evidence was derived almost exclusively from observational studies, the majority of which concerned colectomy and ileorectal anastomosis (CIRA) rather than other procedural variations. Average length of stay (LOS) ranged between 7-15 days. Although inconsistent, laparoscopic surgery may be associated with longer mean operating times (210 vs 167 min) and modest decreases in LOS (10-8 days). Complications occurred in approximately 24% of patients. Six (0.4%) procedure-related deaths were observed. Recurrent episodes of small bowel obstruction occurred in about 15% (95%CI: 10-21%) of patients in the long-term, with significant burden of re-hospitalisation and frequent recourse to surgery. Most patients reported a satisfactory or good outcome after colectomy but negative long-term functional outcomes persist in a minority of patients. The influence of resection extent, anastomotic configuration and method of access on complication rates remains uncertain. Available evidence weakly supports selection of patients with an isolated slow-transit phenotype. CONCLUSION Colectomy for CC may benefit some patients but at the cost of substantial short- and long-term morbidity. Current evidence is insufficient to guide patient or procedural selection.
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Affiliation(s)
- C H Knowles
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - U Grossi
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - M Chapman
- Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - J Mason
- University of Warwick, Coventry, UK
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- National Institute for Health Research: Chronic Constipation Treatment Pathway
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- Affiliate section of the Association of Coloproctology of Great Britain and Ireland
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Affiliation(s)
- Charles H Knowles
- Barts Health NHS Trust, The Blizard Institute, Barts &The London School of Medicine and Dentistry, The National Centre for Bowel Research &Surgical Innovation, 1st Floor Abernethy Building, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK
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Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. Hand-Assisted Laparoscopic Approach in Colon Surgery. J Gastrointest Surg 2015. [PMID: 26302878 DOI: 10.1007/s11605015-2924-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study sought to compare outcomes of patients who underwent hand-assisted laparoscopic (HAL) colectomy with open and laparoscopic colectomy (LP). STUDY DESIGN The NSQIP databases were used to examine the clinical data of patients who underwent elective colectomy during 2012-2013. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS We sampled a total of 21,090 patients who underwent colectomy. Of these, 7480 (35.5 %) had open colectomy (OC), 8751 (41.5 %) had a laparoscopic colectomy, 2860 (13.6 %) had a HAL colectomy, and 1999 (9.5 %) had an open procedure converted from LC or HAL. Multivariate regression analysis revealed HAL colectomy had a similar mortality (AOR 0.53, P = 0.07) and a lower morbidity (AOR 0.37, P < 0.01) compared to OC. LC had lower mortality (AOR 0.58, P = 0.02) and morbidity (AOR 0.43, P < 0.01) compared to OC. Mortality of patients who underwent HAL was not significantly different from LC (AOR 0.90, P = 0.79); however, morbidity of such patients was significantly higher than for patients who underwent LC (AOR 1.29, P < 0.01). CONCLUSIONS HAL colectomy is a safe approach with significant advantages compared to open colectomy. Although the morbidity of patients who underwent HAL is higher than patients who underwent LC, the morbidity rate is still lower than OC.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Steven Mills
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. Hand-Assisted Laparoscopic Approach in Colon Surgery. J Gastrointest Surg 2015; 19:2045-53. [PMID: 26302878 DOI: 10.1007/s11605-015-2924-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/11/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study sought to compare outcomes of patients who underwent hand-assisted laparoscopic (HAL) colectomy with open and laparoscopic colectomy (LP). STUDY DESIGN The NSQIP databases were used to examine the clinical data of patients who underwent elective colectomy during 2012-2013. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS We sampled a total of 21,090 patients who underwent colectomy. Of these, 7480 (35.5 %) had open colectomy (OC), 8751 (41.5 %) had a laparoscopic colectomy, 2860 (13.6 %) had a HAL colectomy, and 1999 (9.5 %) had an open procedure converted from LC or HAL. Multivariate regression analysis revealed HAL colectomy had a similar mortality (AOR 0.53, P = 0.07) and a lower morbidity (AOR 0.37, P < 0.01) compared to OC. LC had lower mortality (AOR 0.58, P = 0.02) and morbidity (AOR 0.43, P < 0.01) compared to OC. Mortality of patients who underwent HAL was not significantly different from LC (AOR 0.90, P = 0.79); however, morbidity of such patients was significantly higher than for patients who underwent LC (AOR 1.29, P < 0.01). CONCLUSIONS HAL colectomy is a safe approach with significant advantages compared to open colectomy. Although the morbidity of patients who underwent HAL is higher than patients who underwent LC, the morbidity rate is still lower than OC.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Steven Mills
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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