| Constipation is a common gastrointestinal motility disorder that is often ignored by patients. The prevalence of constipation in America ranged from 2% to 34%. The prevalence of constipation in our country ranged from 3.6% to 24%,but only 16% patient will visit a doctor.Constipation appears to increase with increasing age,and female are more easy to constipate than male. Mean costs of diagnostic studies for constipation have been shown to approach $3000 per patient. The cost of ambulatory and inpatient care for constipation in the United States was $235 million in 2001.The constipation patients crowd are big and the cost of constipation treatment is huge, so specialists should pay attention to the diagnosis and treatment for constipation. In order to improve the quality of life and save therapy money, correct guidance and treatment is necessary. Diet, medical therapy and biofeedback therapy are recommended as first-line therapy for most of the constipation. Only a little of outlet obstructive constipation patients need to surgery operation, including rectocele(RC) and rectal-intussusception(RI). Our department apply Khubchandani neoplasty to the outlet obstructive constipation patients for about 2 to 3 years. The therapeutic effect is satisfactory, but the satisfaction will descend as the time passing. We designed a new surgery operation for the outlet obstructive constipation patients about 1 year ago. The new surgery operation, we called it"sandwich", is that include Khubchandani neoplasty, procedure for prolapse and hemorrhoids (PPH) and injection of sclerosing agent. We predict that sandwich will maintain a good effect for a long term and will not increase the wound. To test the prediction, we review 64 patients with outlet obstruction constipation in our hospital.All the 64 patients who underwent Khubchandani neoplasty or"sandwich"for ODS caused by RI and/or RC at our department, were all multipara.38 patients with ODS who underwent Khubchandani neoplasty ,mean age 46.8years(range 24～63 years),mean history 48.8 months(2～240 months). The rest of 28 patients, mean age 48.2years (range 28～73 years), mean history 40.5 months (1～216 months), underwent"sandwich". All patients underwent a full history and physical examination. Longo's obstructed defecation syndrome (ODS) score system was used to evaluate defecation problems preoperative and postoperative. Barium defecography is required, and colonoscopy, colonic transit time, EMG is used to rule out colonic causes of constipation. The diagnosis criteria as follow: (1) Corresponding to diagnosis standards of the RomeⅢ;(2) Physical examination is able to find the physiologic changing of the ODS patients. (3) Barium defecography, the first choice of ODS examination, display a significant results. Our reseach finding that: (1) Only a few patient's diagnosis is RI(3.1%) or RC(3.1%), most of the patient have tow or more diagnosis. (2) Life of quality: Evaluation by physical examination, barium defecography and ODS score. (3) The wound to the patients: Only one postoperative complication occur in the sandwich group. The sandwich group's mean hospital stay is 9.72d (range 5～15d). Comparing to the Khubchandani neoplasty group 9.81d (range 5～14d), there is no different. And the volume of the narcotic is almost the same in two group, 17.2% in Khubchandani neoplasty group to 21.4% in sandwich group. Conclusions: Diagnosis of ODS can be confirmed after a full history, physical examination and barium defecography. Both techniques are safe and effective in the treatment of outlet obstruction; nevertheless, the sandwich group seems to be preferable due to longer effective, less residual rectocele at defecography. A fully preoperative physical evaluation will give help for prognosis estimation.
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