Comparison Of Efficacy Between Subtotal Colectomy With Ileosigmoidal Anastomosis And Cecorectal Anastomosis Treating Slow Transit Constipation

Objective: Slow transit constipation is a kind of functional intestinal disorders which is characterized by slow colon transit.Patients with slow-transit constipation typically have suffered through decrease of stool frequency,bowel problems.Those always accompany by abdominal distension,persistent symptoms,their symptoms get worsen with the progress of the disease.Slow transit constipation often occurre in female patients,this may be related to abnormal estrogen especially the disorder of the gesterone abnormalities.In addition,some endocrine and metabolic diseases such as hypothyroidism,hypoparathyroidism,pituitary dysfunction can lead to slow transit constipation by reducing intestinal motility.Many of these patients have a long history of laxative abuse and have become dependent on these agents.Long-term use of anthraquinone compounds such as senna,aloe,rhubarb which can damage the enteric nervous system will aggravate constipation.These patients taking laxatives may obtain satisfactory bowel movement in the stage,but with the progression,even taking more laxatives,the effect rather get worsen,until completely ineffective and have to use hand-assisted methods or enemas to promote feces.Some patients eventually require surgery.Procedures including the following:(1)Total colectomy-ileorectal anastomosis;(2)Subtotal colectomy surgery;(3)Partial colectomy;(4)Colonic exclusion;(5)Colostomy.Surgical procedures above have their own advantages and disadvantages,relieve the symptoms of constipation and postoperative recurrence rate differently.We need to choose surgical procedures depending on specific circumstances.Currently,total colectomy-ileorectal anastomosis,subtotal colectomy-ileosigmoidal anastomosis or subtotal colectomy cecorectal anastomosis is often used to treat STC.Compared with the IRA,the postoperative incidence rate of diarrhea and fecal incontinence was significantly lower after subtotal colectomy.Subtotal colectomy which includes ileosigmoidal anastomosis and cecorectal anastomosis is an alternative to treat STC.There is few comparisons between ileosigmoidal anastomosis and antiperistaltic cecorectal anastomosis in treating slow transit constipation.The aim of the study was to compare the functional outcomes of ileosigmoidal anastomosis(ISA)with antiperistaltic cecorectal anastomosis(CRA)after subtotal colectomy in patients with slow-transit constipation.Methods:1 We performed a retrospective analysis 62 patients who confirmed slow transit constipation in research center of coloproctology of Hebei province during 2006 to 2013.According to different surgical methods,ISA and CRA group contain 31 cases each group.We collect the perioperative period dates of the general date,operation time,blood loss,postoperative stay,incision infection,anastomotic leakage after a review of medical records.Patients were followed up by outpatient follow up or phone.2 Efficacy was evaluated according to improvement of wexner constipation score(%).Excellence: the improvement of wexner constipation score(%)? 80%;Effectiveness: 70% ? the improvement of wexner constipation score(%)< 80%;Inefficiency: the improvement of wexner constipation score(%)<70%.The improvement of wexner constipation score(%)=(preoperative WCS-postoperative WCS)/ preoperative WCS�100%;The total rate of efficiency=(excellence cases+effectiveness cases)/total cases�100%.3 Record the dates of bowel movements per week,laxative and prokinetic agents use,abdominal pain and abdominal bloating(Abdominal pain and abdominal bloating were assessed by using visual analog scale.According to their past experience and the current degree of abdominal bloating and abdominal pain,the patients marked in a ruler with 10 cm length.�0� represents no abdominal pain or bloating,similarly,�10� represents the most severe abdominal pain or bloating.Therefore scores are collected);Record the properties of defecation,referring Bristol stool classification that type 4 is excellent,type 3 and 5 is good,type 1,2,6,7 is poor.Rate of excellent and good properties=(excellent+good)/(excellent+good+poor)�100%.Record intestinal obstruction,abdominal mass,postoperative diarrhea(postoperative diarrhea defined as defecation frequency ?5 times daily)and other complications.Satisfaction and quality of life were assessed.Patient's satisfaction with the operation was assessed through self-described.Patients were asked to rate their outcome as excellent,good,fair,or poor(poor=1 point;air=2 point;good=3 point;excellent=4point).Quality of Life gastrointestinal was evaluated by quality of life index(GIQLI)which ranges from 0 to144.4 Analyses were performed by using the SPSS13.0 statistical software package.Enumeration data were expressed by percent.Sex and complications using chi-square test,but properties of defecation and total efficacy rate using Mann-Whitney U test.Measurement data were expressed by means of standard � deviation,using t-test.P < 0.05 was considered statistically significant.Results: ISA group included 1 male and 30 female.The Average age was 49.29�12.48(21�71)years.Patients of ISA group with a mean duration of 9.87�6.09(2�30)years before surgical intervention.CRA group included 2 male and 29 females.The Average age was 47.23�11.34(22�69)years.Patients of CRA group with a mean duration of 12.60�9.41(0.5�40)years before surgical intervention.2 groups' difference was not statistically significant in sex,age,duration(P> 0.05).There was no significant difference in the operation time,blood loss,postoperative stay,incision infection,anastomotic leakage in 2 groups(P> 0.05).During follow-up period,the total efficacy of ISA group was better than CRA group(P <0.05).Postoperative defecation frequency,abdominal pain,abdominal bloating both in two Groups were improved significantly compared with preoperative data(P<0.05).Compared with the CRA group,ISA group had a lower defecation frequency(mean13.32�7.08vs18.97�12.68;P<0.05),abdominal bloating score(0.32�1.28vs1.29�2.34;P<0.05)and postoperative complication(9.7%vs48.4%;P<0.05).But properties of defecation,satisfaction score and GIQLI in ISA group were significantly better than that CRA group(P<0.05).Conclusions:1 Both Ileosigmoidal anastomosis(ISA)and antiperistaltic cecorectal anastomosis(CRA)can relieve symptoms of constipation and be used for the treatment of slow transit constipation.2 Compared with antiperistaltic cecorectal anastomosis(CRA),ileosigmoidal anasto-mosis(ISA)has better efficacy,properties of defecation,satisfaction,quality of life.However,ileosigmoidal anastomosis(ISA)has lower abdominal bloating and abdominal mass than antiperistaltic cecorectal anastomosis(CRA)during follow-up.We should make a reasonable choice of surgical procedures based on the individual patient when we decide to treat slow transit constipation by surgery.