A Comparative Study Of Laparoscopic Versus Open Subtotal Colectomy With Antiperistaltic Cecorectal Anastomosis For Slow Transit Constipation

Objective: Slow transit constipation(STC)is the most common functional constipation.The effect of medication is unsatisfactory,whereas subtotal colectomy with antiperistaltic cecorectal anastomosis is an effective method for STC.In this study,we aimed to evaluate the safety and efficacy of laparoscopic versus open subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of STC.Methods: From September 2015 to December 2017,35 STC patients in the Department of General Surgery,the First Hospital of Lanzhou University were analyzed.Patients were divided into two groups: open surgery group(19 cases)and laparoscopic surgery group(16 cases).Clinical data including preoperative general information,perioperative conditions,postoperative defecation and satisfaction were comparatively analyzed between the two groups.SPSS 24.0 statistical software was used,and the measurement data were expressed as ?±s.P<0.05 was considered statistically significant.Results: 35 patients were analyzed,which included 10 males and 25 females.The average age was 44.5±15.4 years,and the course of the disease was 11.51±8.21 years.The follow-up rates at the 1st,3rd,6th,12 th and 24 th months after operation were 100 %,100 %,100 %,54.3 % and 34.3 %.The results showed that there was no statistical difference in age,sex ratio,course of constipation,defecation cycle,Wexner constipation score,contemporaneous complication,and history of abdominal surgery between the two groups(P>0.05).Both groups of patients were successfully completed subtotal colectomy with antiperistaltic cecorectal anastomosis.The laparoscopic group operating time was 259.1 ± 50.2 minutes,and the open group operating time was 176.8 ± 22.2 minutes,it reached statistically significant differences(P<0.05).The intraoperative blood loss was 57.2 ± 11.5 ml in the laparoscopic group and 250.6 ± 178.4 ml in the open group,it showed statistically significant differences(P<0.05).There was no statistically significant difference in the postoperative recovery of intestinal function and stool frequency between the two groups(P>0.05).Comparing with the open group,laparoscopic group had a significant advantages in the frequency of pain relievers,the amount of peritoneal effusion,infection rates in surgical incision,postoperative hospital stay and patient satisfaction with surgery(P<0.05).There was no statistically significant difference in the Wexner constipation score and gastrointestinal quality of life index between the two groups within two groups 2-year follow-up after surgery(P>0.05).Comparing with preoperative,the symptoms of constipation were significantly relieved and the quality of life was significantly improved.There was no statistically significant difference in the stool frequency at 1,3,6,12 and 24 months after operation between the two groups(P>0.05).Conclusions: When compared with open surgery,laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis requires longer operation time,but it significantly reduces surgical trauma and postoperative complications,reduces perioperative blood loss and shortens hospital stay,and it can significantly improve patient satisfaction and quality of life.Therefore,it is a safe and effective surgical method for STC.