A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs. long colonic reservoir

Abstract

Background: To observe and compare the short term results and functional recovery of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSCACRA) in the treatment of Adult slow transit constipation (STC) with two different reservoir length: short colonic reservoir and long colonic reservoir.

Methods: All STC patients treated with LSCACRA between April 2007 and December 2011 at our institution were followed up. Patients with 2 cm to 3 cm ascending colon preserved above the ileocecal junction were designated as observation group, whereas those preserved by 10 cm to 15 cm were classified as control group. 41 cases in the observation group and 40 cases in the control group were enrolled. Preoperative and outcome parameters of patients were collected, including gender, age, body mass index, operative time , blood loss, first flatus time, hospital stay, postoperative complications, Wexner constipation scale(WCS), Wexner incontinence scale, gastrointestinal quality of life index(GIQLI), abdominal pain intensity scale(APIS), abdominal pain frequency scale(APFS) and abdominal bloating scale(ABS).

Results: Laparoscopic surgeries were successfully carried out for all patients, without any case transferred to laparotomy or death related to surgery. The operative time, blood loss, first flatus time, and days of hospital stay of the two groups did not show significant differences. We found no significant differences on complications (Clavien-Dindo grade > I) between the two groups. No patient exhibited anastomotic leak. No fecal incontinence occurred in both groups. On the 3(rd), 6(th) and 12(th) month after operation, the parameters of both groups significantly improved compared with the preoperative conditions (P < 0.05) except the APIS at 3(rd) and 6(th) month in control group. On the 3(rd), 6(th) and 12(th) month after operation, the Functional Recovery outcomes of WCS、GIQLI、APIS、APFS and ABS in the observation group were superior to those in the control group (P < 0.05).

Conclusion: LSCACRA has a significant effect in the treatment of STC in adult. Postoperative outcomes can be optimized by shortening the length of the preserved ascending colon above the ileocecal junction, which promise better life quality of patients.

Trial registration: Chinese Clinical Trial Registry ChiCTR-OPC-14005280, 2014-09-29.

Figure 1

Resection area of observation group. The shadow is resection area.

Figure 2

Post-operational schematic diagram of observation group.

Figure 3

Resection area of control group. The shadow is resection area.

Figure 4

Post-operational schematic diagram of control group.

Figure 5

WCS Scores. X-axis: scores of WCS; Y-axis: time points pre- and post-operation. ●: mean of WCS in control group;○: mean of WCS in observation group;┊: 95% Confidence interval of WCS in control group;│: 95% Confidence interval of WCS in observation group.

Figure 6

GIQLI Scores. X-axis: scores of GIQLI; Y-axis: time points pre- and post-operation. ●: mean of GIQLI in control group;○: mean of GIQLI in observation group; ┊: 95% Confidence interval of GIQLI in control group;│: 95% Confidence interval of GIQLI in observation group.

Figure 7

ABS, APIS and APFS Scores. X-axis: scores of ABS, APIS and APFS; Y-axis: time points pre- and post-operation. ●: mean of ABS in control group;○: mean of ABS in observation group; ▲: mean of APFS in control group;△: mean of APFS in observation group; ▼: mean of APIS in control group;▽: mean of APIS in observation group; ┊: 95% Confidence interval of each index in control group;│: 95% Confidence interval of each index in observation group.

Figure 8

The barium enema. Note:large amount of barium has dried in block and remained in cecum and colon. Intestine has been emptied and rectum was basically emptied.