Comparison of laparoscopic selective colectomy based on barium-strip examination and subtotal colectomy for adult slow-transit constipation

Abstract

Background: Surgical management of adult slow-transit constipation (ASTC) can be effective for patients with intractable symptoms. This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.

Methods: A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014. Patients were evaluated by the barium-strip technique, colonoscopy, defecography and anorectal manometry. Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy (LSC) group underwent LSC at the precise location identified by barium strip. Spontaneous bowel movements, the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index (GIQLI) were assessed post-operatively at 3, 6, 12 and 24 months.

Results: A total of 49 patients were included in the analysis. The median follow-up was 37 months (range, 26-60 months). The mean post-operative hospital stay was 12 days and similar between groups (P = 0.071). The length of colon resection, operative time and intra-operative blood loss were reduced in the LSC group (all P < 0.05). No major complications occurred. A similar number of patients (24 in the standard group and 25 in the LSC group) exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer (P = 0.986). Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups, the mean GIQLI of the LSC group was significantly higher at 3, 6 and 24 months post-operatively (all P < 0.05).

Conclusions: LSC based on barium-strip examination is an appropriate modality for treating ASTC.

Keywords: barium strip; laparoscopic selective colectomy; laparoscopic subtotal colectomy; quality of life; slow-transit constipation.

Figure 1.

Pre-operative barium-enema examination (A) and barium-strip examination (B) of a patient with slow-transit constipation who underwent laparoscopic selective colectomy

Figure 2.

Pathological findings in resected colon show hypoganglionosis in the colon-wall muscle layer. (A) Hematoxylin-eosin staining,×200; (B) hematoxylin-eosin staining,×400.

Figure 3.

Comparisons of the Gastrointestinal Quality of Life Index (GIQLI) (A), Wexner Constipation Scale (WCS) (B) and spontaneous bowel movement (SBM) (C) between the standard group and LSC group (*P < 0.05). Pre-op, pre-operative; Post-op, post-operative.