Outcomes after surgery for refractory constipation patients complicated with megacolon / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the efficacy of different procedures for refractory constipation complicated with megacolon.</p><p><b>METHODS</b>Clinical data of 112 patients of refractory constipation complicated with megacolon undergoing surgery in our institute from June 2007 to January 2013 were retrospectively analyzed. Of these 112 patients, the duration of constipation ranged from 4 to 22 years. Seventy-four patients had previous abdominal operations. Surgical procedures: (1)Jinling procedure (subtotal colectomy plus ascending colorectal posterior wall side-to-side anastomosis, n=81), including 24 laparoscopy-assisted procedures, 18 terminal ileostomies. (2)total colectomy plus ileorectal side-to-side anastomosis(n=18). (3)total colectomy plus end ileostomy, and ileorectal posterior wall side-to-side anastomosis 6 months later(n=13). The end ileostomy was reversed 6 months after operation.</p><p><b>RESULTS</b>The successful rate was 100%, and no surgery-related deaths were found. Postoperative complications included early diarrhea (90 cases, 80.4%), anal pain and incomplete evacuation (22 cases, 19.6%), urinary retention within 24-48 h after catheter removal (16 cases, 14.2%), anastomosis bleeding (9 cases, 8.0%), anastomosis leakage (6 cases, 5.4%), and intestinal obstruction (15 cases, 13.4%). Six patients with intestinal obstruction underwent adhesiolysis, and others were managed by conservative therapy. At the postoperative follow-up at 6 months, the Wexner constipation score was significantly reduced (5.8-8.3 vs. 21.4-28.7, P<0.01), and malnutrition improved as well.</p><p><b>CONCLUSION</b>Surgical intervention results in good efficacy for refractory constipation complicated with megacolon.</p>

Perioperative nutritional support in refractory constipation patients complicated with megacolon / 中华普通外科杂志

Objective Refractory constipation,when complicated with megacolon,is difficult to manage.This study aimed to compare the clinical outcomes of different preoperative nutritional therapies on refractory constipation patients complicated with megacolon.Methods Patients of refractory mixed constipation complicated with megacolon receiving surgical interventions between 2006 Jun and 2011 Jun were enrolled.Perioperafive nutrition support was evaluated in terms of postoperative recovery.Results 78 constipation patients received therapies of NPM,gastrointestinal decompression and total parenteral nutrition during the first 7-14 days.34 patients retained intestine patency and after 2 weeks of enteral nutrition therapy,they (enteral nutrition group) successfully received selective surgery.The other 44 patients (non-enteral nutrition group) received emergency surgery after correcting homeostasis.The surgical procedures included Jinling procedure (n =45),Jinling procedure plus ileostomy (n =6),total colectomy plus ileum-rectum side-to-side anastomosis (n =18) and total colectomy plus ileostomy (n =9).EN group patients had a significant low rate of pneumonia (0％ vs 11.4％),anastomotic leakage (0％ vs 11.4％),anastomotic bleeding (2.9％ vs 18.2％) and ostomy (0％ vs 34.1％),compared with N-EN group.At one month follow up,the nutrition status was significantly better in EN group than that in N-EN group.Condusions Refractory constipation complicated with megacolon required surgical intervention.Recovering the intestinal patency and receiving enteral nutritional support therapy preoperatively benefits patient's recovery.