Influence of difference ileocecal junction length on the efficacy of laparoscopic subtotal colectomy antiperistaltic cecorectal anastomosis in treatment of slow transit constipation / 中国医师进修杂志

ABSTRACT

Objective To investigate the influence of difference ileocecal junction length on the efficacy of laparoscopic subtotal colectomy combined with antiperistaltic cecorectal anastomosis (LSCACRA) in treatment of slow transit constipation (STC). Methods Ninety- two STC patients undergoing LSCACRA were divided into 2 groups by random digits table method:10-15 cm group (10-15 cm ascending colon preserved above ileocecal junction, 46 cases) and 2-3 cm group (2-3 cm ascending colon preserved above ileocecal junction ,46 cases). All the patients were followed up for 24 months, and the Wexner incontinence score (WIS), ileocecal junction emptying time of barium enema, Wexner constipation score (WCS), abdominal pain intensity score (NRS), gastrointestinal quality of life index (GIQLI), abdominal pain frequency score and abdominal bloating frequency score were compared between 2 groups. Results All the patients successfully completed LSCACRA, with no conversion to open surgery and death occurred. There were no statistical differences in amount of bleeding, operative time, hospitalization time, exhaust time, incidences of postoperative intestinal obstruction and pulmonary infection, defecation time, WIS and abdominal bloating frequency score between 2 groups (P>0.05). The WCS, GIQLI, NRS and abdominal pain frequency scores 6, 12 and 24 months after operation in 2-3 cm group were significantly better than those in 10 - 15 cm group, WCS (1.7 ± 1.3) scores vs. (4.2 ± 2.3) scores, (1.7 ± 1.1) scores vs. (4.1 ± 1.9) scores, (1.2 ± 0.5) scores vs. (3.9 ± 2.5) scores;GIQLI(116.8 ± 6.2) scores vs. (98.5 ± 14.7) scores, (122.9 ± 7.5) scores vs. (104.7 ± 16.5) scores, (124.3 ± 5.9) scores vs. (108.3 ± 15.1) scores; NRS (1.3 ± 0.5) scores vs. (2.5 ± 1.7) scores, (0.9 ± 0.3) scores vs. (2.3 ± 1.4) scores, (0.8 ± 0.3) scores vs. (2.2 ± 1.5) scores;abdominal pain frequency score(0.9 ± 0.3) scores vs. (1.6 ± 1.2) scores, (0.7 ± 0.3) scores vs. (1.4 ± 1.1) scores, (0.7 ± 0.2) scores vs. (1.2 ± 1.0) scores, and there were statistical differences (P<0.05). The ileocecal junction emptying time of barium enema 24 months after operation in 2-3 cm group was significantly shorter than that in 10-15 cm group (17.6 ± 8.4) h vs. (21.3 ± 10.8) h, and there was statistical difference (P<0.05). Conclusions STC patients with LSCACRA is safe and effective. The shorter length of ascending colon preserved above ileocecal junction can improve the efficacy of LSCACRA in the treatment of STC and the prognosis of patients. The 2-3 cm length of ascending colon preserved above the ileocecal junction should be recommended.