Current status in surgical treatment of constipation / 中华胃肠外科杂志

ABSTRACT

Chronic constipation is a polysymptomatic heterogeneous disorder with the incidence rising in many countries, and becomes a common disease affecting the quality of life and financial burden. In China surgical guideline, the primary constipation is divided into 3 types slow transit constipation, outlet obstructive constipation, mixed constipation. The Rome IIII( criteria is usually referred to diagnosis, considering with clinical features and patient complaints. Through detail interrogation, physical examination and various detections, the secondary causes should be excluded, and etiological treatment is worth to try. Surgery is generally recommended as the second-line therapy, and finally only few patients require operation. There are still several controversies over the choice of surgical procedures and the mode of anastomosis in patients with slow transit constipation. Common surgical procedures include total colectomy with ileorectal anastomosis (TAC-IRA), subtotal colectomy with ileosigmoid anastomosis, ileorectal anastomosis or cecal-rectal anastomosis. Now laparoscopic operations have been widely applied to these patients, and have achieved good efficacy, and the application of robots is also under exploration. With the outlet obstructive constipation complicated pathogeny, the mechanisms currently involved include paradoxical puborectalis contraction, increased perineal descent, rectal intussusception, rectocele and rectal prolapse. In recent years, aiming at the above mechanisms, variety of surgical methods has been explored, including bilateral partial resection of puborectalis (PDPR) for paradoxical puborectalis contraction, rectal mucosa longitudinal plication plus sclerosing agent injection, procedure for prolapse and hemorrhoids (PPH), rectal mucosal resection and muscle plication procedure (Delorme), stapled transanal rectal resection (STARR) and laparoscopic ventral mesh rectopexy (LVR) etc for rectal prolapse. However, there is still no long-term large sample study to prove the advantages and disadvantages of these operations, so operative procedure should be chosen according to the actual situation of the patient. With the integration of the pathogenesis and the diversification of the treatment methods, the constipation still needs the precise treatment combined with multidisciplinary support in the future.