Feasibility of the Laparoscopic Total Colectomy with Ileal j-Pouch-Rectal Anastomosis in the Treatment of Chronic Constipation Refractory to Medical Therapy: Observations about a Case Report

Abstract

In October 2012, a 29-year-old woman affected by chronic constipation underwent surgery for a laparoscopic total colectomy with ileal j-pouch-rectal anastomosis. After a precise instrumental work-up, the patient was selected as a potential candidate for the surgical treatment after failing to respond to all other medical treatment. During the first three months following the surgery, the patient recorded 3 -4 daily evacuations of soft stool. After the third month, the number of evacuations stabilised at 2 -3 a day, with formed stool, and no mention of incontinence or abdominal pain. Although the laparoscopic total colectomy with ileorectal anastomosis (TC with IRA) and the laparoscopically assisted subtotal colectomy with cecorectal anastomosis (SC with CRA) are the most frequently practiced procedures in the surgical treatment of chronic constipation, the laparoscopic colectomy with ileal j-pouch has shown in our experience to be a feasible and effective procedure, with similar results to the two aforementioned procedures in terms of morbidity, mortality and quality of life. In fact, like the first two, the total colectomy with ileal j-pouch has demonstrated the advantages of laparoscopic surgery: low invasiveness, less post-operative pain or ileus, respect of parietal integrity, reduced hospitalization and, lastly, a better cosmesis.