Long-term results of subtotal colectomy with cecorectal anastomosis for isolated colonic inertia

Abstract

AIM:To evaluate the results of sub total colectomy with cecorectal anastomosis (STC-CRA) for isolated colonic inertia (CI). METHODS:Fourteen patients (mean age 57.5 ± 16.5 year) underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2 ± 0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time (CTT). CI was defined as diffuse markers delay on CTT without evidence of pelvic floor dysfunction. All patients underwent STC-CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 ± 3.6 years (range 5-16 years) during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery. RESULTS:There was no postoperative mortality. Postoperative complications occurred in 21.4% (3/14). At the end of follow-up, bowel frequency was significantly (P < 0.05) increased to a mean of 4.8 ± 7.5 per day (range 1-30). One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation. Overall, 78.5% of patients would have chosen surgery again if necessary. CONCLUSION:

Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation

“…In fact, SCCRA is a complicated procedure, to be performed out with patience and precision, therefore, requiring time to be performed appropriately. In this light, differently from the case report by Iannelli et al [18], we always preserve the greater omentum, even though it can make the procedure more complicated and longer.…”

“…Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) seems to provide a valid alternative to total colectomy with ileorectal anastomosis (IRA), the most widely adopted procedure for slow-transit constipation, with potentially less functional impairment [5][6][7][8][9].…”

Colonic total and segmental transit times in healthy Italian adults

“…Ad altri test fisiologici usuali, come la scintigrafia, la manometria anorettale, il test dell'espulsione del palloncino, la manometria colica, viene attribuito lo stesso grado o un grado inferiore di utilità clinica basata sull'evidenza [24]. Lo studio radiologico dei TTC fornisce un'idea obiettiva dei disturbi dei pazienti con stipsi ed è utile criterio nella selezione dei pazienti destinati alla terapia chirurgia [25][26][27] o alle terapie con farmaci enterocinetici [28][29][30]. La Metcalf [18] Danquechin [19] Spanish Group [20] Chan [21] Bouchoucha [22] Metcalf [18] Bouchoucha [16] Metcalf [18] Metcalf [18] Bouchoucha [16] Pomerri [15] test and colonic manometry, reach the same or lower evidence-based utility levels [24].…”

“…La Metcalf [18] Danquechin [19] Spanish Group [20] Chan [21] Bouchoucha [22] Metcalf [18] Bouchoucha [16] Metcalf [18] Metcalf [18] Bouchoucha [16] Pomerri [15] test and colonic manometry, reach the same or lower evidence-based utility levels [24]. CTTs give an objective idea of patients' complaints of constipation and are useful in selecting patients for surgery [25][26][27] and evaluating the effects of enterokinetic drugs [28][29][30]. Another, albeit timeconsuming and expensive, way to assess colonic transit at specialised medical centres [9,31] is scintigraphy.…”

Long-term Follow-up of the Jinling Procedure for Combined Slow-Transit Constipation and Obstructive Defecation

“…10,13 Subtotal colectomy with ileosigmoid anastomosis has also been performed, but this procedure may result in an increased incidence of diarrhea or small bowel obstruction, necessitating conversion to total colectomy in some patients. 12,14 Subtotal colectomy with cecorectal anastomosis to preserve the ileocecal valve has been performed in patients in Western populations, 15,16 although the results may be undermined by marked relaxation of the cecum. 17,18 Isolated slow-transit constipation is an unusual cause of chronic constipation, and many patients with slowtransit constipation have concomitant obstructive defecation.…”