Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2018; 24(23): 2491-2500
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2491
Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy for the treatment of slow transit constipation in an aged population: A retrospective control study
Yang Yang, Yong-Li Cao, Wen-Hang Wang, Yuan-Yao Zhang, Nan Zhao, Dong Wei
Yang Yang, Yong-Li Cao, Wen-Hang Wang, Yuan-Yao Zhang, Nan Zhao, Dong Wei, Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
Author contributions: Yang Y and Cao YL contributed equally; Wei D, Yang Y, and Cao YL designed the research; Cao YL, Wang WH, and Zhang YY performed the research; Yang Y and Zhao N analyzed the data; Yang Y wrote the paper; and Wei D and Cao YL critically revised the manuscript for important intellectual content.
Supported by the Medical Science and Technology Project of Henan Province, No. 2011030031.
Institutional review board statement: The protocol of this study was approved by the Ethics Committee of No. 150 Central Hospital of PLA. All procedures performed in studies involving human participants were conducted in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Wei, MD, Chief Doctor, Professor, Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Huaxia Road, Luoyang 471031, Henan Province, China. yy_150@126.com
Telephone: +86-379-64169319 Fax: +86-379-64169319
Received: March 15, 2018
Peer-review started: March 16, 2018
First decision: March 30, 2018
Revised: April 5, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: June 21, 2018
Processing time: 91 Days and 20.4 Hours
Abstract
AIM

To compare the efficacy, improved quality of life, and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) for the treatment of slow transit constipation.

METHODS

Between October 2010 and October 2014, aged patients with slow transit constipation who were hospitalized and underwent laparoscopic surgery in our institute were divided into two groups: the bypass group, 15 patients underwent SCBAC, and the bypass plus colostomy group, 14 patients underwent SCBCAC. The following preoperative and postoperative clinical data were collected: gender, age, body mass index, operative time, first flatus time, length of hospital stay, bowel movements (BMs), Wexner fecal incontinence scale, Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI), numerical rating scale for pain intensity (NRS), abdominal bloating score (ABS), and Clavien-Dindo classification of surgical complications (CD) before surgery and at 3, 6, 12, and 24 mo after surgery.

RESULTS

All patients successfully underwent laparoscopic surgery without open surgery conversion or surgery-related death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group (P = 0.007). No significant differences were observed in first flatus time, length of hospital stay, or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At 3, 6, and 12 mo after surgery, the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at 3, 6, 12, and 24 mo after surgery in both groups significantly improved compared with the preoperative conditions (P < 0.05), except NRS at 3, 6 mo after surgery in both groups, ABS at 12, 24 mo after surgery and NRS at 12, 24 mo after surgery in the bypass group. WCS, GIQLI, NRS, and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at 3, 6, 12, and 24 mo after surgery (P < 0.05) except WCS, NRS at 3, 6 mo after surgery and ABS at 3 mo after surgery. At 1 year after surgery, a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group (P = 0.007).

CONCLUSION

Laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in an aged population.

Keywords: Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy; Subtotal colonic bypass with antiperistaltic cecoproctostomy; Minimally invasive surgery for treatment of constipation; Clinical efficacy; Slow transit constipation in an aged population

Core tip: Constipation is one of the most common gastrointestinal symptoms. From October 2010 to October 2014, we employed laparoscopic subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) to treat aged patients with constipation and conducted a retrospective control study in comparison with subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC). From our study, we concluded that laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC.