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
ARTICLE HIGHLIGHTS
Research background

Constipation affects more than 30% of the aged population and seriously alters the life quality of patients. In terms of treatments for constipation, surgical treatment is a common approach for treatment of intractable slow transit constipation, especially for those with poor responses to conservative treatment. This study offers a better procedure for the treatment of slow transit constipation in an aged population.

Research motivation

Although the current surgical methods have good efficacy in the treatment of slow transit constipation, they are not suitable for aged patients or patients in poor physical condition because of the large wound produced and the length of the operation; these patients need non-surgical treatments. After long-term treatment with oral laxative agents, patients become nonresponsive to these agents and have to undergo enema administration periodically to alleviate their constipation. Some patients cannot tolerate the suffering of constipation and have to choose ileostomy.

Research objectives

The main aim of this study is 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.

Research methods

Aged patients between October 2010 and October 2014, who had slow transit constipation, were hospitalized and underwent laparoscopic surgery in our institute and were divided into two groups: the bypass group and the bypass plus colostomy group. 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.

Research 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. 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 month 3, 6, and 12 after surgery, the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at month 3, 6, 12, and 24 after surgery in both groups significantly improved compared with the preoperative conditions, except for NRS at month 3 and 6 after surgery in both groups, ABS at month 12 and 24 after surgery, and NRS at month 12 and 24 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 month 3, 6, 12, and 24 after surgery except WCS, NRS at month 3, 6 after surgery and ABS at month 3 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.

Research conclusions

We draw a conclusion from this study that laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can improve the prognosis significantly. 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 the aged population.

Research perspectives

This work is a retrospective single-center study. We will further develop a multicenter randomized controlled study. Meanwhile, we will expand the sample size and continue long-term follow-up to evaluate further efficacy of the subtotal colonic bypass plus colostomy.