Preservation of superior rectal artery in laparoscopic colectomy: The best choice for slow transit constipation?

Abstract

Laparoscopic colectomy with ileorectal anastomosis may be beneficial for patients with slow transit constipation who do not respond to conservative treatment, particularly if the superior rectal artery (SRA) is preserved. Several important concerns have been addressed in this commentary. It is important to first go over the definition of surgical procedure as it is used in this text. Second, the current study lacked a control group that had SRA preservation. Thirdly, it would be best to use a prospective, randomized controlled study. Lastly, a description of the mesenteric defect’s state following a laparoscopic colectomy is necessary.

Key Words: Laparoscopic colectomy, Slow transit constipation, Ileorectal anastomosis, Superior rectal artery, Anastomotic leak

Core Tip: It is advised that patients with slow transit constipation (STC) who did not respond to conservative treatment undergo laparoscopic colectomy with ileorectal anastomosis. Preserving the superior rectal artery (SRA) can assist lower the occurrence rate of anastomotic leak. It is possible that laparoscopic colectomy with ileorectal anastomosis and preservation of SRA will be the best surgical choice for patients with STC.

TO THE EDITOR

A retrospective observational research on the efficacy of laparoscopic partial colectomy with ileorectal anastomosis and preservation of the superior rectal artery (SRA) in patients with slow transit constipation (STC) has recently been announced by Wu et al[1]. Without any anastomotic leaking, the study’s laparoscopic colectomy with SRA greatly improved bowel function, indicating that maintaining the SRA may prevent anastomotic leakage and result in excellent surgical results. Even with the study’s useful information, there are a few important issues that still need to be discussed.

Initially, it is important to address the article’s definition of “subtotal colectomy with ileorectal anastomosis”. According to prior papers[2,3], the surgical procedure employed in this study should have been “total colectomy with ileorectal anastomosis” as described in the section on surgical technique. Secondly, there could be multiple biases in a retrospective observational study that could compromise the validity of the findings. For instance, inconsistent data recording or gathering practices may distort the results. Third, without SRA preservation, no control group was enrolled in this investigation. In the absence of a comparison group, it was challenging to claim the special advantages of keeping the SRA. The benefits of laparoscopical colectomy with SRA preservation, such as the rate of anastomotic leakage, the first flatus or stool, the length of hospital stay, and other factors, would be more compellingly demonstrated by a prospective, randomized controlled trial. Finally, and perhaps most importantly, the author did not indicate whether or whether the mesenteric defect was closed during laparoscopic colectomy with ileorectal anastomosis. According to reports, high-risk patients, particularly those undergoing left-sided restorative treatments, should be encouraged to close the mesenteric defect following laparoscopic colorectal surgery[4]. This action may lower the subsequent internal hernia incidence rate. Additionally, the anastomosis’s tension, which is a significant contributing element to anastomotic leakage[5], could be well managed. The mesenteric defect during laparoscopic colectomy with ileorectal anastomosis was typically closed by our surgical team.

According to our clinical experience, laparoscopic colectomy with ileorectal anastomosis typically preserves the SRA. Additionally, in our clinical practice with STC, specimens were extracted by a natural orifice like anus, which may have a better clinical prognosis than pulling out bowel segment through the study’s mentioned 4-5 cm Pfannenstiel incision. Nonetheless, we share the authors’ evaluation and belief that a laparoscopic colectomy with ileorectal anastomosis with SRA preservation is the best surgical procedure for STC.