Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1897
Peer-review started: December 31, 2019
First decision: January 16, 2020
Revised: March 27, 2020
Accepted: April 17, 2020
Article in press: April 17, 2020
Published online: May 26, 2020
Slow-transit constipation (STC) is characterized by a loss in the colonic motor activity. A minority of patients suffering from long-term intractable symptoms and poor quality of life (QOL) and showing no response to any medical interventions are ultimately recommended for surgery. Currently, the main surgical procedures for STC are ileorectal anastomosis and cecorectal anastomosis.
However, the reported outcomes of colectomy are controversial and conflicting. In these studies, lack of prospectively defined follow-up intervals is a general problem. Moreover, long-term outcomes of surgery for STC are rarely reported. Furthermore, negatively persistent symptoms including abdominal pain, bloating, intractable diarrhea, malnutrition, constipation recurrence, fecal incontinence, and intestinal obstruction are not uncommon following surgery, adversely affecting defecation function and QOL following these procedures.
This study investigated the effectiveness of total or subtotal colectomy, with respect to short- and long-term defecation function and overall QOL during 2-year regular follow-up.
From March 2013 to September 2017, 30 patients undergoing surgery for STC in our department were analyzed. Preoperative, intra-operative, and postoperative 3-mo, 6-mo, 1-year, 2-year follow-up details were recorded. Defecation function was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use, diarrhea, and the Wexner constipation and incontinence scales. QOL was evaluated using the gastrointestinal QOL index and the short-form-36 survey.
The majority of patients (93.1%, 27/29) stated that they benefit from the operation at the 2-year follow-up. At each time point of the follow-up, the number of bowel movements per week increased significantly compared with that of the preoperative conditions (P < 0.05). Similarly, compared with the preoperative values, a marked decline was observed in bloating, straining, laxative, and enema use at each time point of following up (P < 0.05). Postoperative diarrhea could be controlled effectively and improved notably at the 2-year follow-up. The Wexner incontinence scores at 6-mo, 1-year, and 2-year were notably lower when compared with those at the 3-mo follow-up (P < 0.05). Compared with those of the preoperative findings, the Wexner constipation scores significantly decreased following surgery (P < 0.05). Thus, was reasonable to find that the gastrointestinal QOL index scores clearly increased (P < 0.05) and the 36-item short form results displayed considerable improvements in six spheres (role physical, role emotional, physical pain, vitality, mental health, and general health) following surgery.
Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’ QOL.
Because this was a retrospective single-center study with certain limitations, multicenter randomized controlled studies are necessary in the future. In addition, we will also expand the sample size and perform long-term continuous follow-up to further evaluate defecation function and QOL after surgery.