Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 1897-1907
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1897
Defecation function and quality of life in patients with slow-transit constipation after colectomy
Yue Tian, Li Wang, Jing-Wang Ye, Yong Zhang, Hui-Chao Zheng, Hao-De Shen, Fan Li, Bao-Hua Liu, Wei-Dong Tong
Yue Tian, Li Wang, Jing-Wang Ye, Yong Zhang, Hui-Chao Zheng, Hao-De Shen, Fan Li, Bao-Hua Liu, Wei-Dong Tong, Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
Author contributions: All authors helped to perform the study; Tian Y and Tong WD designed the study; Li F, Liu BH and Tong WD performed the surgeries; Tian Y finished the postoperative follow-up; Wang L, Ye JW, Zhang Y and Zheng HC collected and analyzed the data; Shen HD completed the figures and tables; Tian Y wrote the paper; Tong WD critically revised the manuscript; all authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81270461, No. 81570483 and No. 81770541.
Institutional review board statement: This study was approved by the Ethics Committee of Daping Hospital.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at vdtong@163.com. Participants gave informed consent for data sharing. No additional data are available.s
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Wei-Dong Tong, MD, PhD, Chief Doctor, Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing 400042, China. vdtong@163.com
Received: December 31, 2019
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
Processing time: 145 Days and 18.4 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’ QOL.

Research perspectives

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.